Zambia uses G8 debt cancellation to make health care free for the poor

The government of Zambia today (1 April) introduced free health care for people living in rural areas, scrapping fees which for years had made health care inaccessible for millions.

The move was made possible using money from the debt cancellation and aid increases agreed at the G8 in Gleneagles last July, when Zambia received $4 billion of debt relief; money it is now investing in health and education.

65 per cent of Zambia's citizens live on less than a dollar a day. Until today the average trip to a clinic would have cost more than double that amount, the equivalent of a UK worker having to £120 (US$200) just to visit a clinic.

"This is one of the first concrete examples of how the G8 deal last year has made a real difference to peoples' lives," said Barbara Stocking, Director of Oxfam. "People often bemoan the lack of good news coming out of Africa – well here's an example of real progress. It shows what can happen when people both in the rich world and the developing world push their leaders to deliver. Those who backed the Make Poverty History campaign last year should be proud of this achievement."

User fees were introduced in Zambia under IMF and World Bank pressure in the early 1990s. Young girls in rural areas were the main victims of the policy as their families were rarely willing or able to pay for their treatment.

Now that user fees for health have been scrapped, experience from other countries shows that there will be a surge of patients accessing health clinics across the country, many of these people would not have been able to afford care previously. In Uganda most clinics saw a doubling in their patient numbers.

According to Oxfam, Zambia's next challenge will be their chronic shortage of health workers. There is currently only one doctor per 14,000 people in Zambia (compared to one doctor per 600 people in the UK) and the numbers of nurses in the country needs to be doubled. Health workers are currently paid a pittance in the public sector and have to work in appalling conditions.

"We commend the government for removing user fees in rural areas and urge them to do the same in urban areas. This is the first step towards addressing the health crisis in Zambia. More money is now urgently needed for medicines and to improve the working conditions of doctors and nurses," said Henry Malumo, National Coordinator for the Global Call to Action against Poverty in Zambia.

To ensure that the scrapping of fees results in high quality health care Oxfam is calling on donors to provide Zambia with support for the training and recruitment of health care workers, such as that Britain's Department for International Development is providing in Malawi.

The IMF also needs to ensure that its loan conditions do not restrict the employment of extra health care workers.

"Today's announcement will make a real difference to millions of poor people. On the ground it will mean thousands of people get treatment for the first time in their lives. Zambia will need continued support to recruit new staff but this is a massive leap in the right direction. We now need other African countries to follow suit," said Barbara Stocking, director of Oxfam.

In a recent survey of 30 African countries only 3 did not have user fees for heath care.