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Policies to introduce user fees for health care in developing
countries has done the full circle. There is increasing evidence of its
negetive effects on access to care and equity. To state in stark terms,
the introduction of user fees in developing countries would have cost
several hundred thousand or millions of the poor to lose their lives,
especially in Africa.
Two questions need to be answered if we are to avoid such calamities
in the future.
Firstly, who should be held accountable for such 'blunders' in health
policy? Is it the donor agencies (or richer countries) that insist on such
market-oriented poicies or the weak policymakers in developing countries
who say 'yes' to any foreign advice? How do we make these players more
accountable to their 'solutions'?
Secondly, why is it that donor agencies and policy advisers continue
to ignore success stories from poor countries such as Sri Lanka? Together
with Cuba, Cost Rica and Kerala in India, our achievements have been
exemplary. Much has been written about their models, but rarely are there
attempts to replicate them in developing countries (1). Are they out of
date or are they too alien to even consider?
1 Bhutta Z, Nundy S, Abbasi K. Is ther hope for South Asia? Yes, if we can
relicate the models of Kerala and Sri Lanka. BMJ 2004; 328: 777-9
No competing interests
05 October 2005
Faculty of Medicine, University of Colombo, Sri Lanka