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Submitted by Rob Yates on
Given the multiple factors that impact on population health it is difficult to attribute changes in health outcomes to any one particular policy. Also most of the examples of countries removing user fees have occured in only the last 7 years and DHS's are usually only conducted every 5 years. But in saying this there is a lot of evidence emerging of fee removal with increased public financing leading to large increases in health are utilisation which then results in large improvements in health indicators. The examples of Thailand, Brazil and Mexico have been well documented and take a look at this recently from Niger: The figures from Burundi (see the latest DHS) are even more impressive and follow the introduction of free health care for pregnant women and children in 2006. In fact I and many others are convinced that this phenomenon is one of the major contibutory factors to what the Ecomonist recently called The best story in development: Note how this acceleration in improvements in child mortality happened over the last 7 years when so many of these countries replaced private financing (fees) with public financing. Also the authors single out rapid increases in coverage of bednets as one of the major factors in improving health outcomes but this only happened in Africa when governments switched from selling nets through social marketing to giving them away in mass FREE distributions. Perhaps this is an area of where the World Bank could do some more research