[Development issues] User fees and health care

The IRIN news service has a good piece on the debate over user fees in African health care.

Late last year, the Liberian health ministry suspended the imposition of user fees for primary health care and set up a committee to investigate the impact of such fees on the country's extremely poor population.

The research is in part to show the level of revenue gained from fees contrasted with the extent fees keep people away from health services, one development expert in Liberia said. Many who advocate lifting fees say they do not contribute significantly to government coffers, reported IRIN.

The World Bank is working with Liberia to figure out alternative ways to fund health care. A health economist with the organization pointed out that World Bank does not support user fees, as is commonly assumed. “We’re neither for nor against user fees – what we’re for is that the poor and children have access to health care.”

A spokesman for Britain's Department for International Development said, “We think the evidence is clear that user fees are not desirable because they don't attract a lot of revenue in a typical African country, but nonetheless act as a significant disincentive for poor people to seek health care."

The Globalist, for its part, took a broader look at the challenges of health care in Africa. Particularly, how to make the biggest positive impact on public health with limited resources.

Some of the key problems it cited:
-The problems of childbirth
-The scarcity of physicians
-The 'brain drain' of domestic health workers toward Europe and North America
-Deadly diseases like tuberculosis, AIDS and malaria
-Curing the stigma against AIDS