Rapport Free accessto primaryhealth care : a rewardingstrategyAppeal to the G8

Free accessto primary health care : a rewarding strategy. Appeal to the G8

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SUMMARY

SUMMARY
LIST OF ABBREVIATIONS AND ACRONYMS
INTRODUCTION .
- 1 ) Global health, a rising concern and yet insufﬁcient progress made
- 2 ) Removing ﬁnancial barriers : a ﬁrst decisive step towards universal access to primary healthcare
- 3 ) The call to the G8
CHAPTER I : The questioning of user fees and the appearance of free healthcare policies
- 1 ) Origin of the paradigm of user fees
- 2 ) Health impact and equity
- 3 ) A limited mechanism of funding
- 4 ) Cost recovery policy : a model now questioned
- 5 ) Improving ﬁnancial accessibility to healthcare : a growing concern in developing countries
CHAPTER 2 : Exemption of payment for pregnant woman and children under ﬁve ; the case of Niger
- 1 ) The health situation and health system in Niger
- 2 ) Promising results marked by a quantitative and qualitative increase in access to primary health care
- 3 ) The impact of exemptions on the health system
Chapter 3 : Free access to primary healthcare, MdM’s experience in Haiti
- 1 ) The heath situation and user fees in Haiti
- 2 ) A positive impact on the utilisation rate and the organisation of health centres
- 3 ) Exemption measures and ﬁght against household poverty in Haiti
- 4 ) Future prospects
RECOMMENDATIONS TO THE ATTENTION OF THE G8
Notes

SUMMARY

Among the many barriers that impede access to healthcare, the obligation on service users to pay for health ser-vices represents a major obstacle. Every year, more than 100 million people fall into poverty because of disastrous health payments.
Today the policy of user fees is being seriously reconsidered, resulting in a growing number of countries adopting national policies that aim to remove or ease the ﬁnancial barriers facing patients. Several international donors have also distanced themselves from policies of recovering costs from users.

Médecins du Monde is convinced that the elimination of ﬁnancial obstacles constitutes a decisive step towards universal access to primary care in low-income countries. For nearly two years, our organisation has been involved in several projects to improve affor-dability of healthcare, particularly in Niger and Haiti. This ﬁeld experience demonstrates the positive impact of free healthcare in terms of health coverage for the population.

However, the success of this approach is heavily dependent on strong political will on the part of the national authorities, as well as on stable and sustainable funding. In low-income countries, where governments’ own resources are inadequate to cover the cost of free care, it is essential that the national budgetary effort be accompanied by agreed and predictable international aid. In this context, and in light of the growing number of countries who have decided to provide free healthcare, the G8 countries now have a responsibility to support countries in the effective, long-term implementation of this new policy.

During the forthcoming Hokkaido summit, G8 countries should clearly reafﬁrm the com-mitment made in 2005 to promote access to free primary health care ( wherever countries choose to provide this ) and should spe-ciﬁcally state their intention to support the abolition of direct payments by health service users ( “user fees” ).

^{Avril 2008}