Analysing unofficial user fees in government and non-government hospitals in Uganda

Master Thesis


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University of Cape Town

Unofficial fees are a common feature in Ugandan health facilities and exist in different forms. This study explores the forms of unofficial fees existing in Ugandan hospitals and compares findings from government and non-governmental hospitals in both rural and urban areas. It also investigates the reasons for or causes of such fees as well as the relationship between unofficial fees and other factors such as quality of care within the hospitals. The overall aim of the study is to analyze the magnitude and impact of unofficial fees on patients' expenditure and thereby make recommendations for improvement in efficiency and equity with regards to out-of-pocket funding. Both qualitative and quantitative interview methods are used to obtain data from service providers and patients in each hospital and a comparison of findings obtained using the two methods is made. The main findings from the study are that unofficial fees are rampant in government hospitals and can be classified into four categories; fees for commodities such as drugs; fees for access to services; fees for services such as laboratory, radiology and surgery and gratuity payments. The latter category is the commonest form reported in non- government hospitals while all the others are rare. Estimates of unofficial fees amount to a significant percentage of patients' expenditure, especially in the cases where surgery and radiology are required especially for rural-based patients. It's also found that most of the patients attending government hospitals pay at least one form of unofficial fees. Unofficial fees were found to be closely associated with poor quality of care in that the latter enhanced an informal economy, which resulted in the fees being charged/paid. The study shows that efficiency and equity (access to quality care and ability to pay) are negatively affected by the practice of collecting unofficial fees. Recommendations for policy makers to address the problem are made as well as suggestions for the best-suited methodology for analysing unofficial fees in the Ugandan context.

Bibliography: leaves 83-89.