There is an old English phrase, derived from hunting, that someone has “shot your fox”. It means that, instead of the long and bloody struggle anticipated, someone has dispatched your problem efficiently and quickly. They have, so to speak, undercut your whole plan.
Yesterday, in his address to the World Health Assembly in Geneva, Jim Yong Kim, President of the World Bank Group, did something revolutionary. He shot our fox.
A long and bloody history
Save the Children, with many others, has been fighting a long battle against charging cash payments from people when they need healthcare. We argue that it deters the poorest from seeking help, or forces them deeper into poverty.
We have carried out important research that shows the impact of user fees for healthcare. We have lobbied with growing success.
The UK Government has been very vocal in the past, and always defends the principle of free-at-the-point-of-use health services. UNICEF took a long time to resolve its position but issued guidance encouraging its country representatives to help countries remove fees.
The last bastion
The outstanding problem has been the World Bank which, along with UNICEF, was the architect of persuading governments to introduce direct payments in the 1980s. Although the Bank has been loudly championing the principles of universal health coverage, there was great resistance to acknowledging that direct payments are wrong. Until yesterday.
As part of a speech which emphatically committed the World Bank to working to support countries to introduce universal health coverage, Jim Yong Kim made a statement that is revolutionary:
“Anyone who has provided health care to poor people knows that even tiny out-of-pocket charges can drastically reduce their use of needed services. This is both unjust and unnecessary.”
We couldn’t have put it better ourselves.
Plenty more to do
Of course, the issue will not go away completely, so we will have to be vigilant and look out for parts of the World Bank as well as donors and high-burden governments who are continuing to promote fees.
Still, if this issue is really resolved, we can now all concentrate on how to achieve universal health coverage. There is plenty to do. We need to persuade more governments to build fair systems where people pay in according to their wealth, but receive healthcare based on their need.