The reform of health care systems is supposed to make access to health care better. But in the particular case of user fees, the opposite effect was observed. During the 1980s and 1990s, health sector reforms to improve the efficiency of health systems and the quality of care provided were implemented in low-income countries, mainly in Africa. The reforms included the introduction or consolidation of cost recovery mechanisms, otherwise known as user fees. In most instances, user fees had the unintended effect of decreasing access to health care by the poor. The conclusion drawn by Dyna Arhin-Tenkorang, visiting scholar at the Center for International Development at Harvard University and a senior economist for the Commission on Macroeconomics and Health, is that alternate financing mechanisms are required to provide financial risk protection to people in low-income households.