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Cahiers d'études et de recherches francophones / Santé

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Debate and challenges on the topic of free medical care in Africa: “Back to the Future”? Volume 19, issue 2, avril-mai-juin 2009

Authors
Département de médecine sociale et préventive Unité de santé internationale, centre de recherche du CHUM Université de Montréal 3875, rue Saint-Urbain, bureau 507 Montréal, Qc Canada, H2W 1V1 Canada, Institut de recherche en sciences de la santé (IRSS) du CNRST du Burkina Faso 11 BP 1904 Ouagadougou CMS 11 Burkina Faso, Département de santé publique London School of Hygiene and Tropical Medicine Londres Royaume-Uni

In its 2008 annual report, WHO affirmed the importance of resisting the temptation to depend on direct payment for primary health care. Members of the WHO committee on the social determinants of health as well as of those at the conference on primary health care in Ouagadougou in 2008 reaffirmed the need to make access to health care systems more equitable. Several decades after imposition of direct payment began, convincing data clearly demonstrate its harmful effects on the basic fairness of access to care. Accordingly, the current debate in the field of financial support for health involves the elimination of payments. More precisely, we can finally say that this is a debate about a return to the free care that existed before the widespread implementation of "cost recovery" systems. Here we want to review these discussions and prepare the ground for a debate on possible effective strategies for making health care systems more equitable from the perspective of universal coverage. We will thus note that analyses today must certainly focus more on how to eliminate direct payments than on the reasons to do so, already amply demonstrated. The international community must now undertake to support governments that want to move in this direction and ensure that the process is thoroughly documented so that it can also produce useful knowledge for the formulation of fair public policies.