Health care too costly for the public

Almost one-in-seven Burundians lack access to the most basic of health care because of the application of an expensive cost recovery health care system, Meinie Nicolai, the operational director of Medecins Sans Frontieres-Belgium (MSF), said on Thursday in Nairobi, Kenya. "Burundi is not yet a developing country," she said at a news conference in the Kenyan capital, "it is a post-conflict region." For these reason, she added, the cost recovery system was "not at all adapted" to the situation in the country. Cost recovery is a method intended to create sustainable health care in developing countries she said, presenting an MSF report on economic access to health care in Burundi. The report says that the system requires patients to pay 115 percent of the cost of health care treatment and, as a result, two-thirds of the population are required to sell personal possessions or engage in forced labour to pay for this. The report, titled "Acces aux soins de sante au Burundi - Resultats de trois enquetes epidemiologiques Mars 2004 - compares the mortality rates and economic accessibility of three health care systems operating in Burundi by surveying 2,700 families who live within a five-kilometre radius of health care facilities. According to MSF, mortality rates were 50 percent higher in regions outside the MSF subsidised areas. The results show the mortality rates of these regions as 1.6 per 10,000, well above the emergency threshold of one death per 10,000. Almost 70 percent of Burundi's 6.9 million people have had to cover the costs of their medical treatment. The report also reveals that, 99 percent of Burundians live below the threshold of absolute poverty of US $1 per day. MSF also states that 85 percent of the general population is forced to survive on less then $1 per week. "Given the level of extreme poverty in which Burundians live, asking the population to finance their own health care system is tantamount to totally denying them health care," Luc Nicolas, the MSF operational coordinator for Burundi, said. To respond to this situation the Burundian Ministry of Health has supported MSF and NGOs operating in the provinces of Karuzi, Bujumbura Rural, Cankuzo and Ruyigi under a "Flat Fee" policy. Under this system, patients are responsible for only a small fixed fee, regardless of the treatment required. As an alternative, CORDAID, an NGO operating in Burundi, has introduced, in the southern province of Makamba, a third system whereby patients are required to cover half the cost of medical treatment. MSF estimates that the cost of sustaining Burundi’s health care system as a fully subsidised programme would be approximately $10 million per year. "It is imperative to subsidise the health services to avoid the current exclusion. MSF is calling on all development and health actors involved to guarantee essential care for this impoverished and vulnerable population," Nicolas said.