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Submitted by sofia on
he blog also presents various ideological and ill-supported claims as facts, tying the use of public health financing to doctor incompetence and lack of effort, and to health worker absenteeism. It also makes the argument that people use medicines (and other health services) frivolously when these are offered free of charge. There is little evidence to show that user fees prevent frivolous demand. Rather, user fees have been an ineffective, inefficient and inequitable financing mechanism that, in the words of WHO's Margaret Chan, have "punished the poor." This blog takes us back 25 years, to the days when the Bank was pushing user fees in developing countries, with disastrous consequences for the world's poorest people. The World Bank has moved on from those days. Its current Health, Nutrition and Population strategy says the Bank will support interested countries to remove user fees (although it puts up too many obstacles to providing that support, such as already having financing and planning in place), and the Bank has done fantastic work in some countries, such as in Sierra Leone where it recently supported a promising program to remove fees for maternal and child health, which is seeing early success. Furthermore, President Kim made a speech at the UN last month in which he acknowledged that high out-of-pocket healthcare expenditures are among the leading causes of poverty. So what is the Bank's real policy on this issue?