The Financial Impact of Removing Malaria User Fees for Children under Five in Mali
Malaria continues to be the leading cause of morbidity among children under 5 (U5) in Mali. Moreover, seven out of ten deaths of children occur at home, which is strongly suggestive of problems related to access to health care. Like many other African countries, Mali has recently embarked on a number of user fee exemption policies. The primary objective is to remove a financial barrier to care, thereby increasing health service utilization. In 2007, the government introduced artemisinin-based combination therapies (ACTs) for malaria treatment in health facilities and waived ACT and rapid diagnostic test (RDT) fees for children U5. Other costs associated with treatment, such as consultation service charges and pharmaceutical drugs commonly prescribed with ACTs, were not included in the fee exemption policy.
The application of user fees for health services has been highly controversial internationally, with a considerable literature on the impacts of such fees. In a context of high poverty, direct payments by the user are considered a barrier to the use of health services, and may thus be an important contributor to negative health outcomes among vulnerable populations. On the other hand, health facilities depend on revenues from user fees to procure drugs and to cover a large proportion of their operational expenses. With the support of the Presidential Malaria Initiative (PMI) at the United States Agency for International Development and in collaboration with the Government of Mali, Health Systems 20/20 studied the implications (operational and financial) of expanding user fee exemptions related to malaria treatment among U5 children, to include consultation costs, diagnostics tests, and all related pharmaceuticals.
The objectives of this study are to:
- Describe how user fee policies in general – and for malaria treatment in particular – are implemented in facilities in Mali.
- Assess the attitudes of health providers and key stakeholders in Mali with regard to removing all U5 user fees for malaria treatment, and identify the major challenges.
- Estimate the financial impact of expanding user fee exemptions for malaria treatment of U5 children in primary and first reference facilities in Mali.
