Financing Blood Transfusion Services in sub-Saharan Africa: A Role for User Fees?
Hensher, M., & Jefferys, E. Health Policy & Planning (2000), Vol. 15 No. 3, pp. 287–295.
Given the high costs of protecting a nation’s blood supply, country budget constraints, and high levels of HIV, these researchers model multiple scenarios to understand whether levying user fees on blood recipients is a feasible way of financing blood transfusion services (BTS) in sub-Saharan Africa. The authors first undertake a literature review and detail the BTS in Côte d’Ivoire, Mozambique, and Zimbabwe, including financing. BTS expenditures were estimated at 0.8 percent of total public health expenditure in Côte d’Ivoire, 1.5 percent in Zimbabwe, and, for comparison purposes, 0.5 percent in England. Different scenarios are posed for collecting user fees, including three institutional funding options (fully central budget–funded, fully hospital-funded, or mixed) and five patient payment options. The authors present strengths and weaknesses of each scenario, concluding that there is a “limited role” for user fees in these settings. They summarize five key lessons learned from the costing exercise for program planners and donors to consider.