User fees are charges paid by the patient at the time of use of health care in the public sector facilities. The practice of charging user fees in low income countries was given a boost as part of the structural adjustment policies, often as a condition of lending from the World Bank and IMF. Apart from increasing revenue, user fees were ostensibly introduced to achieve the objectives of reducing frivolous demand, improving quality and coverage, and increasing efficiency. They have been in operation in many low income countries for more than twenty years. A World Bank survey of 37 African countries in 1993 found that 33 of them had cost-recovery policies. Since then, however, many African and Asian countries have abolished user fees in health care. In India, the practice continues in many states. This policy brief aims to summarise evidence and discuss various concerns from a low-income perspective.

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