In an inspiring speech at the 66th World Health Assembly of the World Health Organisation, the President of the World Bank Jim Yong Kim said: “Anyone
who has provided health care to poor people knows that even tiny
out-of-pocket charges can drastically reduce their use of needed
services. This is both unjust and unnecessary.”
Twenty years after the infamous World Bank “Investing in Health”
report that set the path towards implementation of user fees and
privatisation of health care, no less than the President of the World
Bank dares to criticise user fees. The evidence is now very clear that
health user fees punish poor people and prevent them from accessing
life-saving treatment, especially women and marginalised groups. It is
about time to abolish user fees globally. Yet to do so successfully,
countries need financial and technical support from the WHO and the
World Bank as well as from other donors. The World Bank’s advice and
technical assistance at a country level will continue to be a decisive
factor in supporting countries to move towards Universal Health Coverage
(UHC) and determining whether or not the World Bank meets its
commitments.
And it is not just poor people who face problems with payment for
health care. People living above the poverty line and the so-called
lower middle class are also badly affected. According to WHO estimates,
every year 100 million people are pushed into poverty and 150 million
more suffer economic hardship due to the cost of health care.
For me personally these are not just dry statistics. The numbers
represent people that I know very well: family, friends, and neighbours –
many of whom have chronic illnesses that require life-long health care
which drain the family income and assets
In his speech Jim Kim outlined five specific ways in which the World
Bank will support countries to realise UHC: enhancing analytic work and
support for strengthening health systems; helping countries to reach the
Millennium Development Goals 4 and 5 on maternal and child mortality;
developing a monitoring framework for UHC coverage in collaboration with
the WHO; intensifying work on the science of delivery; and stepping up
efforts to improve health through action in other sectors that impact on
health.
These are welcome commitments. However, as the English say: “the
proof of the pudding is in the eating”, which means you have to eat the
pudding to know what is inside it. The challenge for the President and
his team is now to translate these words into practical measures that
bring real benefit to poor people. Still, Jim Kim and the health team
behind him represent a breath of fresh air at the World Bank.
Evidence from countries which have achieved or are on their way to
achieving UHC, shows that universal coverage cannot happen without
major, scaled up public investments in health. Jim Kim highlighted the
case of Thailand where the state financed health care expansion against
World Bank advice. It is not surprising that the Thai delegate at WHA
said that UHC is possible to achieve. Evidence also shows that to reach
the poorest and most vulnerable people, governments should expand public
delivery of health services. This is clearly the message from the
successes in Ethiopia where 30,000 health workers were trained in just 3
years – against the advice of donors!
One important lesson from countries such as Thailand and Ethiopia is
that policies to achieve UHC should not be defined by the existing low
government health budgets. Such approaches will automatically lead to
designing financial systems that place the burden of payment on
patients. Countries need help to reform their tax systems to build a
fair and progressive system where not only well-off people pay their
share but also foreign companies pay their tax duties.
I was inspired by Jim Kim’s speech and his personal commitments to
UHC and poverty eradication. Now I am watching to see what it means for
my family, friends and neighbours who so desperately need access to
free, quality health care.
Source: http://www.globalhealthcheck.org/?p=1452
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