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COTE D'IVOIRE: Free health care window highlights challenges

DAKAR, 10 June 2011 (IRIN) - The Ivoirian government has extended a special period of free health care to help a population reeling from months of turmoil. But in a country where cost recovery for health services has long been the policy, an abrupt change to free care is posing challenges.

“If we are to provide quality care for the population, we must take a step back, study this and reorganize,” said Fabrice Blé, a doctor at a community health centre in Port-Bouët in the main city Abidjan.

Shortly after Alassane Ouattara took power in April 2011, he announced that public health services would be free until the end of May as a way to help people in the aftermath of widespread unrest and economic stagnation.

On 8 June, after a few days of uncertainty about this policy, the Health Ministry announced free care would be extended “until further notice”.

In recent years some countries in West Africa have made health services free for certain groups like women and under-five children, but Côte d’Ivoire has maintained health user fees; offering free care in public hospitals was for the current exceptional circumstances only. The system is not set up for free health services.

Doctors reported 20-30 times the number of patients after free care was announced. Advocates of free care say the explosion of patients indicates that cost is one of the biggest barriers to access.

But even advocates say a shift to free care is not like flicking a switch. “This is not something that changes overnight,” said Ina Bluemel, senior health coordinator with Save the Children, which is calling for universal health care.

Côte d’Ivoire would have to determine additional staff and supply requirements, reform tax and insurance systems, mobilize additional funding from the national budget and inform the public of the policy change, Save the Children says in a communiqué.

“Even though the temporary waiving of fees has benefited people across the country, it remains a short-term solution to a much deeper problem.”

Rob Yates, health economist with the UK government’s Department for International Development, says several "supply-side" reforms are necessary when a government removes fees, including increasing health workers' salaries and benefits, ensuring they are paid regularly and improving accountability mechanisms.

It is not clear whether the Ivoirian government is considering waiving fees for good.

Taking stock

Health officials are evaluating how the initial phase went, said Ousmane Aïdara, communications officer in the Health Ministry. “We are looking at what worked and what didn’t and the public’s take on this approach. We are studying whether it should be extended again and if so for how long.”

In April, just as the heaviest fighting subsided, several aid agencies provided supplies and support to health facilities, and medicines to the central pharmacy. But emergency aid is not part of a sustainable health system.

Save the Children has welcomed the extension, saying it and other NGOs continue to meet Health Ministry officials to help develop a long-term solution to accessible health care.

Meanwhile, health workers are struggling to absorb the high number of people coming through and navigate in the new no-fee mode. Blé, the doctor in Port-Bouët, said under cost recovery the money patients pay goes into state coffers. “If now the government figures it can offer free health care to the population, fine and good. But health workers then must have all the means at their disposal to offer quality care.”

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Theme (s): Children, Governance, Health & Nutrition,

[This report does not necessarily reflect the views of the United Nations]

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