Côte d'Ivoire

Free health care, for now

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ABIDJAN, 12 May 2011 (IRIN) - Many public hospitals in Côte d'Ivoire are overflowing as people rush to benefit from a brief period of free medical services, announced by the government as part of the recovery from months of post-election chaos. But the health ministry has been quick to point out that this is a temporary measure and fees will be reinstated at the end of May.

Not everyone will benefit from the free care, announced in April. In some areas medicines and services are scarce after sanctions drained drug supplies, many health workers fled their posts, and hospitals were looted during the conflict. [ http://www.irinnews.org/Report.aspx?ReportID=92268 ]

After the November presidential run-off election both incumbent Laurent Gbagbo and rival Alassane Ouattara claimed the presidency and the deadlock set off unprecedented violence throughout the country. The 11 April arrest of Gbagbo began a process toward economic recovery and calm, but observers agree the tough work lies ahead; damage to an already faulty health system has been considerable.

"The timeframe [for free care] is too short," Machiami Keïta, 27, told IRIN in the main city Abidjan. "Making health services free in public hospitals and clinics is very helpful after everything the people have been through. But I don't think this will provide enough time for all those who will need medical care to benefit."

Rémi Allah Kouadio, the interim health minister, recently said on state television that medicines and supplies were gradually being replenished, thanks in large part to partners that included the UN Children's Fund, World Health Organization and Médecins Sans Frontières. "We cannot charge the population for medicines we're receiving free."

Restoring health facilities will take time. "Healthcare is free in our hospital but we don't have a constant supply of medicines," said Georgette Atsé, a pharmacy worker at a hospital in Abidjan's Abobo District.

"Meanwhile, we are seeing several times more consultations than usual - in paediatrics, gynaecology [and other departments]." People at the hospital told IRIN they had been waiting for several hours. "We are barely past the crisis," Atsé said. "Some staff are still absent, and buildings and materials have been destroyed."

Martin Kobenan, a doctor in the Marcory area of Abidjan, said the number of consultations had risen from around 75 per day to as many as 300 per day. "But many of our health workers fled Abidjan during the crisis and we're still waiting for them to return."

Karim Fofana, 26, said he had received a free examination at the Abobo hospital but could not afford treatment and would probably see a traditional healer about his lung infection. "The doctor gave me a prescription but not all the drugs are available here. I'd have to go to a private pharmacy but I haven't got a cent."

There has long been debate in the developing world over whether user fees deprive the poorest people of medical care, with some NGOs urging governments to make services free. Côte d'Ivoire, once the economic powerhouse of West Africa, has maintained a policy of charging fees.

"Côte d'Ivoire's policy is cost recovery for health services. This period of free care is exceptional; it's due to the crisis," Siméon N'da, communications officer in the Ministry of Health and Public Hygiene, told IRIN.

The post-crisis measure highlights the challenges of providing medical care to poor populations, especially those affected by conflict. In the years following Côte d'Ivoire's first-ever coup d'état in 1999, the number of poor families has skyrocketed. [ http://www.irinnews.org/Report.aspx?ReportId=81804 ]

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