Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya
Identifieur interne : 004885 ( Istex/Corpus ); précédent : 004884; suivant : 004886Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya
Auteurs : S. Moses ; F. A Plummer ; S. Moses ; F. A Plummer ; F. Manji ; J. E Bradley ; N. J. D Nagelkerke ; M. A MalisaSource :
- The Lancet [ 0140-6736 ] ; 1992.
English descriptors
- KwdEn :
- Attendance, Centre, Chancroid, Common diagnoses, Community health, Essential health services, Genital herpes, Gonorrhoea, Health care, Health centres, Health planning management, Health policy planning, Health services, Human immunodeficiency virus type, Initial visit, Kenya, Medical microbiology, Monthly attendance, Monthly income, Nairobi, Nairobi city commission, Outpatient health facilities, Primary level, Private sector, Referral centre, Same level, Special treatment clinic, Std, Syphilis, Untreated stds, User, User charges, User fees, World bank.
- Teeft :
- Attendance, Centre, Chancroid, Common diagnoses, Community health, Essential health services, Genital herpes, Gonorrhoea, Health care, Health centres, Health planning management, Health policy planning, Health services, Human immunodeficiency virus type, Initial visit, Kenya, Medical microbiology, Monthly attendance, Monthly income, Nairobi, Nairobi city commission, Outpatient health facilities, Primary level, Private sector, Referral centre, Same level, Special treatment clinic, Std, Syphilis, Untreated stds, User, User charges, User fees, World bank.
Abstract
Abstract: We investigated the impact of a short-lived policy of charging fees to patients attending public-sector outpatient health facilities in Kenya by collecting data on attendance at Nairobi's Special Treatment Clinic for sexually transmitted diseases (STDs) before (23 months), during (9 months), and after (15 months) the user-charge period. During the user-charge period, the seasonally adjusted total mean monthly attendance of men decreased significantly to 40% (95% Cl 36-45) of that before fees were levied. Attendance rose in the post-user-charge period, but reached only 64% (59-68) of the pre-user-charge level. For women, the adjusted total mean monthly attendance during the user-charge period was reduced significantly to 65% (55-77) of the pre-user-charge level. Mean monthly attendance by women rose in the post-user-charge period to 22% (9-37) above the pre-user-charge level. There was no evidence of an increase in attendance over the course of the user-charge period among either men or women. The introduction of user fees probably increased the number of untreated STDs in the population, with potentially serious long-term health implications. The user-fee experience in Kenya should be carefully evaluated before similar measures are introduced elsewhere.
Url:
DOI: 10.1016/0140-6736(92)91778-7
Links to Exploration step
ISTEX:DF4DCA1AF08675651360A04DA148803923FA1C86Le document en format XML
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During the user-charge period, the seasonally adjusted total mean monthly attendance of men decreased significantly to 40% (95% Cl 36-45) of that before fees were levied. Attendance rose in the post-user-charge period, but reached only 64% (59-68) of the pre-user-charge level. For women, the adjusted total mean monthly attendance during the user-charge period was reduced significantly to 65% (55-77) of the pre-user-charge level. Mean monthly attendance by women rose in the post-user-charge period to 22% (9-37) above the pre-user-charge level. There was no evidence of an increase in attendance over the course of the user-charge period among either men or women. The introduction of user fees probably increased the number of untreated STDs in the population, with potentially serious long-term health implications. 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During the user-charge period, the seasonally adjusted total mean monthly attendance of men decreased significantly to 40% (95% Cl 36-45) of that before fees were levied. Attendance rose in the post-user-charge period, but reached only 64% (59-68) of the pre-user-charge level. For women, the adjusted total mean monthly attendance during the user-charge period was reduced significantly to 65% (55-77) of the pre-user-charge level. Mean monthly attendance by women rose in the post-user-charge period to 22% (9-37) above the pre-user-charge level. There was no evidence of an increase in attendance over the course of the user-charge period among either men or women. The introduction of user fees probably increased the number of untreated STDs in the population, with potentially serious long-term health implications. 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Kenya</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>1992</date></publicationStmt><notesStmt><note type="content">Section title: EPIDEMIOLOGY</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya</title><author xml:id="author-0000"><persName><forename type="first">S</forename><surname>Moses</surname></persName><roleName type="degree">MD</roleName><note type="correspondence"><p>Correspondence to Dr Stephen Moses, Department of Community Health, University of Nairobi, PO Box 19676, Nairobi, Kenya.</p></note><affiliation>Departments of Community Health and Medical Microbiology, University of Nairobi, Nairobi, Kenya</affiliation></author><author xml:id="author-0001"><persName><forename type="first">F.A</forename><surname>Plummer</surname></persName><roleName type="degree">MD</roleName><affiliation>Departments of Community Health and Medical Microbiology, University of Nairobi, Nairobi, Kenya</affiliation></author><author xml:id="author-0002"><persName><forename type="first">S</forename><surname>Moses</surname></persName><affiliation>Departments of Community Health Sciences, Medical Microbiology, and Medicine, University of Manitoba, Winnipeg, Canada</affiliation></author><author xml:id="author-0003"><persName><forename type="first">F.A</forename><surname>Plummer</surname></persName><affiliation>Departments of Community Health Sciences, Medical Microbiology, and Medicine, University of Manitoba, Winnipeg, Canada</affiliation></author><author xml:id="author-0004"><persName><forename type="first">F</forename><surname>Manji</surname></persName><roleName type="degree">PhD</roleName><affiliation>Health Sciences Division, Regional Office for Eastern and Southern Africa, International Development Research Centre, Nairobi, Kenya</affiliation></author><author xml:id="author-0005"><persName><forename type="first">J.E</forename><surname>Bradley</surname></persName><roleName type="degree">MA</roleName><affiliation>International Projects Assistance Services, Nairobi, Kenya</affiliation></author><author xml:id="author-0006"><persName><forename type="first">N.J.D</forename><surname>Nagelkerke</surname></persName><roleName type="degree">PhD</roleName><affiliation>International Statistical Institute, The Hague, Netherlands</affiliation></author><author xml:id="author-0007"><persName><forename type="first">M.A</forename><surname>Malisa</surname></persName><roleName type="degree">MB</roleName><affiliation>Special Treatment Clinic, Nairobi City Commission, Nairobi, Kenya</affiliation></author><idno type="istex">DF4DCA1AF08675651360A04DA148803923FA1C86</idno><idno type="DOI">10.1016/0140-6736(92)91778-7</idno><idno type="PII">0140-6736(92)91778-7</idno></analytic><monogr><title level="j">The Lancet</title><title level="j" type="abbrev">LANCET</title><idno type="pISSN">0140-6736</idno><idno type="PII">S0140-6736(00)X4825-8</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1992"></date><biblScope unit="volume">340</biblScope><biblScope unit="issue">8817</biblScope><biblScope unit="page" from="463">463</biblScope><biblScope unit="page" to="466">466</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1992</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>We investigated the impact of a short-lived policy of charging fees to patients attending public-sector outpatient health facilities in Kenya by collecting data on attendance at Nairobi's Special Treatment Clinic for sexually transmitted diseases (STDs) before (23 months), during (9 months), and after (15 months) the user-charge period. During the user-charge period, the seasonally adjusted total mean monthly attendance of men decreased significantly to 40% (95% Cl 36-45) of that before fees were levied. Attendance rose in the post-user-charge period, but reached only 64% (59-68) of the pre-user-charge level. For women, the adjusted total mean monthly attendance during the user-charge period was reduced significantly to 65% (55-77) of the pre-user-charge level. Mean monthly attendance by women rose in the post-user-charge period to 22% (9-37) above the pre-user-charge level. There was no evidence of an increase in attendance over the course of the user-charge period among either men or women. The introduction of user fees probably increased the number of untreated STDs in the population, with potentially serious long-term health implications. The user-fee experience in Kenya should be carefully evaluated before similar measures are introduced elsewhere.</p></abstract></profileDesc><revisionDesc><change when="1992">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/DF4DCA1AF08675651360A04DA148803923FA1C86/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>LANCET</jid><aid>92917787</aid><ce:pii>0140-6736(92)91778-7</ce:pii><ce:doi>10.1016/0140-6736(92)91778-7</ce:doi><ce:copyright type="unknown" year="1992"></ce:copyright></item-info><head><ce:dochead><ce:textfn>EPIDEMIOLOGY</ce:textfn></ce:dochead><ce:title>Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya</ce:title><ce:author-group><ce:author><ce:given-name>S</ce:given-name><ce:surname>Moses</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="ART13-COR1"><ce:sup>*</ce:sup></ce:cross-ref><ce:cross-ref refid="ART13-AFF1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>F.A</ce:given-name><ce:surname>Plummer</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="ART13-AFF1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>S</ce:given-name><ce:surname>Moses</ce:surname><ce:cross-ref refid="ART13-AFF2"><ce:sup>b</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>F.A</ce:given-name><ce:surname>Plummer</ce:surname><ce:cross-ref refid="ART13-AFF2"><ce:sup>b</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>F</ce:given-name><ce:surname>Manji</ce:surname><ce:degrees>PhD</ce:degrees><ce:cross-ref refid="ART13-AFF3"><ce:sup>c</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>J.E</ce:given-name><ce:surname>Bradley</ce:surname><ce:degrees>MA</ce:degrees><ce:cross-ref refid="ART13-AFF4"><ce:sup>d</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>N.J.D</ce:given-name><ce:surname>Nagelkerke</ce:surname><ce:degrees>PhD</ce:degrees><ce:cross-ref refid="ART13-AFF5"><ce:sup>e</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>M.A</ce:given-name><ce:surname>Malisa</ce:surname><ce:degrees>MB</ce:degrees><ce:cross-ref refid="ART13-AFF6"><ce:sup>f</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="ART13-AFF1"><ce:label>a</ce:label><ce:textfn>Departments of Community Health and Medical Microbiology, University of Nairobi, Nairobi, Kenya</ce:textfn></ce:affiliation><ce:affiliation id="ART13-AFF2"><ce:label>b</ce:label><ce:textfn>Departments of Community Health Sciences, Medical Microbiology, and Medicine, University of Manitoba, Winnipeg, Canada</ce:textfn></ce:affiliation><ce:affiliation id="ART13-AFF3"><ce:label>c</ce:label><ce:textfn>Health Sciences Division, Regional Office for Eastern and Southern Africa, International Development Research Centre, Nairobi, Kenya</ce:textfn></ce:affiliation><ce:affiliation id="ART13-AFF4"><ce:label>d</ce:label><ce:textfn>International Projects Assistance Services, Nairobi, Kenya</ce:textfn></ce:affiliation><ce:affiliation id="ART13-AFF5"><ce:label>e</ce:label><ce:textfn>International Statistical Institute, The Hague, Netherlands</ce:textfn></ce:affiliation><ce:affiliation id="ART13-AFF6"><ce:label>f</ce:label><ce:textfn>Special Treatment Clinic, Nairobi City Commission, Nairobi, Kenya</ce:textfn></ce:affiliation><ce:correspondence id="ART13-COR1"><ce:label>*</ce:label><ce:text>Correspondence to Dr Stephen Moses, Department of Community Health, University of Nairobi, PO Box 19676, Nairobi, Kenya.</ce:text></ce:correspondence></ce:author-group><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>We investigated the impact of a short-lived policy of charging fees to patients attending public-sector outpatient health facilities in Kenya by collecting data on attendance at Nairobi's Special Treatment Clinic for sexually transmitted diseases (STDs) before (23 months), during (9 months), and after (15 months) the user-charge period. During the user-charge period, the seasonally adjusted total mean monthly attendance of men decreased significantly to 40% (95% Cl 36-45) of that before fees were levied. Attendance rose in the post-user-charge period, but reached only 64% (59-68) of the pre-user-charge level. For women, the adjusted total mean monthly attendance during the user-charge period was reduced significantly to 65% (55-77) of the pre-user-charge level. Mean monthly attendance by women rose in the post-user-charge period to 22% (9-37) above the pre-user-charge level. There was no evidence of an increase in attendance over the course of the user-charge period among either men or women. The introduction of user fees probably increased the number of untreated STDs in the population, with potentially serious long-term health implications. The user-fee experience in Kenya should be carefully evaluated before similar measures are introduced elsewhere.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya</title></titleInfo><name type="personal"><namePart type="given">S</namePart><namePart type="family">Moses</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Community Health and Medical Microbiology, University of Nairobi, Nairobi, Kenya</affiliation><description>Correspondence to Dr Stephen Moses, Department of Community Health, University of Nairobi, PO Box 19676, Nairobi, Kenya.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F.A</namePart><namePart type="family">Plummer</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Community Health and Medical Microbiology, University of Nairobi, Nairobi, Kenya</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S</namePart><namePart type="family">Moses</namePart><affiliation>Departments of Community Health Sciences, Medical Microbiology, and Medicine, University of Manitoba, Winnipeg, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F.A</namePart><namePart type="family">Plummer</namePart><affiliation>Departments of Community Health Sciences, Medical Microbiology, and Medicine, University of Manitoba, Winnipeg, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F</namePart><namePart type="family">Manji</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Health Sciences Division, Regional Office for Eastern and Southern Africa, International Development Research Centre, Nairobi, Kenya</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.E</namePart><namePart type="family">Bradley</namePart><namePart type="termsOfAddress">MA</namePart><affiliation>International Projects Assistance Services, Nairobi, Kenya</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">N.J.D</namePart><namePart type="family">Nagelkerke</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>International Statistical Institute, The Hague, Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.A</namePart><namePart type="family">Malisa</namePart><namePart type="termsOfAddress">MB</namePart><affiliation>Special Treatment Clinic, Nairobi City Commission, Nairobi, Kenya</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1992</dateIssued><copyrightDate encoding="w3cdtf">1992</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Abstract: We investigated the impact of a short-lived policy of charging fees to patients attending public-sector outpatient health facilities in Kenya by collecting data on attendance at Nairobi's Special Treatment Clinic for sexually transmitted diseases (STDs) before (23 months), during (9 months), and after (15 months) the user-charge period. During the user-charge period, the seasonally adjusted total mean monthly attendance of men decreased significantly to 40% (95% Cl 36-45) of that before fees were levied. Attendance rose in the post-user-charge period, but reached only 64% (59-68) of the pre-user-charge level. For women, the adjusted total mean monthly attendance during the user-charge period was reduced significantly to 65% (55-77) of the pre-user-charge level. Mean monthly attendance by women rose in the post-user-charge period to 22% (9-37) above the pre-user-charge level. There was no evidence of an increase in attendance over the course of the user-charge period among either men or women. The introduction of user fees probably increased the number of untreated STDs in the population, with potentially serious long-term health implications. The user-fee experience in Kenya should be carefully evaluated before similar measures are introduced elsewhere.</abstract><note type="content">Section title: EPIDEMIOLOGY</note><relatedItem type="host"><titleInfo><title>The Lancet</title></titleInfo><titleInfo type="abbreviated"><title>LANCET</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">19920822</dateIssued></originInfo><identifier type="ISSN">0140-6736</identifier><identifier type="PII">S0140-6736(00)X4825-8</identifier><part><date>19920822</date><detail type="issue"><title>Originally published as Volume 2, Issue 8817</title></detail><detail type="volume"><number>340</number><caption>vol.</caption></detail><detail type="issue"><number>8817</number><caption>no.</caption></detail><extent unit="issue-pages"><start>439</start><end>496</end></extent><extent unit="pages"><start>463</start><end>466</end></extent></part></relatedItem><identifier type="istex">DF4DCA1AF08675651360A04DA148803923FA1C86</identifier><identifier type="ark">ark:/67375/6H6-BCLBS4D5-7</identifier><identifier type="DOI">10.1016/0140-6736(92)91778-7</identifier><identifier type="PII">0140-6736(92)91778-7</identifier><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</recordContentSource></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/DF4DCA1AF08675651360A04DA148803923FA1C86/metadata/json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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