The cost of a life: the ultimate dilemma

Imagine the ultimate dilemma: if you cannot pay for health care, it costs you your life; and if you do pay, it still costs you your life because it pushes you into poverty and indebtedness. This is the decision faced by poor people when they are forced to pay for health services. This implies that the right to health is only a right if you can afford to pay for it. 

Urmila Nayak’s husband in Orissa, India, is a daily wage labourer. Urmila’s husband wanted to take her to the government hospital for the delivery of her fist child, as she had also contracted malaria during her pregnancy. Not having the funds required to pay for the procedures and medicines, he sold his small piece of land. Sadly, his wife died during childbirth. Then he faced harassment due to his debt of Rs 10,000, incurred for the medical procedures his wife had received. There are many Urmila’s across the world; in India, other parts of Asia, Africa and Latin America. 

It is estimated that 40% of India’s poor pay for hospitalisation expenses by taking loans or selling assets. Consequently, over 20 million Indians are pushed below the poverty line every year as a result of such out of pocket expenses on health care.

It is in such a situation that the W8 applauds Gordon Brown’s recent initiative at the UN General Assembly that recognizes the role of free healthcare in saving lives and seeks free health care services for all. Gordon Brown recently announced support for free health services in Nepal, Burundi, Ghana, Liberia, Malawi and Sierra Leone and has requested donor countries to support developing nations where governments commit to removing fees for health care. We, the W8, have written to Gordon Brown acknowledging the importance of this initiative and urging other donor countries to support it. This free health care initiative has the potential to be a lifeline for the world’s poor but only if all donors get behind it and provide the additional financial and technical support so urgently needed.

Experience across the world has demonstrated that update of services increase dramatically when user fees are removed. For women particularly, who face gender based discrimination, their needs and rights get minimal priority when it comes to deciding where to spend already limited household resources.

We applaud Gordon Brown’s push for universal free health care. Nowhere is this clearer than in India. Here user fees have only been removed for some selective groups. This kind of selective targeting has left millions of the country’s poor excluded from free care.

Gordon Brown acknowledges that provisioning for free health services requires a much greater commitment of resources from national governments. Accordingly, he has urged donor governments to support this policy shift in developing nations through increased and better aid. Total commitments are currently well below the estimated $10bn required to ensure that no one lacks access to health services for want of financial resources. In India the government pays only 20% of overall spending on health care. This means 80% comes from people’s pockets – the majority of whom will go into debt to do so. National governments including India’s must do more to increase spending and demonstrate their commitment to this new push for free health care.

We hope that many other countries, both developing and donor, will recognise the importance of this initiative and join the movement in ensuring that the right to health is not eroded for any individual for lack of resources.

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