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Operational Guidelines on User Fees in Health and Education


The economic crises of the 1970s and 80s led many countries to undergo structural reforms that called for reduced public expenditure for basic services. The reforms resulted in the introduction of cost sharing on the part of beneficiaries. User fees were imposed as a means to address recurrent costs problems and an extra source of revenue for previously “undervalued” services of professional providers. Countries responded differently to the introduction of user charges depending on domestic political risk and institutional capacity to efficiently administer the fees. With the reforms, public financing of health and education declined in many countries, and in some cases, private service providers seized the opportunity to fill the gap. Although the involvement of private service providers helped to meet demand for those able to pay, it limited access of the poor to the same services due to the prohibitive costs.

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