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Using the scoping study method, 20 studies were selected and analysed.

This survey shows that abolition of user fees had generally positive effects on the utilization of services, but at the same time, it highlights the importance of implementation processes and our considerable lack of knowledge on the matter at this time.

Using this combination of approaches, we reached a point of saturation.

The final list was then validated by two external experts in user fees abolition.

In its 2008 annual report, the World Health Organization (WHO) declared that we must ‘resist the temptation to rely on user fees’ (WHO 2008: 26).

Still, African decision-makers want to know whether abolishing user fees is relevant and how best to do so.

First, to be included, studies had to have the abolition of user fees in sub-Saharan health care services as their main focus.

Instead, we adopted the scoping study method, which is recommended for reviewing complex interventions and does not discriminate among studies based on methodological criteria (Arksey and O’Malley 2005).

The period under review extends from 1988 (earliest date, corresponding to the generalized introduction of user fees in sub-Saharan Africa) to July 2008, inclusive.

Because of space limitations, and because the research report was prepared for French-speaking West African decision-makers and respected their need for a survey in that language, the tables are not presented with this article but are available online, in French, at:

Finally, for each country, we assessed the quantity of data available on a scale ranging from (few) to (many).

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