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Health Policy and Planning; 15(1): 59-65
© Oxford University Press 2000

User fees and drugs: what did the health reforms in Zambia achieve?

Sjaak Van Der Geest1, Mubiana Macwan’gi2, Jolly Kamwanga2, Dennis Mulikelela2, Arthur Mazimba2 and Mundia Mwangelwa2

1 Anthropological–Sociological Centre, University of Amsterdam, Amsterdam, The Netherlands
2 Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia

The article reports on exploratory research into the effects and prospects of health reforms in Zambia. The research, which was qualitative, was carried out in two rural and two urban health centres and their surrounding catchment populations. The authors focus on four principles of health reform: community involvement (including cost sharing), prevention, equity and quality of care. One of their main conclusions is that many people criticize the introduction of cost sharing because it does not improve the quality of care, by which they first of all mean the availability of drugs. The authors plead for a humane implementation of user fees in public health care that is directly linked to a more efficient provision of essential medicines.


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