Exemption from user fess in practice: a case study of Juaboso-Bia District

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This study was undertaken to access the Implementation of the exemption from user fees in the Juaboso - Bia District of the Western Region. Due to rising cost of running health care services, the government of the Ghana introduced a policy of cost sharing and cost recovery known as user fees in 1982. The system has been greatly opposed by the general public as it has become a barrier to access to health care, especially the lower income group, due to its regressive nature, hence the introduction of the exemption policy in 1997. The study method adopted includes interviews of beneficiaries of the exemption policy and qualitative interviews of managers of health facilities and the use of focus group discussions. The sample size was one hundred and fifty - eight (158). Both closed and open-ended questions were used in designing the questionnaires, pre-tested and used to collect information from the respondents using face-to-face interviews. The respondents were conveniently and purposely selected. Results and findings indicate that, the exemption package that covers the poor and destitute had not worked. From table 4.1.7 about 74% of 143 exempted patients interviewed darned they were not aware of the exemption policy. The findings of the assessment showed that, 88 out of 143 constituting 65.5% of beneficiaries use health facilities (table 4.1.4). It was further observed that lack of statistics and guidelines affected the implementation of the exemption policy. From these findings, the researcher concluded that, the implementation of the exemption from user fees has not been effective. Exempted patients especially the poor, need to benefit from the exemption policy. Therefore, it was suggested that, all stakeholders should get involved to play significant roles in order to make the exemption policy more beneficial to the beneficiaries. Effective health education programmes should be instituted to create awareness. The collection and collation of data for exemptions from user fees need holistic approach to overcome the delay in reimbursing the drug account and other problems hindering the implementation of the exemption policy.
A thesis submitted to the Department of Community Health, School of Medical Sciences, College of Health Sciences Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the award of MSc.degree in Health Services Planning and Management, 2004