Health care utilization dropped following widespread implementation of health care user fees across African in the 1980s and 1990s. This thesis investigates the political factors that affected why and how user fees were implemented and removed in Kenya and Uganda, and how and why utilization changed after these policy alterations. Thus we examine the impact of political factors on elements affecting people's utilization choices. Data was collected from the scientific and social science literature, Kenyan and Ugandan newspaper articles, and reports by governments and international organizations. We find that in both countries, care quality and drug supplies generally remained low regardless of user fees, and utilization decreased after user fee implementation and increased after their removal. User fees did not function as intended, largely due to planning and financing deficiencies. The government-donor relationship, elections' influence on motives, the lack of state bureaucracy accountability, and weak institutions influenced this commitment insufficiency.