As part of the Structural Adjustment Policies (SAPs) instituted in the 1980s on the advice and insistence of the World Bank and the International Monetary Fund, the then highly contentious user fees were introduced as part of the health sector reforms. This was part of a wider package of the reforms across government that led to massive retrenchments in civil service, liberalization of much of the economy and privatization of many state owned enterprises. In a highly popular move in 2000, cost sharing in health was scrapped, officially marking a new era in universal provision of free health services.

This was aimed at making health services accessible to all and most especially to the poor who were unable to afford the fees to access medical services. Although research findings from studies carried out after the landmark policy suggest that there was a marked increase in the utilization of health service immediately after cost-sharing was scrapped of up to 55% to 70% ( Nabyonga et al 2005), there is also a realization that as much as user fees were an important barrier to accessing health services, especially for poor people, and also negatively impacted on adherence to long-term expensive treatments, these shortcomings were offset to some extent by potentially positive
impacts on quality when people paid for health care services (James et al, 2006).