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ABSTRACTThis article examines the arguments for and against user fees, privatisation, and decentralisation of health care and family planning delivery systems and compares the effectiveness of fee-for-service delivery by decentralised systems with that of centralised systems with services provided free of charge. Developing countries have achieved remarkable reductions in fertility rates in the past 25 years, but continuing gains depend largely upon increasing the capacity of family planning and health care delivery systems in rural areas. National governments are unlikely to allocate additional funds to improve delivery systems to rural areas because of the greater political influence of urban areas and the declining health-care budgets of the central government. This situation has led many to propose alternative arrangements for health-care delivery in rural areas.

Pros and cons of privatization; decentralization, user fees, and incentives in contraceptive delivery systems in rural areas; four country studies. Peru, Ecuador, Colombia, and Indonesia.

The effectiveness of fee-for-service health care delivery in decentralized systems is compared with services provided free of charge in centralized systems, especially in the area of fertility & family planning. Developing countries have achieved remarkable reductions in fertility rates, but continuing this pattern depends largely on increasing the capacity of family planning & health care delivery systems in rural areas. National governments are unlikely to allocate additional funds to improve delivery systems to rural areas because of the greater political influence of urban areas & declining health-care budgets. This situation has led many to propose alternative, including private, arrangements for health-care delivery in rural areas. 1 Table, 42 References.