What I find astonishing about this blog is that charging user fees for medicines and basic services with exemptions for the poor is presented as a new idea. Everyone knows that these policies were inflicted on the developing world by the Bank in the late 1980s and were a complete failure. Access to essential health services plummeted and because exemptions for the poor were unenforceable this meant that poor and vulnerable were effectively excluded. Rather than quote a small thirty year old study I would suggest checking the vast research literature on this topic - MIT's Poverty Action Lab is a good place to start with lots of large RCTs. Also you may want to refer to the Bank's latest HNP strategy which, in para 105, says that the Bank will support countries that want to remove user fees.