In 1987, the World Bank recommended that the principle of cost recovery be incorporated into an agenda for financing publicly provided health services in developing countries. Concern remains widespread, however, that the introduction of user fees in government operated facilities or costly membership in insurance plans could deny the poorest people access to modern health services. The World Bank study better heath in Africa (1994) proposed several reforms for health care systems. These included increasing spending by governments on health care from $8 per capita to $13 per capita. This level is considered necessary to provide a cost-effective package of basic preventative and curative services, including safe drinking water and improved sanitation in low-income African countries. These countries represent 60 percent of the continent's population.