504 SCIENCE IN AFRICA 



some revenue is obtained by this means, particularly for salvarsan 

 injections. For these, payment is charged on three scales in accor- 

 dance with the average wealth of different areas, and patients 

 are encouraged to take a full course of treatment by a reduction 

 in the fee per injection. In hospitals and dispensaries there is a 

 charge of up to two shillings a week for in-patients in a general 

 ward, subject to ability to pay, and seven shillings a day for a 

 private ward. 



In Basutoland the out-patient departments of each of the six 

 hospitals charge one shilling for each attendance from native 

 patients, but in-patients pay nothing. 



It has been urged that all medical treatment of Africans should 

 be free, on the grounds that the services are largely financed from 

 native taxation, and that the provision of free treatment might 

 encourage further resort to it. On the other hand many authorities 

 hold the opposite view, that Africans in rural areas are likely to 

 appreciate treatment more if the service is not taken entirely for 

 granted. Experience in many parts of the continent shows that 

 Africans, like Europeans, are apt to think that the benefit they 

 receive from treatment is in direct proportion to the amount they 

 pay. In Kenya Africans have been found to believe that an injec- 

 tion which costs ten shillings is ten times better than one costing 

 one shilling, and practical difficulties ensue, since they will save 

 up for expensive single injections and imagine that they need not 

 take courses. There might seem to be advantages in a simple 

 co-operative system whereby small fees were charged on a regular 

 basis and responsibility for payment rested with the village head- 

 men. 



Some authorities regard as preferable the provision of free 

 treatment, a certain proportion of the poll-tax being considered as 

 a contribution on the lines of health insurance in some European 

 countries, the balance of the cost of medical services being met by 

 a grant from the state and a tax on the employer of labour. The 

 definite allocation of a percentage of the poll-tax would tend to 

 stabilize expenditure on medical services even in periods of finan- 

 cial depression, and limit reduction of service to specific benefits 

 rather than allow a general reduction of medical work just at a 

 period when the need for it is greatest. A special aspect of this- 



