Household Coping Strategies in Response to the Introduction of User Charges for Social Services: A Case Study in Uganda

Abstract

This study examines approaches to health care seeking and financing by households living in communities in \ntwo poor rural districts of Uganda. It seeks to explore differences in the choice of provider and methods of \nfunding care between the two districts, and the economic circumstances and social attitudes which influence \nthese differences. It considers the impact on \nhouseholds budgets of health care charges, both at public facilities \n(licit and illicit) and by private sector providers. \nQualitative fieldwork was used to determine attitudes to the \nintroduction of user charges, the extent to which they have influenced health care seeking behaviour and \nwhether attempts by households to find sustainable coping strategies, either individually or through community \norganisations, have been successful in ensuring adequate health care for all their members. \nThe research raised issues as to the appropriate definition of utilisation of services in circumstances where \nprofession staff are often substituted by 'assistants' and drugs are frequently prescribed in public facilities but \nthen have to be purchased from private suppliers. It stresses the relative autonomy of facility staff and \nconstraints on effective supervision. Under these circumstances there is room for considerable confusion \nbetween sanctioned user-charges and illicit demands by providers. Many households face difficulties with what \nthey see as a multiplicity of demands for \ncash \npayments, of which education and health charges are a major \ncomponent. Community organisations do not appear to make a major direct contribution to meeting such \ncharges. However, community based savings and credit societies, where they exist, appear to play a central role \nin overcoming seasonal fluctuations in cash availability. Making these more accessible to poor households or \ndeveloping effective and sustainable systems for providing services on credit might alleviate current problems.

Cite this work

No public copy is stored for this record, so only the metadata is cited.

Stored only when both papers are in the corpus — 32 citations exist upstream.