Cost recovery for drugs provided at the rural dispensary: an experiment in Niger.

Abstract

An intervention was conducted in 1989-1990 in rural Niger to introduce a cost recovery system for the drugs prescribed at the dispensary level. The community concerned, about 27,000 persons, chose to pay a fixed fee per episode of illness. The fee covered the treatment for a maximum of seven days. The rate was fixed at US$ 0.8 per adult and US$ 0.4 per child. The drug prescription was rationalized through decisional guidelines including standardized treatments with essential drugs. All drugs were bought locally but most of them were commercial brands. During the first ten months of intervention, the revenues only covered 51% of the drug expenses. Aware of the deficit, the village representatives decided to double the fees. As a consequence, the cost recovery rate reached 77%. During the low fee period, the utilization of the curative services increased by 80%. When the fees were doubled, the attendance steadily declined and tended to reach the rate registered before the intervention while the mean cost per case and the percentage of costly treatments with antibiotics increased. It can be assumed that the increase in fees deterred patients requiring low-cost treatment.