Free healthcare works if quality service provided

NGOs have welcomed the Zambian government's decision to provide free healthcare to people living in rural areas, but at the same time asked the authorities to ensure that they had the capacity to deal with the resulting increase in patient numbers. Access to free primary healthcare, which used to cost more than a US dollar, is significant in a country where 65 percent of the population live on less than a dollar a day. The decision, announced at the weekend, was made possible by using money saved from the country's debt cancellation by the G8 countries. According to finance minister Ngandu Magande, Zambia's coffers are US $150 million richer. "While the move will be beneficial for the thousands of poor people in rural Zambia who cannot afford healthcare, the government must supplement the services to ensure there are adequate medicines and healthcare workers in these clinics," said Jack Jones Zulu, a coordinator with the Jesuit Centre for Theological Reflection, a local think-tank. The UK-based development agency, Oxfam, which has studied the impact of cancelling user fees on primary healthcare services across the world, said it found that the number of users in Uganda had shot up by between 50 percent and 100 percent, and between 20 percent and 60 percent in South Africa. "Cancelling user fees alone is not the solution to make healthcare accessible to all - governments have to take into consideration that they have to have the infrastructure and resources to cope with the increased demand. Investment is critical in more drugs and better wages for health workers," said Bethan Emmett, a policy advisor with Oxfam-GB. The state-owned newspaper, the Zambia Daily Mail, reported last week that more than half the positions of doctors and nurses in state-run hospitals had not been filled. According to NGOs, the country loses a substantial portion of its work force to better-paid job opportunities in Europe or to HIV/AIDS every year. There is currently only one doctor per 14,000 people in Zambia, compared to one doctor per 600 people in the UK, and the number of nurses needs to be doubled, according to Oxfam. A 2004 study by the USAID-funded Health Systems Services Programme found that a Zambian doctor employed by the government earned $425 per month, compared to $10,554 in the United States and $2,836 in neighbouring South Africa, reported the Zambia Daily Mail. A Zambian nurse earned about $106, against $3,056 dollars in the US and $1,486 in South Africa. User fees were introduced in Zambia as part of a financial reform package by the International Monetary Fund and World Bank in the early 1990s. "We did have free healthcare only a decade ago - we don't ... [expect] a dramatic increase in the number of patients," said ministry of health spokesman Victor Mukonka. He pointed out that the government had already phased in free primary healthcare for certain segments of the society, such as the elderly and pregnant women. The brain drain, he acknowledged, was "a serious problem", and said the government would launch an intensive exercise this week to lobby for funds from donors, including the World Bank and the IMF, to develop and maintain human resources in the health sector.