In many developing nations, project administrators try to design programs which are monetarily self sufficient. Unfortunately, this is often impossible. Local governments are unable or unwilling to fund health services adequately. Other resources such as grants from wealthier donor nations or Non Governmental Organizations (NGOs) are used to bridge the gap. In general, however, these sources are unwilling to commit to long-term payments for operational costs for many health initiatives. They often prefer to pay for capital costs for construction materials, essential equipment, initial drug stocks, sanitation or clean water facilities, or assistance with education and training.
Experience over the years with well-intentioned, but nonetheless defunct projects has taught donors to be careful with their contributions. As a prerequisite for funding, most donor agencies will require proof that the program will be adequately supervised, is realistic, and has some prospect for self-perpetuation. In addition, they usually require some assurance that the program will have a significant beneficial effect which can be periodically measured. Donors also know that in general, independent projects are less cost effective than integrated ones. In some cases they will provide some operational expenses which must be supplemented by other programs like those listed below.


Many innovative strategies have been devised to allow patients to contribute towards the cost of their care. Payments made for health services can be made in the form of cash, goods, work, or other services of value. Payment plans (in cash or in kind) employed by successful local healers or buisnesses can give clues to practical payment methods within a given community. Many experts believe that the charging of fees of some kind (except in true emergency situations) is critical not only to assist in funding, but to reinforce the sense of value of the services to the community and to prevent abuse of services.
Payment is easier to obtain when patients are convinced of the value of the services. This is more likely to be true for curative rather than preventative services because the benefits are more immediately apparent. Systems employing cash payments per visit are common and often essential, especially for small programs, but adjustments are often needed to prevent placing an undue financial burden on the chronically ill who must visit the facility frequently or on the very poorest who cannot pay even a small fee. Exceptions may also need to be made in cases of contagious diseases such as tuberculosis which require long-term therapy during which the patient may be free of symptoms and unlikely to return if faced with a fee.

Community-shared payment

Many other policies have been developed to allow the community as a whole to help share in the costs of health provision--a basic form of health "insurance." Members of the community can provide the labor (for construction or public health projects). This strategy serves both to defray costs and foster a sense of commitment and worth in the project. Rural communities can use proceeds from cash crops or animals raised on communal land to fund health projects. Alternatively, they can support community health workers by raising their crops and animals for them. In urban centers fund-raising events such as raffles, dances, movies and other social events can be successful. In areas with a suitable social structure a "tax" can be levied to support health activities. In some circumstances local businesses, cooperatives or individual patrons may be able to assist in financing.

Drugs Sales

Most experts agree that a charge of some kind must be levied on drugs except in situations (mentioned above) of true emergencies or epidemics or with certain diseases such as TB where patients are often not motivated to pay for long courses of treatment and where control of spread is essential. The levying of fees for medicines prevents dependency, reinforces the value of the medicine, assists in perpetual financing of the pharmacy and discourages abuses of the system. For example, where patients are charged a fee per visit only, patients have been known to exaggerate symptoms in order to get more free medications. These may in turn be sold or redistributed without proper control or understanding.