Paying for the Kasongo hospital in Zaire: a conceptual framework

Experiences and discussions relative to community financing of health services tend to focus on the health facility of first access, that is, the health centre. The referral level, the hospital, a crucial element in the district health system, is hardly mentioned in the debate.

In this paper a conceptual reference framework for user fees is presented. It is argued that a financing policy at district level should be comprehensive and, therefore, not a priori exclude the referral level. Criteria for raising fees, as well as the rationale for fees - apart from raising funds - are discussed. Special emphasis is put on fees charged at the district hospital, which may be an important source of financing (complementary to external - national or international - funding). The case of the Kasongo hospital is presented in detail.