The user fee, which patients must pay, continues to be one of the biggest obstacles to accessing health services in Mozambique. This is the finding of the Citizen Observatory for Health (OCS) in a study released on Tuesday in Maputo.

Entitled "Socioeconomic Effects of User Fees in the Health Sector" in Mozambique, the study shows that user fees harm users and also shows that the cost of charging is greater than the benefit.

For the OCS's executive director, Jorge Matine, the study shows that the user fee is not efficient, as it constitutes a barrier to citizens' access to health services, not to mention the costs incurred by the state to ensure that the fee is collected.

"It means that the state spends more on paying the people who charge the usury tax than the tax actually being an income to increase the hospital's resources," said Jorge Matine, quoted by AIM.

According to the source, the fee is not only charged on entry to the hospital, but for each service requested. For this reason, the user fee can reach 1,500 meticais (one dollar equals 64 meticais), compared to the initial and officially established fee of 50 meticais, which can also change depending on the service.

"The fee varies from 500 to 1,500 meticais, but because there is no organization as to how they should be charged, these fees are not only charged at the entrance, but also at the various services," said the source, adding that there are many cases identified during the study in which patients had to take with them materials, including water, candles, among others for labour.

As a solution to the problem, the OCS proposes, in addition to eliminating the user fee, the implementation of other ways of financing the health system, such as the adoption of a Universal Insurance system that could cover the costs of treating patients who are victims of accidents at work, for example.

"It's in these fiscal steps that we think the government can get the money, and not in the citizen's pocket," adds the OCS executive director.

For his part, Edmilson Mavie, representing the Quality Management and Humanization Department at Maputo Central Hospital (HCM), said that the concept of the user fee, taking his institution as an example, aims to reduce the use of quaternary level hospitals (central hospitals) unnecessarily.

"But it also works, as the study showed, as an alternative income for financing, given the scarcity of resources," he said, explaining that patients who go to hospitals at the quaternary level with a transfer note are exempt from paying the user fee.