In many transitional countries where school and health fees have been introduced, school attendance has fallen and some health problems have spread. There are signs of literacy rates decreasing among young people. School infrastructure has deteriorated considerably over the last 10 years. Lack of heating is a major reason for children's non-attendance in countries such as Kyrgyzstan, Mongolia, Tajikistan, Armenia and Georgia. The quality of education is declining in many countries, as budgets cannot stretch to educational materials and salaries, which motivate teachers.
Many parents feel their children are receiving a worse education than they themselves received.
49 per cent of people surveyed in Kyrygzstan in 1997 said they would not seek treatment when sick because they expected the costs to be too high. Recommendations User fees should only be charged for non-essential health services and for tertiary education. Failing to ensure all children's access to a good quality education and to guarantee basic health services to all is mortgaging the welfare of present and future generations, and jeopardising countries' economic development. User fees in poor countries have been shown to be a tragic experiment with poor people's lives. With exemption systems largely ineffective, it is by no means clear that formal charges will replace informal charges, and it is extraordinary that donors and international financial institutions have not learnt from this experience.