Many policy-makers and health economists are interested in designing and implementing user fee/quality improvement programs in public facilities in Sub-Saharan Africa on a national scale.

This research addresses two design issues for a national program : (I) to what extent would user fees finance the costs of quality improvements, and (2) whether a uniform program could be implemented throughout the country or the user fees should differ between urban and rural areas or across health regions.

A national survey was conducted to determine the population's willingness and ability to pay for seven quality improvements : (I) facility maintenance, (2) supervision of personnel, and drugs to treat (3) diarrheal diseases, (4) acute respiratory infections (ARI), (5) malaria, (6) intestinal parasites, and (7) sexually transmitted diseases (STDs).

Willingness to pay for quality improvements was measured by contingent valuation techniques in which subjects were asked about expenditures for care at government facilities under a hypothetical user fee/quality improvement program.

Ability to pay was measured by monthly expenditures for health care as a percentage of monthly household consumption.

The majority of the population was willing to pay the cost of the quality improvements, which ranged from U.S. $0.40 to U.S. $4.00. (...)