1999/2000. The household and community information is complemented by administrative data gathered through a recently established Health Management Information Services (HMIS) administered by the MOH. The data include monthly information on supply and use of a wide range of services by all public health facilities nationwide, aggregated to the district level. Although not all units report consistently over time, we were able to use about 2,000 data points for each of the different types of services, as discussed in more detail below.

Descriptive statistics relating to sickness and use of health services during the last 30 days by the more than 50,000 individuals included in each round of the household surveys, as reported in Table 2, highlight that ill health is indeed widespread and economically relevant. In the aggregate, almost 30% of individuals (about 55% of them children and 45% adults) reported to have been sick, causing them to lose on average almost 8 work days per incident. Somewhat surprisingly, the data do not indicate a significant change in the incidence of sickness between the first and the second period. Also, disaggregation by quintile suggests little variation in the incidence of sickness or its duration across the income distribution.

This does not imply that the abolition of user fees did not have an impact: In fact, the share of those who used health services when sick increased by about 10% from 69% to 79%. Possibly as a consequence, the number of workdays lost due to sickness by the average sick individual declined from 8.3 to 7. At the same time, lack of comparability between the two surveys makes it difficult to get a clear picture of the change in market share by the public sector, causing us to rely on outcome indicators (e.g. incidence of rationing and workdays lost due to sickness) rather than use of public or private facilities the relevant indicator for analysis.<sup>9</sup> Further support for an impact of the policy change at the descriptive level is provided by the fact that the share of sick households who reported to not have utilized health services due to high cost decreased from about 50% in 1999 to about 35% in 2002, a reduction that was particularly pronounced in the country’s poorest region, the North, where, after the change, less than 30% reported to not have used health services due to the cost involved.<sup>10</sup> Looking at changes over time across the income distribution illustrates that, indeed, the impact of the policy change seems to have been strongly pro-poor: The percentage increase of those who visited a hospital when sick was, with 12 and 14 percentage points, highest for those in the bottom two quintiles, compared to less than 6 percentage points for the top quintile. This is even more obvious if one considers the reasons for non-attendance: The share of those who quoted cost reasons for not attending a hospital when sick decreased by about 20 percentage points in the bottom three quintiles

> 9 While the 2002/03 survey has a clear definition of the ownership of each health facility, the 1999/00 one gives type of ownership only for hospitals but not for clinics, dispensaries and health centres and drug shops which therefore had to be assigned to one type in 1999, which could explain the decline in the shares given that it may be difficult for the respondents to distinguish between  the different definitions. 10 Tables showing the regional disaggregation are available from the authors upon request.

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