Review cost-sharing in health care, UN official urges

A senior UN official urged the government of the Central African Republic on Tuesday to reconsider its objection to a cost-sharing proposal in health care, so as to take into account the public's low purchasing power. The official, Ramiro Lopes Da Silva, is the special humanitarian adviser on the CAR for the UN Office for the Coordination of Humanitarian Affairs(OCHA). He said at a news conference in the CAR capital, Bangui, that the few operational health facilities in the war-affected areas were selling drugs at prices beyond the reach of most people. Therefore, he said, cost sharing should be considered to facilitate affordable prices. Urgent action was needed, he said, because CAR was in an endemic belt for diseases such as malaria and meningitis. "All the ingredients are in place for a more catastrophic situation by the end of the year, if nothing is done," he said. Since the end of the first EC-financed medical programme in December 2003 in the northwest, during which drugs were distributed free of charge by Italian charity Cooperazione Internazionale, the government has demanded that the public pay the full cost of drugs. The government said its rejection of a proposal that NGOs pay half the cost was intended to make it acceptable for a reversion to the old prices once the NGOs withdrew. The government’s move has reduced the number of patients reporting to health centres by half and forced many to rely on the unsafe street drugs or on traditional medicine. The public's buying power in the northwest dropped drastically during the rebellion, as farmers lost two planting seasons and their property was looted. Moreover, those who harvested cotton were unable to sell it since cotton factories were stripped of their machinery. Da Silva said that his mission had found that a household in the northwest earned an estimated 1,800 francs CFA ($3.4) weekly, while the average cost of a simple anti malaria treatment was 1,500 francs ($2.9). Apart from the health sector, he said people were facing a difficult food situation, problems of security and an acute lack of clothing. "Many people remain in the bush not because of insecurity but because they have lost everything, including especially their clothes," he said. Da Silva arrived in Bangui on 29 February to assess the country's humanitarian situation. He is due to fly to Geneva, Switzerland, on Wednesday to meet donors. Later, he will go to New York for a meeting with the UN under-secretary-general for humanitarian affairs.