PHA-Exchange> Zambia scraps healthcare fees for poor rural people

[Abraham Thomas]

Zambia scraps healthcare fees for poor rural people

 Peter Moszynski
 09 April 2006

The government of Zambia last week introduced free health care in rural
areas. It scrapped the user fees that had made health care largely
inaccessible to millions of people living below the poverty line in one of
Africa's poorest countries.

The British charity Oxfam, which aims to alleviate poverty around the world,
said that Zambia's move was made possible through using money from the
cancellation of debt and the increases in aid agreed at last July's summit
at Gleneagles of the G8 group of wealthiest countries, when Zambia received
$4bn (£2.3bn; €3.3bn) in debt relief.

"This is one of the first concrete examples of how the G8 deal last year has
made a real difference to peoples' lives," said Barbara Stocking, Oxfam's
director. "Those who backed the 'Make poverty history' campaign last year
should be proud of this achievement."

Pressure from the International Monetary Fund and World Bank led Zambia to
introduce user fees in the early 1990s, but there has been mounting concern
that such schemes effectively disqualify many of those most in need of
health care. Critics argued that young girls in rural areas were the main
victims of the policy, as their families were rarely willing or able to pay
for their treatment.

Oxfam says experience from other countries shows that there will now be a
surge of patients seeking health care from facilities across the country. It
pointed out that when fees were lifted in Uganda "most clinics saw a
doubling in their patient numbers."

The charity stresses that Zambia's next challenge is a "chronic shortage of
health workers," and it has asked donors to help with funding and training
new personnel. The country currently has only one doctor per 14 000 people.

Campaigners warn that poor pay and working conditions have made Zambia
particularly vulnerable to Africa's medical "brain drain." The World Health
Organization's 2006 report on world health says that Africa carries more
than 24% of the world's disease burden but has only 3% of the world's health
workers.

A recent WHO study showed that between January 2003 and June 2004 Zambia
lost 790 health workers, of whom 314 died, 83 retired, 281 resigned and the
rest were either transferred elsewhere, dismissed, or their contract
expired. The country has only half the doctors and nurses that it needs, the
study says.

Henry Malumo, the coordinator in Zambia of the Global Call to Action against
Poverty, an alliance of campaigning groups, said: "We commend the government
for removing user fees in rural areas and urge them to do the same in urban
areas. This is the first step towards addressing the health crisis in
Zambia. More money is now urgently needed for medicines and to improve the
working conditions of doctors and nurses."

Oxfam urges more countries to follow Zambia's example, pointing out that
only three of 30 African countries in a recent survey did not charge user
fees.

Mrs Stocking said: "Zambia will need continued support to recruit new staff,
but this is a massive leap in the right direction. We now need other African
countries to follow suit."

   *Acknowledgement: This news article appeared on
   - British Medical Journal <http://bmj.com/> *
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