Free and Public

World Bank champions free health care!

There have been some surprised emails going around amongst some of my colleagues in the NGO and academic community about a recent news item posted on the World Bank website. The title is ‘Lao PDR: How Free Births are Saving Women’s Lives’.

The surprise comes not from the Lao PDR government’s decision to pilot free care – more and more countries are trying this. It rather comes from the World Bank’s apparent public celebration of this approach. While it is not a first – we have seen the World Bank highlight the effectiveness of free care in countries like Sri Lanka and Malaysia before now – it is very rare. It is also very welcome and will hopefully send a message to other governments that they have the opportunity to consider submitting requests for similar support from the Bank, as well as other donor agencies, as part of their efforts to scale up access to health care.

In an effort to accelerate poor progress on saving women’s lives the Lao PDR government is piloting free facility-based maternal deliveries in two districts – Nong and Thapanthong – as part of the Health Sector Improvement Project. The World Bank says it is supporting the project – a $15 million grant was issued in 2005 and this was extended with an additional $12.4 million in May of this year. 

Further details on the pilot are not easy to find. The World Bank reports that ‘the impact of the pilot is currently being studied but preliminary results suggest a significant increase in childbirths in health facilities since services being provided are for free. As such, the mothers who delivered at health facilities were at much lower risk of fatal complications.’

Any further information would be very welcome and let’s hope this is a sign of things to come from the Bank.

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4 Responses to “World Bank champions free health care!”

  1. Richard P K says:

    Do we really need to prove that when healthcare is free it is more widely used and effective?

    I think my nephew could tell me that and he’s 5!

    Next they’ll be saying we need to prove that having better trained teachers improves educational outcomes…

    • Rob Yates says:

      Yes it’s obvious isn’t it Richard. But I can send you documents from the late 1980s which argued that if you charged for services it would improve quality, utilisation and even benefit the poor!

  2. Devi Prasad Prasai says:

    Once Nepal removed the user fees on maternal and child health, poor disproportionately got the benefits. But Do we sustain them?
    Where from the money come to compensate the user fees? Tax revenue may not adequate to compensate the loss of user fees.

    I will share the evidences.

    Devi Prasad Prasai,

  3. Gabriel Madiye says:

    The challenge is nurses’ resistance to the change required of free health care. In Sierra Leone, we are faced with high resistance from nurses that refusal of care has resulted in violence against patients or nurses. A case in Sierra Leone now tried in the magistrate Court No.3 in Freetown involves a nurse* and a patient’s mother* who took her under-five child to a Children’s Hospital and was refused care after spending two days seeking attention of health care workers. The child’s mother demanded explanation from the nurse who replied with anger and violence. The mother was arrested by the Police and detained for three days with the sick child without permission to seek health care until granted bail by the court on representation by the Peoples Health Movement Sierra Leone. We are positive about free health care but nurses may need more convincing. Without the right support from nurses, free health care may compromise quality and treatment outcome. We will request health activists around the world to support our advocacy to defend the patient right that now stands abused in the Children’s Hospital in Freetown. We are in court defending the mother who has been charged with the offence of assault by the police. Free health care can make the impact where there is a good will on the part of health care workers to provide service with empathy and not vendetta

    *Names were included in the original comment but have been removed to protect the privacy of the individuals involved

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Global Health Check was created by Anna Marriott and is currently edited by Mohga Kamal-Yanni