An Unnecessary Evil? User fees for healthcare in low-income countries

This paper gives an account, based on published and unpublished papers, of the development of user fees for healthcare in low-income countries. It discusses how and why user fees were developed; their impact on health services and households; how donor policy evolved in relation to them and what happened when some countries removed them (either fully or in part) as a financing mechanism. The paper draws conclusions on whether it is desirable and feasible to abolish user fees.