Journal Article
|CommentaryHealth problems in areas of human vulnerability: field experience of Medecins Sans Frontieres (MSF) in the Sahel region
Abstract
During the nutritional crisis of 2005, malnutrition rates reached very high levels in certain regions of Niger and neighbouring countries. In Niger, 40,000 severely malnourished (Weight/Height (W/H) below 70 %) children were treated in MSF’s therapeutic feeding centres. In spite of the severe crisis, general free food distribution did not happen. As alternative, subsidized food was brought on the local market, but this remained out of reach of most of the already completely destitute families. This year, a similar crisis announces itself, with many months of continuing high levels of malnutrition. The question begs whether one can still speak about a temporary crisis situation or rather can label this an endemic state of malnutrition and associated child mortality.
In most Sahel countries, basic health care services are paid for by patients, also in public structures. Patient fees need to be paid before care can be obtained. MSF conducted epidemiological surveys in several of these low-income countries, to assess the impact of these patient fees in terms of exclusion of patients in need of care and in terms of further impoverishment of households. The results of the survey in Mali illustrate the degree of the problem. Thirty percent of people did not seek any care during their last episode of illness, mainly because of lack of money to pay for care. Moreover, using the public health centre signified for an important proportion of patients the need to borrow money or sell goods to mobilize the cash. This led to delays in health care and carries risks of further impoverishment of the family. The median price paid for care was the equivalent of 6 $US, epresenting twenty days of an average income. Less than 2% of the patients were exempted from payment, in spite of the national policy on protection of those unable to pay. Patient fees in a context of generalized poverty jeopardize access to essential health care and are counterproductive within the framework of the international commitment of poverty reduction and the Millennium Development Goals.
In most Sahel countries, basic health care services are paid for by patients, also in public structures. Patient fees need to be paid before care can be obtained. MSF conducted epidemiological surveys in several of these low-income countries, to assess the impact of these patient fees in terms of exclusion of patients in need of care and in terms of further impoverishment of households. The results of the survey in Mali illustrate the degree of the problem. Thirty percent of people did not seek any care during their last episode of illness, mainly because of lack of money to pay for care. Moreover, using the public health centre signified for an important proportion of patients the need to borrow money or sell goods to mobilize the cash. This led to delays in health care and carries risks of further impoverishment of the family. The median price paid for care was the equivalent of 6 $US, epresenting twenty days of an average income. Less than 2% of the patients were exempted from payment, in spite of the national policy on protection of those unable to pay. Patient fees in a context of generalized poverty jeopardize access to essential health care and are counterproductive within the framework of the international commitment of poverty reduction and the Millennium Development Goals.
Subject Area
Languages
English
