On Tuesday we had our monthly conference call which focused on how the UK government can support developing countries to provide free healthcare. Our guest speaker was Dr. Sophie Witter, a Health Economist who has carried out extensive research on user fees removal in developing countries. The recording of the call is now available on our website.
Dr. Witter explained that many developing countries were encouraged to institute user fees by the World Bank and other institutions in response to the harsh economic crisis and serious under-funding of health systems which characterized the late 1970s to early 1980s. As a result, ‘cost sharing’ became the dominant policy principle. This meant that individuals had to pay for health services out of their own pocket. It was claimed that this policy would increase resources for the health sector and improve the general quality of health services delivery in these countries.
Academic research has demonstrated that in fact that there were many problems with the ‘cost-sharing’ model. Dr. Sophie Witter explained that “if you want to raise money, taking a lot of small payments from people who cannot afford to pay very much is not going to be effective”. The objectives that were originally hoped for when the fees were instituted were therefore not being met and millions were dying each year from preventable causes in the developing world.
Some of the issues that user fees create are:
- They constitute a major barrier for poorer households to access healthcare
- Because women are often less prioritised and powerful in families, user fees disproportionately impact on women and children and are therefore a serious gender equity issue
- User fees lead to significant reductions in the utilisation of health services
- User fees cause the poor to delay accessing diagnosis and treatment, contributing to the spread of fatal diseases such as TB and HIV
As a result of the gradual recognition of these issues many institutions have begun to change their views on user fees for healthcare and momentum is now growing for their removal. Dr. Witter warned however, that even though the dominant consensus is for the removal of user fees, there is also a strong ideological philosophy which believes that healthcare is a personal responsibility. Such thinking was portrayed in the recent American political discourse on the proposed reform of their healthcare system. In developing countries, this system would not be effective as most of the people in these countries live in extreme poverty.
The UK government therefore, has a very important role to play as a supporter of public healthcare, and should act on this by leading global advocacy for the removal of user fees in developing countries. They also need to commit resources in keeping with such advocacy to ensure that the implementation of the removal of user fees is done effectively and efficiently. The UK should provide high quality technical assistance to put in place strong alternative financial arrangements, along with monitoring and evaluation capacity to ensure the sustainability of free healthcare.
This month’s action will focus on pushing the government to commit to this critical agenda. If you weren’t able to join us on the call, do listen to the recording and take the action – more information is available on the action sheet on our website. If you need any support please get in touch with us in the RESULTS office.