PHM-Exch> The ghosts of user fees in the past

[Claudio Schuftan]

    From:    david.woodward at neweconomics.org

    Subject:  "The ghosts of user fees past: Exploring accountability for
victims of a 30-year economic policy mistake"

New paper by Rick Rowden:


Health and Human Rights    Vol. 15, No. 1, June 2013  pp. 175-85.
http://www.hhrjournal.org/wp-content/uploads/sites/13/2013/06/Rowden-FINAL.pdf

Abstract:

Today, there is an unmistakable shift in international consensus away from
private health financing, including the use of user fees toward public
financing mechanisms (notably tax financing), to achieve universal health
coverage (UHC). This is, however, much the same as an earlier consensus
reached at the WHO”s World Health Assembly at Alma-Ata in 1978. When
considering the full circle journey from Alma-Ata in 1978 to today’s
re-emerging support for UHC, it is worth taking stock and reflecting on how
and why the international health community took this nearly three decade
detour and how such misguided policies as user fees came to be so widely
implemented during the intervening period. It is important for the
international health community to ensure that steps are taken to compensate
victims and determine accountability for those responsible. Victims of user
fees suffered violations of their human right to health as enshrined in
Universal Declaration, ICESCR, and a number of other human rights treaties,
and yet still cannot avail themselves of remedies, such as those provided
by international and regional human rights fora or the various United
Nations treaty-monitoring bodies, and the responsible institutions and
individuals have thus far remained unaccountable. This lack of
accountability suggests a degree of impunity for international
organizations and health economists dispensing with health policy advice.
Such a lack of accountability should be noted with concern by the
international health community as it increasingly relies on the advice and
direction of health economists. Steps must be taken to provide survivors of
user fees with compensation and hold those responsible to account.

Conclusion

The new consensus towards UHC suggests that an evidence-based approach to
policy may finally be prevailing over an ideologically driven approach.
While the new consensus shifting in favor of UHC is to be welcomed, the
international health community cannot dismiss the unnecessary suffering and
harm caused by the reckless adoption of ideologically driven user fees
policies over the last 30 years. It is incumbent on the international
health community to reflect and take stock of what went so badly wrong that
led to the widespread application of user fees in the world’s poorest
countries and take steps to determine accountability for those responsible.
As we welcome the new consensus, the past victims of user fees must have
their voices heard and all potential avenues for compensation must be fully
pursued. More broadly, the current lack of accountability and liability in
the economics profession should be of concern to the international health
community as it increasingly relies on the advice and direction of health
economists.
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