Increasing access to ‘free’ health services: are health workers not a missing link?

Title Increasing access to ‘free’ health services: are health workers not a missing link?
Year 2011
Author J. Campbell, J. A. Oulton, B. McPake and J. Buchan
DOI 10.1111/j.1742-1241.2010.02446.x
Journal International Journal of Clinical Practice
Document Type Journal Article
Document Availability Full Text
Classification Access
Abstract In September 2009, in front of a global audience in New York, leaders from Burundi, Ghana, Liberia, Malawi, Nepal and Sierra Leone made public commitments to increase access to free health services in their respective countries, particularly for pregnant women and children younger than 5 years. The commitments reflected, in part, a desire to: ‘accelerate action towards universal access to primary health care’ as laid out in the World Health Assembly Resolution of May 2009; specifically address poor maternal and child health outcomes by focusing on women and children, and in turn enhance progress against the health-related Millennium Development Goals. A common theme within the country commitments is the removal of financial barriers to access health services: in particular, user-fees at the point of service. This is not a new approach and has been implemented in both high- and low-income countries, albeit with varying degrees of success. In a 1945 address to Congress on the health of the Nation, Harry S. Truman recognised that ‘the principal reason why people do not receive the care they need is that they cannot afford to pay for it on an individual basis at the time they need it’. His resulting policy highlighted ‘that financial barriers in the way of attaining health shall be removed; that the health of all its citizens deserves the help of all the Nation’. The logic from 1945 is as relevant today. Published evidence, including reports from the World Health Organisation (WHO), the WHO Commission on Social Determinants for Health (CSDH), and articles in The Lancet  and in the Bulletin of the World Health Organisation, indicates that user-fees are one of the most regressive forms of health financing and a barrier to reduce maternal and child mortality.


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