The WHO Commission on Macroeconomics and Health, which reviewed 72 articles on the impact of macroeconomic adjustment policies, including SAPs, found both positive and negative consequences on health outcomes. In sub-Saharan Africa, however, it found mostly negative consequences. Accordingly user fees, many of which were introduced during the 1980s, have been found to be a barrier to access to health services, particularly for the poor, thus exacerbating health inequalities between poor and rich.