THE IMPACT OF USER FEES ON UTILISATION OF HEALTH CARE FACILITIES IN GHANA; A CASE STUDY OF THE TEMA DISTRICt,

ABSTRACT User fees have been in place since 1985 and have over the years generated a lot of debates and arguments in Ghana. This study aimed to investigate the impact of cost sharing policies, otherwise known as user fees on the utilisation of health care facilities in the Tema District of the Greater Accra Region of Ghana. Other issues such as how households rank other available alternatives to public health facilities, households’ views on the user fees concept, the effectiveness of the exemption scheme as far as patients are concerned and the impact of fees on hospitals were also investigated. Qualitative research techniques were used to investigate the behavior of patients after the introduction of these policies. Different questionnaires were administered to patients who were using the health facilities as well as those who were not using the hospitals at the time of the study. In-depth interviews of health workers were also used for the purposes of the study. The findings of the study indicate that though patients claim that fees are a bit too expensive for their pockets, there have not been decreases in utilisation levels after all. Exemption policies were non-existent as far as patients were concerned. For a greater portion of the population the drug stores are their first places of contact whenever they are ill and the drugs bought are not prescribed by any physician. This implies a considerable degree of selfmedication in the district. Services and facilities at the various hospitals have improved considerably as a result of the use to which the fees are put. The study recommends that a lot of training be given to dispensers and attendants at drug stores since they play a very major role in the health needs of the populace especially in the rural Tema. User fee exemption policies also need to be worked out well and implemented properly so that the very needy are not excluded from the use of health care facilities.