• Sierra Leone
• Developing Countries
• Health User Fees
• Impact Evaluation

I exploit a policy change in Sierra Leone to investigate the effect of the elimination of health user fees on the demand for women and children use of medical care and on health outcomes, such as anthropometric indicators and mortality. I use the Demographic and Health Survey dataset including the aforementioned information for mothers and children. The reform I study came into effect in April 2010 and it abolished hospital user fees for pregnant and lactating women and children under five. For each indicator of interest I estimate a difference-in-differences model using older cohorts of children or women delivering before the policy change as controls. I find significant effects on the frequency of women delivering in a health facility and on weight-for-age for children under five. I do not identify any effect for child mortality, whereas effects on maternal mortality are ambiguous. Effects vary substantially by income, place of residence and distance to the health facility, with women and children with middle and high income, urban and far away households being in general more responsive to the policy change. In order to add credibility to the results I relax the functional form assumption and repeat the estimation non-parametrically through a kernel weighted propensity score matching strategy. My results shed some light on the potentially positive short-run effects of reducing financial barriers to the access of health care in low income countries.