Mechanisms to offset some of
these effects have generally included requirements for increased
local decision-making and public participation.
For example, decisions have
been localized at community level on:
- what level of fees should
be charged;
- how exemption should be managed;
- retaining fees locally to
improve quality of care;
- encouraging local participation
in fee management;
- ensuring that additional revenues
raised are earmarked for primary care services (Wang'ombe,
1997).
This has often been done, however,
without taking the additional step of ensuring that local-level
decision-making is not simply dominated by local elites or by
hospital-based personnel who monopolize these resources within
hospital services (Loewenson,
2000b). |