Local retention of user fees in government health facilities

Benefits of such a theory are discussed, including improved motivations for fee payment and collection and new accountability at the local level. In addition, critical viewpoints are presented, including the problem of perceived earmarking of funds. The cost recovery programs of four countries (Belize, the Central African Republic, Cameroon, and Swaziland) are detailed as examples, including information about legal considerations, legislation, fee management, and use of funds. These case studies indicate that health centers in developing countries that retain fees locally would enjoy benefits such as an increased percentage of costs recovered and increased health center utilization and quality. Local fee retention, however, is only one of several factors affecting cost recovery and the sustainability of health services. Another important factor is the level of prices. (Author abstract, from PN-ABY-621)