COST RECOVERY FOR DRUGS PROVIDED AT THE RURAL DISPENSARY - AN EXPERIMENT IN NIGER

An intervention was conducted in 1989-1990 in rural Niger to introduce a cost recovery system for the drugs prescribed at the dispensary lev el. The community concerned, about 27,000 persons, chose to pay a fixe d fee per episode of illness. The fee covered the treatment for a maxi mum of seven days. The rate was fixed at US$0.8 per adult and US$0.4 p er child. The drug prescription was rationalized through decisional gu idelines including standardized treatments with essential drugs. All d rugs were bought locally but most of them were commercial brands. Duri ng the first ten months of intervention, the revenues only covered 51% of the drug expenses. Aware of the deficit, the village representativ es decided to double the fees. As a consequence, the cost recovery rat e reached 77%. During the low fee period, the utilization of the curat ive services increased by 80%. When the fees were doubled, the attenda nce steadily declined and tended to reach the rate registered before t he intervention while the mean cost per case and the percentage of cos tly treatments with antibiotics increased. It can be assumed that the increase in fees deterred patients requiring low-cost treatment.