Too poor to pay: Over sixty organizations call on world leaders to make free healthcare a reality for millions

Published: 14th September 2009

Failure to provide free public healthcare in poor countries means that millions of people are paying with their lives, according to a research report published today by a group of 62 NGOs and health unions. The report, "Your Money or Your Life," says that half a million pregnant women die each year because they do not have access to healthcare and people are facing abuses such as being imprisoned in clinics, because they cannot pay doctors fees.
Millions of poor people should be offered a lifeline next week, when governments have the chance to expand free healthcare in developing countries. World leaders will meet at the United Nations General Assembly for a high-level event on health on the 23rd September where they are expected to extend free health services for at least seven countries: Burundi, Ghana, Liberia, Malawi, Mozambique, Nepal and Sierra Leone.
But leading NGOs including Action Aid, Merlin, Médecins Sans Frontières, Oxfam, Save the Children, World Vision, and White Ribbon Alliance are worried that announcements alone are not enough. This initiative must be the start of a solid commitment to financial and technical support and be extended universally to all poor countries.
Oxfam GB Chief Executive Barbara Stocking said: “How many lives will be needlessly lost before leaders act? Poor people simply cannot afford fees and inaction will continue to deny access to life-saving healthcare for millions.”
Jasmine Whitbread, Save the Children's Chief Executive, said: “If free health care had been introduced in 2000 when world leaders promised to reduce child mortality by two-thirds, the lives of more than two million children could have been saved by now. Leaders have the power and the responsibility to make healthcare free for poor families. Allowing any more children to die because they can't afford treatment is inexcusable.”
For people living in these seven countries the initiative could make the difference between life and death:

  • In Burundi 88 per cent of people live on just $2 a day. People have to pay for healthcare and are reportedly imprisoned by clinics if they don’t have the money.
  • In Ghana the average life expectancy is just 58 years. Seventy per cent of people in the three northern regions live on less than $1 a day.
  • In Liberia one in nine children will not live to see their fifth birthday and less than 20 per cent of the rural population have access to health facilities.
  • In Malawi one woman in every hundred will die in pregnancy and childbirth. The entire population of nearly 14 million (is looked after by just) have only 266 registered doctors.
  • In Mozambique 1.3 million people are living with HIV and AIDS and 60 per cent of HIV-infected adults are women.
  • In Nepal a newborn baby dies every 20 minutes and 49 per cent of children have symptoms of chronic malnutrition.
  • In Sierra Leone life expectancy is only 34.3 years, it has the highest maternal and infant mortality rates in the world and only 7 per cent of the rural population has access to safe sanitation facilities.

Progress on health is desperately off track and the 2015 Millennium Development Goals deadline is fast approaching. Every year 4 million newborn babies die within 28 days of birth* and the number of women dying in pregnancy and childbirth has barely changed since 1990*, despite the MDG commitment to reduce the number of deaths by three quarters.
Governments need new funding to scale up and expand services, recruit and retain more doctors and health workers and provide more facilities that are easy to reach and accessible to everyone.
Adrienne Germain, President of the International Women’s Health Coalition said, “I’ve seen myself the impact of imposing—and lifting—user fees on women, children and families. We urgently need the carefully designed action called for in “Your Money or Your Life.
TUC General Secretary Brendan Barber said, "People everywhere should have the right to free health care and access to qualified health workers. Quality public health services are also vital to economic growth and prosperity."

How many lives will be needlessly lost before leaders act?...Inaction will continue to deny access to life-saving healthcare for millions.
Barbara Stocking
Chief Executive, Oxfam GB

Notes to editors

The report has been backed by:

Action Aid, AIDES France, Avocats pour la Santé dans le Monde France, Cara International Consulting, Citizens United to Promote Peace and Democracy in Liberia, Commonwealth Nurses Federation, Diverse Women for Diversity, Essential Services Platform of Ghana, European Public Health Alliance, GCAP Liberia, Global Health Advocates India, Global Health Advocates Switzerland, Initiative for Health Equity & Society, Integrated Social Development Center (Ghana), International Women’s Health Coalition, International Peoples Health Council (South Asia), Liberia Democratic Institute, Malawi Health Equity Network, Medecins du Monde (UK, France, Portugal & Spain), Médecins Sans Frontières, People's Health Movement, Physicians for Human Rights, Public Services International, Merlin, National Organization of Nurses and Midwives of Malawi, National Association of People Living with HIV and AIDS (Malawi), Oxfam, Plan, Resource Center for primary healthcare (Nepal), Save the Children, Treatment Action Group, TUC, UNISON, UK Student Stop AIDS Campaign, VSO, WEMOS (Netherlands), White Ribbon Alliance, World Vision International, Women and Children First.

* Unicef's State of The World's Children report, 2009.

* According to the World Health Statistics 2009, the global maternal mortality ratio of 400 maternal deaths per 100,000 live births in 2005 has barely changed since 1990. Most maternal deaths occur in the African Region, where the maternal mortality ratio is 900 per 100,000 live births, with no measurable improvement between 1990 and 2005.