User-Fee System Excludes Burundi's Poorest from Basic Health Care

from Doctors Without Borders/Medecins Sans Frontieres (MSF)

In Burundi, a country struggling to emerge from a decade-long civil war, a user-fee, or cost-recovery, system has become the cornerstone of health-care financing. As a result, the country's most impoverished are paying a catastrophic price. A recent medical survey by MSF found mortality rates double the emergency threshold, and little or no health care for those who could not pay. In regions covered by the user-fee system, malaria deaths were twice as high as in areas adopting a low flat fee. One in five people interviewed said they didn't visit health centers even when they are sick because they couldn't afford it, not surprising in a country where nearly 99% of the people live on $1 a day and a staggering 85-90% survive on $1 a week. For many, even a simple consultation costs an average of 12 days' worth of income. To access lifesaving care, the sick risk further impoverishment by selling off all of their tools and livestock or by borrowing sums of money that can take years to repay. Hospitals have even held patients in confinement until the family finds money for treatment. Deficient state funding and international donor priorities only reinforce the system, even though there is no evidence that cost-recovery contributes to either the sustainability or efficiency of health-care delivery. In the end, it is the health of the war-affected country's poorest citizens that suffers most from the failed policy.

Read more about Burundi here –

Doctors Without Borders/Medecins Sans Frontieres (MSF) – – is an international independent medical humanitarian organization that delivers emergency aid to people affected by armed conflict, epidemics, natural and man-made disasters, and exclusion from health care in nearly 70 countries.


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