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Making free healthcare a reality

110 representatives (including Save the Children) from mainly West African countries are meeting in Dakar this week to share their thoughts and experiences on how to make healthcare free for all, or at least for mothers and children under five.

We have had presentations this morning from Sierra Leone, Nigeria, Ghana, Burkina Faso and Mali. Each of these countries has made some attempt to remove health fees at the point of use, such as a health centre. Nigeria, for example, has passed a law which makes healthcare free at point of use for women and children, but is having difficulty implementing this at the federal level. Ghana has made great strides in improving access to free healthcare through its National Health Insurance System, although only 45% of the poor are protected by this approach. Sierra Leone has removed fees for women and children and is even thinking of going beyond these groups.

It’s wonderful that the issue of access to healthcare has taken centre stage and is so openly discussed and supported by donors as varied as the World Bank, UNICEF and the World Health Organisation.

However, despite the fact that there is abundant evidence on the negative impact of community-based health insurance, this seems to be the mechanism that it is being support most enthusiastically. Clearly, evidence is not enough. There is also a strong political influence on what mechanism gets chosen. It is one thing to convince donors that people should have access to healthcare, whether or not they have money to pay for it. It ‘s quite another to make it a reality. We still have a lot of work to do to make this happen…

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