Response on Oxfam's “Make free public health care for all a reality” campaign
October 2008
Thank you for your recent e-mail supporting the campaign to make free public health care for all a reality. I wanted to respond to the three specific requests of the campaign:
- invest in free public health services in developing countries
In the UK Government’s 2006 White Paper “Eliminating world poverty: making governance work for the poor”, the Department for International Development (DFID) set out its commitment to help partner governments abolish user fees for basic health services, as part of our wider effort to support quality and equitable healthcare for all. We know that in many countries user fees, and other charges, mean poor people cannot afford to use clinics and hospitals when they get ill. This is slowing progress towards the Millennium Development Goals (MDGs). For example, over 3 million child deaths could have been avoided over the past 20 years had financial charges not been imposed.
That is why DFID currently supports several partner governments in providing free public health care. In recent years increased DFID aid has helped the Governments of Uganda, Zambia, Burundi and Ghana to provide free access to essential health services. In addition, we have provided technical assistance to these and other countries (notably Mozambique and Nepal) to help make sure that free healthcare results in the greatest possible health benefits for poor people.
We are also working with other development partners to build support for this
view. The World Bank is now willing to support countries that want to remove
user fees from public facilities, provided that the lost revenue is replaced
with sustainable, well-managed funds. Dr Margaret Chan, Director-General of the
World Health Organisation (WHO), also agreed at the launch of
DFID’s Health
Strategy
(1180
kb) in
2007 that “If you want
to reduce poverty, it makes sense to help governments abolish user fees.”
- invest in 4.25 million more health workers worldwide
We agree strongly that there is a health workforce crisis in the developing world. This is one of the major bottlenecks to improving the health of the poor, in particular for pregnant mothers and infants who need skilled midwives to ensure they are healthy when they are at their most vulnerable.
More health workers are also needed to sustain and scale-up the successes that have already been achieved, for example in AIDS treatment. That is why the updated DFID AIDS strategy “Achieving Universal Access the UK’s strategy for halting and reversing the spread of HIV in the developing world” (http:www.dfid.gov.uk/pubs/files/achieving-universal-access-evidence.pdf), launched in June this year, sets out our commitment to address the health workforce crisis.
We will provide our support through our country programmes and globally through our support to the international organisations like the Global Health Workforce Alliance. We have committed £6 billion to strengthening health systems and services, including health workers, over seven years to 2015.
We do recognise that more must be done internationally. That is why in 2008, the UK Government has been calling for concerted international action to address the global shortage of health workers. In April, Gordon Brown and George Bush announced joint UK/US support for health workers in four African countries and called on the G8 and to provide similar assistance. As a result, at the Toyako Summit in July 2008 the G8 agreed to “work towards increasing health workforce coverage towards the WHO threshold of 2.3 health workers per 1000 people, initially in partnership with the African countries…that are experiencing a critical shortage of health workers”.
We will continue to press for urgent action to tackle the health workforce crisis, including at the United Nations (UN) High Level Event on 25 September 2008 in New York.
- stop promoting private health care services that are risky and unproven.
The reality in many low-income countries is that public health services cannot provide the standard of healthcare required by its citizens. As a result, many poor people rely on the non-state sector for their health services. A study in Nepal found that more than a third of the poorest people went to private providers for health services, and most episodes of malaria in Sub-Saharan Africa are initially treated by private providers. If we are to improve, quickly, the health of the poor, DFID and other partners will need to help governments to make better use of these non-state providers. This is not just the private for-profit sector, but also non-government and faith-based organisations. We agree that this engagement must be based on strong evidence of what works to improve the health of poor people. That is why in our 2007 Health Strategy we made a commitment to strengthen the evidence base underlying health systems strengthening to inform the effectiveness of both our own work and that of other organisations.
DFID is committed to supporting universal access to basic health services in the poorest countries. Ultimately, this is the only way we will reach the health Millennium Development Goals.
Thank you for your interesting this important issue.
I hope you find this helpful.
Gillian Merron
Parliamentary under Secretary of State for International Development
