The Removal of Charges for Health Services in the Jamaican Public Health System: Impact on the Health Practitioners' Performance

There is an ongoing discussion between governments, international agencies, and advocacy groups on whether user fees imposed at government health facilities in poor countries should be removed.Proponents argue that abolition of charges would lead to greater access for the poor, therefore offering the underserved the opportunity to access health services.There are limited studies that examined how health practitioners, an important stakeholder are affected.This research examined the impact of the 2008 removal of charges for health services on health practitioners in Jamaica.Using a mixed method evaluation design, we found that main health practitioners -nurses, doctors and pharmacists were not satisfied with the policy change.When compared to that before removal of charges, 10% less practitioners felt that performance on the job was good.Health practitioners alluded to increased workload, negative effects on their physical and emotional status and dissatisfaction with their work environment.Other problems encountered by health practitioners included unavailability of resources, shortage of staff, lack of equipment and lack of administrative support.The lesson learned for policymakers is that the critical problems identified will eventually outweigh the substantial health gains if adequate resources (financial and human), administrative support as well as improved service management are not soon injected into the public health system.