In 1987, the World Bank recommended thatthe principle of cost recovery be incorporated into anagenda for financing publicly provided health services indeveloping countries. Concern remains widespread, however,that the introduction of user fees in government operatedfacilities or costly membership in insurance plans coulddeny the poorest people access to modern health services.The World Bank study better heath in Africa (1994) proposedseveral reforms for health care systems. These includedincreasing spending by governments on health care from $8per capita to $13 per capita. This level is considerednecessary to provide a cost-effective package of basicpreventative and curative services, including safe drinkingwater and improved sanitation in low-income Africancountries. These countries represent 60 percent of thecontinent's population.
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