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.
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.
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.
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.