As far as health freebies are concerned, the good times are over. As Cte d'Ivoire's (Ivory Coast) peace process moves forward and emergency health care providers start withdrawing, the government has restarted its medical care. This means that health fees are back too.

"[In conflict zones] communities benefited from free health care. Now the communities will have a difficult time paying", Jean Denoman, deputy director general at the Ministry of Health was reported.

For those who support universal free health care, a return to full health care costs will tax the poor. The World Bank and some donors have long argued the merits of user fees for basic health and education, while many aid groups argue that user fees deprive a major portion of the population of basic services and severely diminish standards of living.

In public hospitals in Man and Bouak, Mdecins Sans Frontires (Doctors Without Borders) began providing free health care services after rebels took over the cities in 2002 and government-paid doctors and nurses fled for their lives. But with efforts toward peace advancing, health workers have started returning to the region. MSF pulled out of Bouak public hospital in May and the Man public hospital in July.

"With the withdrawal of MSF, clearly the Ivorian government has the problem of financing the central hospitals of Bouak and Man," Denoman said. "Now the question is: Shall we let these hospitals function without the public's participation? Clearly that would ruin these facilities," he opines. So far the administrations at the two government hospitals continue to provide health services and medicines for free but this cannot last for long.

According to Kouie Jean Plo, head of the Bouak hospital, it is imperative that the government resume fees gradually. "We cannot bring free health services to an abrupt halt," he says. Denoman says that fees may start out at a 50-percent discount "then move pro
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