Medical user fees

THE decision by the University Teaching Hospital management to increase user fees is regrettable but perhaps understandable given the prevailing financial circumstances.

It is regrettable because the hospital caters for a very wide section of Zambian society. As a referral hospital patients come from within and outside Lusaka and in both cases many patients are unable to raise the fees and hence fail to utilize the service.

Even at K10 for a full blood count many clients were unable to afford the test. Now at K30 it is obvious that many more will not be able to access the service – which could have proved to be life saving.

This development, more than anything else, brings to the fore the fragility of our social services delivery system. The Patriotic Front Government promised free services across the board, but this is increasingly proving difficult to sustain.

That is why the UTH and other hospitals must consider introducing effective contributory schemes that will raise requisite finance for the institutions. The hospitals must also introduce social health medical schemes. These will enable individuals and corporate institutions contribute and support the hospitals while providing an assurance of service.

Zambia will not be the first country to introduce user fees, many other developing countries have introduced fees but have also created inbuilt quality and assurance measures that monitor the control of funds collected from the public.

With suitable controls in place the hospitals must be allowed a level of autonomy to ensure that they recruit staff who can be remunerated to a level that will ensure quality service delivery. The medical personnel must be well remunerated and looked after to encourage them perform to the best of  the ability and thereby make these institutions worth the money clients will spend.

The UTH ambition to match private hospitals in Lusaka is refreshing and no doubt  clients, if assured of improved service, would rather patronize the referral institution.

There is no doubt that the  massive infrastructure programme embarked on by the Government  has consumed a very substantial portion of the Budget and is yet to consume more as the loans against which the roads and universities have been constructed fall due.

This will inevitably means that funds for the sustenance and support of these projects must come from local sources often times from the communities.

Previous attempts at greater user support and cost recovery have failed because there has been little control, monitoring and accountability. Promised improvements in quality of service have not materialize, leading to frustration and reduced public morale.

If indeed the concepts of user fees has to be sustained an equally efficient monitoring system must be introduced to ensure that full value is achieved.

In the case of the UTH we would recommend that the low cost section must continue to enjoy a subsidy because not all patients will afford the new fees. This means that the high cost must be of a quality and level of service which must produce a surplus to support other services.

However UTH must not price itself beyond prevailing rates in the private sector: a factor which may mean low utilization and a failure to perform the core value and function of the hospital as a referral institution.

While appreciating the constraints the Government should not renege on its responsibility to the hospital by continuing to invest in improved technology, high quality human resource and research.

Of prime importance is the imperative for UTH to remain an institution that is accessible to all. There should be no  medical poverty trap which will preclude sections of society from accessing quality medical care.