The Impact of User Fee Removal on Equity, Efficiency and Health Outcomes in Low-Income Countries
DOI:
https://doi.org/10.71222/k2arvf11Keywords:
health policy, health equity, healthcare efficiency, health outcomes, public financingAbstract
Universal health coverage (UHC) is a core global target, and user fee removal has emerged as a key policy instrument to reduce financial barriers in low-income countries (LICs). This study systematically evaluates the multifaceted impacts of user fee removal policies in LICs across three critical dimensions: health equity, healthcare system efficiency, and population health outcomes. Adopting a structured literature review design, this research integrates peer-reviewed academic publications and grey literature, using snowball sampling to ensure comprehensive evidence selection. Results indicate that user fee removal significantly improved health equity for women and marginalized groups by lowering economic barriers to care, yet pronounced rich-poor and urban-rural disparities persisted. The policy effectively boosted healthcare utilization among targeted populations, including children under five and pregnant women, thereby improving allocative efficiency, but intergroup and regional gaps in service use remained substantial. Vulnerable populations experienced measurable improvements in health outcomes, including reduced mortality and enhanced treatment adherence. However, the policy imposed severe fiscal strain on public health systems, leading to funding shortages, drug stockouts, staff demotivation, and informal payments. In conclusion, user fee removal contributes meaningfully to fairer health resource distribution, higher service uptake, and better health outcomes for priority groups. Nevertheless, persistent socioeconomic inequalities and systemic financial vulnerabilities limit the full realization of policy objectives. For user fee removal to achieve sustainable success in advancing UHC, it must be paired with reliable public financing, targeted pro-poor interventions, and strengthened health system capacity.References
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