Malawi has been able to maintain near full enrollment since that time. The purported logic of education and healthcare user fees is that payments from children's families and sick people will enable government service agencies to provide services to more people. But this is a twisted rationale, which should be rejected on both principled and practical grounds. As an issue of principle, access to primary education and healthcare is a right that should not be conditioned on ability to pay. In practical terms, the real-world record shows that user fees deny children educational opportunity and people of all ages access to basic health services.
Charges typically generate little revenue in any case.
So the ultimate result of user fees is service denial, not expansion. Most importantly, the real way to free up resources for education and healthcare is for the World Bank and IMF, without delay, to use their existing assets to cancel the debts owed them by poor countries. There are no significant corporate or monied interests served by the imposition of user fees in desperately poor countries. The IMF and World Bank continue to support them out of a dogmatic commitment to a marketized ideology that refuses to concede to empirical refutation. The Treasury Department is opposing corrective legislation so that it can preserve its control of the IMF and World Bank without Congressional interference.