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Chipo lives 5 km from her college. On her way to school she passes by the clinic. The thought of dying crosses her mind. She is afraid one day she will end up dead if she does not seek treatment for her long diagnosed STI. She is well aware of what is supposed to be done, yet almost every day for the past 2 months she passes past the clinic and never gets in to get treatment. What is inhibiting her to access the health care she so much need is the User fee.
User fee refers to the direct payment by patients according to set tariff, for health care services they use.
According to the Access to SRH services Focus Group Discussions conducted by SAYWHAT, 85% of the students who are referred from college clinics are not able to pay the user fee required at the clinic. The user fee does not only limit people from accessing health care services but affect people’s health seeking behavior. They also negatively impact on adherence to long-term expensive treatments.
Falling sick therefore make the patient even poorer as they have to sacrifice their assets to get the user fee. Since most clinics outside college campus are about 8km away, there are other costs that are also incurred which include transport and food costs which makes health care inaccessible for most college students.
Students will only go to a clinic when they feel their condition has worsened. Logically this becomes expensive on the part of the government and the patient as maybe the patient would need special expensive drugs than they would have required earlier.
According to the Alma Atta Declaration, primary health care should be universally accessible to individuals and communities yet no financial protection is offered to young people like Chipo, a college student with no source of income.
The poor and other vulnerable groups such as PLHIV have a high reliance on user fees and other out-of-pocket expenditures on health which are both impoverishing and provide a financial barrier to care as they can not afford health insurance such as medical aid schemes. Most students who are under the SAYWHAT positive living program concurred that before the CD4 cell count visits initiated by SAYWHAT, they had never gone for a CD4 count as they could not afford the user fee
Abolition of user fees in Uganda in 2000 led to improved access and increased use of services and less work days lost due to sickness thereby increasing productivity in various work spheres.
Does Zimbabwe have the capacity to sustain free health care? Primary health care is not a new phenomenon in Zimbabwe. In the first 10 years after Zimbabwe attained its independence it adopted the Free Health for all
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