Cost Recovery in Mauritania: Initial Lessons from Reform

The analysis of the Mauritanian experience, where cost recovery was introduced in 1993, contributes on a number of key points to the discussion surrounding user fees contribution to health care systems. Initial results appear to be largely positive regarding the improvement of the quality of health care and the overall level of utilisation of basic health establishments. They suggest that users are globally willing to pay when the quality of health care improves, and that, contrary to a frequently-voiced concern, EPI activities have increased. Several elements tend to show that cost recovery accompanied by a fair supply of essential drugs and by a better motivated staff has contributed to improve the efficiency of the health system. But a coherent price structure is needed to guide more efficiently the patients to the different levels of the health pyramid. It is therefore vital that user fees are practically extended, as the Government intends, to the second and third levels of the health system. The analysis conducted here also suggests that cost recovery has probably had no major negative effects as far as equity is concerned, although further investigation is necessary before a more precise judgement can be made.