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Women line up to vaccinate their children in Kitahurira village, Uganda.
Andrew Aitchison/Corbis via Getty Images
Andrew Aitchison/Corbis via Getty Images
Andrew Aitchison/Corbis via Getty Images
There’s new — and shocking — evidence about the toll that health care costs are taking on the world’s most vulnerable. A joint report pulished in the journal Lancet Global Health this week by the World Bank and the World Health Organization estimates that each year more than 100 million people are pushed into extreme poverty in order to pay for health services — meaning that after covering their health bills, their income amounts to less than $1.90 a day.
Another 800 million people are spending at least 10 percent of their household budget on health care. And 3.5 billion people — accounting for more than half of the world’s population — are simply forced to go without most essential services.
The kind of care they are missing out on is life-saving but also often extremely basic, says Tim Evans, senior director of health, nutrition and population at the World Bank Group.
“Nearly 20 million infants don’t receive the immunizations they need to protect them from diphtheria, tetanus and pertussis,” he says. “These are very common childhood infections that can be completely prevented through low-cost vaccination.”
Similarly, he adds, “more than a billion people live with uncontrolled high blood pressure — meaning they have no access to treatment.”
The problem is particularly acute in sub-Saharan Africa and parts of South Asia. And Evans says that to a large extent it’s due to the lack of health infrastructure, personnel and supply chains to serve remote regions where there’s high poverty.
But he says just as problematic is the lack of health spending by governments. Many contribute very little toward subsidizing care for low-income people. There’s also often no viable system of health insurance.
Left to pay for care out of their own pocket, “people either don’t go when they need to, or they go too late,” says Evans.
The consequences can be especially severe when there’s a health emergency — say, someone is in a car accident, or a pregnant woman needs a caesarean section. A hospital might agree to treat them. But a separate report by the London-based think tank Chatham House, also released this month, suggests that in cases where the patient can’t afford to pay, it’s surprisingly common for hospitals to detain them until their families can cough up the money.
“Some of the most vulnerable people you can imagine are being kept prisoner, basically,” says Robert Yates, the lead author of that report.
“They’re locked up in a sort of secure area with security guards. They are then often not given ongoing medical care that they need, and maybe not given sufficient food. … It’s really quite brutal.”
It’s also technically illegal. That makes it difficult to determine just how widespread the practice is. But after an exhaustive review of local reports and news accounts across a large number of countries, Yates estimates that hundreds of thousands of people are subjected to this kind of medical detention each year. And once again the problem is most prevalent in sub-Saharan Africa.
As depressing as this picture may appear, says the World Bank’s Evans, the situation is far from hopeless.
Over the last 15 years, he notes, governments of low-income countries and the international community invested heavily to ensure that the world’s poorest wouldn’t have to cover the cost of high-priority diseases such as HIV/AIDS and malaria. The result is that “we saw some really spectacular increases in access to, for example HIV treatments. … So there’s reason to suggest the trend is moving in the right direction.”
But paradoxically the increasing availability of care in areas where it was previously less common has also increased demand for it — even as people’s ability to pay has not.
This has put a growing number of people in an impossible position: “People need and want more care,” says Evans. “But the financing system hasn’t kept up. … So people will go to extreme lengths to afford it.”
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YAOUNDÉ, Cameroon – Recent strikes by public health workers in the Republic of Benin have Catholic bishops worried, as health workers, for nearly a month now, have been asking the government for better pay and improved working conditions as well as a reform of the health sector.
According to the representative of health sector trade unions, Adolphe Oussou, the government has systematically ignored their demands.
“In every country, if you allow social partners to go on strike, you have to call them back to the negotiation table so the two parties can reach an understanding,” he told Benin WebTV.
A near-absence of dialogue between the authorities and health sector workers has led to strike actions that have crippled the country’s health sector, putting the lives of thousands on the line.
The leader of the NGO, Benin Diaspora Assistance, Médard Koudébi says Benin’s health crisis is more visible in its mortuaries.
“No mortuary meets the norms in Benin,” he told La Nouvelle Tribune. He said the sector isn’t even regulated, and poverty drives many people to abandon their corpses in the mortuaries for fear of paying exorbitant mortuary and hospital bills.
“The lack of hygiene conditions in many mortuaries means that several people get contaminated. If mortuary conditions were respected, 25,000 lives would be saved every year, and 120,000 new infections would be avoided,” he told France 24.
Catholic bishops have expressed dismay at the depressing health situation in the country.
In a statement following a plenary general assembly that took place from October 22-25, 2017 in Porto-Novo, the bishops said they were “particularly touched by the strike by health sector workers that has been going on for some weeks with dramatic consequences for the sick.”
La Nouvelle Tribune quotes pregnant Chantal Assogbain at the Abomey-Calavi hospital as saying that she was turned back by midwives on account of the strike actions.
“I came here for prenatal consultation. Midwives told me to go back because they are on strike, but I don’t have the financial means to go consult in a private hospital,” she said.
“We are suffering,” she added.
The bishops say such complaints are frequent, with many people dying as a consequence of the lack of even the minimum care. They have called on the government of President Patrice Talon and social partners to resume dialogue “to speedily come out of the crisis.”
“On no account should patients be abandoned to their fate,” the bishops emphasized.
Reforming the system
In 2016, Talon set up a technical commission in charge of reforming Benin’s healthcare system. It’s called for institutional reform of the healthcare system as well as reforms both in the functioning and organization of Benin’s healthcare system.
According to the rapporteur of the commission, Justin Sossou, a deep analysis of the country’s healthcare system revealed that sector governance is almost non-existent; there’s a near-absence of regulations governing healthcare professionals; and anarchy prevails in private healthcare practice, with blistering poverty denying scores of citizens access to healthcare.
Added to these problems are the catastrophic management of human and financial resources, as well as the over concentration of resources at the central services to the detriment of peripheral health structures.
In the face of all this, the commission has proposed that all legal and regulatory instruments relating to the healthcare sector should be updated to meet present day challenges and that all national policies and strategies on primary healthcare and hospital medicine be updated.
Additionally, the commission called for improved governance, the training and deployment of qualified personnel, improved pay for health sector workers and the inclusion of socio-cultural dimensions in defining health sector strategies and policies.
The commission concludes that such reforms will also entail the restructuring of the Ministry of Health and the creation of a structure to regulate the health sector in Benin.
But health sector workers have been complaining that they were not part of the commission and therefore their views have not been factored into it. They have therefore been asking the government to hand over the draft proposals to them so they could have their input, before it is forwarded to Talon.
A deeper social problem
The health sector crisis in Benin is, however, just a small part of a deeper social crisis. Poverty and misery, according to the bishops, form part of the daily lives of a majority of the Beninese population.
“Many of Benin’s men and women live in permanent pain, and are incapable of taking care of the daily need of their families. Such a situation cannot favor social cohesion, the guarantee for all development,” the bishops wrote.
According to the World Bank, poverty remains widespread in Benin, with 40.1 percent of the country’s 10.9 million people living below the poverty line.