PHA-Exch> WEST AFRICA: Weighing free health care for all

[Claudio Schuftan]

From: RKoppenleitner RKoppenleitner at t-online.de

DAKAR, 17 October (IRIN) - West African governments considering lifting
health care fees for all will soon have a guide to manage the financial
impact of the move.

The guide, which the NGO Save the Children expects to launch in November,
will show policymakers in developing countries how to estimate resource
needs that may arise from abolishing fees.

Groups campaigning for free care for all say even minimal fees can be deadly
when they cut off millions of the world's poorest from lifesaving basic
care, while contributing only a small portion to health sector revenue.

But how to lift fees and sustain a health care system remains complicated.
Countries do not have the tools to plan for such a policy change and its
implementation.

The five steps in the guide, "Freeing up Healthcare", are: analyse starting
position, estimate how removing fees will affect service utilisation,
estimate additional requirements for human resources and drugs, mobilise
additional funding and communicate the policy change.

 In many West African countries, governments, civil society groups and local
and international NGOs are studying how cash-strapped countries with poor
health infrastructure - some recovering from years of conflict - can ensure
basic health care for all.

 Nothing less than free

 The UK's Department for International Development (DFID) supports the
removal of user fees.

 The World Bank in its 2007 health strategy said it "stands ready to support
countries that want to remove user fees from public facilities," if the lost
resources can be replaced for effective functioning of the health system and
if resources go to providing quality services for the poor.

 But NGOs say donors must go further, telling governments they will support
them in lifting health care fees.

 The evidence that abolishing user fees improves access to health is
completely overwhelming. User fees block access to health care for millions
of people.

 Free, but not for all

 The UN's Children's Fund (UNICEF), while supporting universal access to
health services, does not believe that simply abolishing health care fees
everywhere at a stroke is appropriate.

 "In many countries where the health system works relatively well, people
are already used to paying for care," said Celestino Costa, health policy
adviser at UNICEF's West Africa office. "Coming in and just saying we're
going to remove all user fees would disrupt the system. In these cases it is
worth a look into the best option to ensure that poor and vulnerable are not
left out."

But some anti-fee NGOs say eradication is the only way to go.

Free health care is critical for children's health. Rather than focusing
only on the problems countries face removing user fees, UNICEF should be
actively supporting their abolition.

 UNICEF's Costa said the agency "stands ready to help governments who wish
to exempt certain vulnerable groups from health fees," saying the decision
rests with governments. "The most important thing is to see what measures
can be put in place, working with the government, to ensure that the poorest
groups get full access to proper health care." He concluded, "It is a
complex question, and it depends on the reality on the ground in each
country."

 Health experts backing free care said a September 2008 Médecins Sans
Frontières (MSF) report on malaria concluding that free malaria testing and
treatment has dramatically increased the number of people seeking care and
surviving is further evidence to cut out user fees.

 Getting malaria drugs into a country is not sufficient. Access is mostly
about cost.

 In many settings requiring even a small fee for health services forces an
"impossible choice" on families.

 Health experts stress that while fees present one barrier, many others
remain, such as a lack of equipment and medicines in public health centres
and a lack of facilities for remote communities.

 Sticking with health fees

 In Côte d'Ivoire the government studied the question in 2007, and decided
to continue charging fees claiming the fees citizens pay are minimal and the
revenue helps maintain public health facilities.

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