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Addressing Economic Barriers to Towards Universal Coverage

Addressing Economic Barriers to Towards Universal Coverage. Global Health Conference Brussels 10 th June 2010 Rob Yates Senior Health Adviser Department for International Development. Goderich Health Centre, Sierra Leone 3 p.m. Monday 26 April 2010. Goderich Health Centre, Sierra Leone

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Addressing Economic Barriers to Towards Universal Coverage

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  1. Addressing Economic Barriers to Towards Universal Coverage Global Health Conference Brussels 10th June 2010 Rob Yates Senior Health Adviser Department for International Development

  2. Goderich Health Centre, Sierra Leone 3 p.m. Monday 26 April 2010

  3. Goderich Health Centre, Sierra Leone 3 p.m. Thursday 29 April 2010

  4. Children’s Hospital Freetown, Sierra Leone 8 a.m. Tuesday 27 April 2010

  5. Sierra Leone: why people don’t use health services

  6. Recent Research Evidence • James et al in BMJ (2005): removal fees could prevent 233,000 child deaths in 20 African Countries • Kremer and Miguel (2004): 10c charge reduced demand by 80% for deworming medicine for children • Cohen and Dupas (2007) : 75c charge reduced demand by 75% for insecticide treated bed nets amongst pregnant women in Kenya • http://www.povertyactionlab.org/policy-lessons/health/pricing-health-products

  7. The Rapid Removal of Health User Fees in Africa since 2000 Niger free for <5s and deliveries 2006 Sudan free services for <5s and c-sections Feb 2008 Senegal free deliveries 2006 Liberia all services free Feb 2007 Kenya free deliveries Oct 07 Ghana free services for children and pregnant women May 08 Uganda all services free Mar 01 Burundi free for <5s and deliveries Aug 06 Zambia free services in rural districts Apr 06 Countries with free services pre 2000 Lesotho free services at primary level Jan 08 Countries introducing free services since 2000 Source: Yates R. Universal health care and the removal of user fees. The Lancet 2009; 373: 2078-81

  8. Consensus for Maternal, Newborn and Child Health Policy Recommendation 3: “Remove barriers to access, with services for women and children being free at the point of use where countries choose”

  9. Why this is an appropriate position • Focus on MDGs 4 and 5 • A proven quick-win in terms of improving access • Strong efficiency and equity arguments • Allows space for other public and private mechanisms • Does not mean all services must be free • Countries can define their own package of services • Consistent with universal coverage and rights • Many LICs are doing this anyway – not donor led • Good potential for high-level political buy-in

  10. Should be part of wider reforms • There are more barriers than removing fees • Need to replace fees with pre-paid financing mechanisms that pool risks • LICs and donors must increase levels of public spending on health • Improve performance of public financing – effective, efficient and equitable • Need genuine political commitment to oversee policy reforms • Improve mechanisms for populations to hold governments and donors to account

  11. Recommendations • Formalise final agreed position on access to services free at the point of delivery– potential World Health Assembly resolution? • More donor agencies should publicly promote progressive health financing including services free at the point of delivery • International community should provide additional assistance to countries wishing to launch pro-poor health financing reforms

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