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Good Times Over For Ivory Coasts Ill

gressively toward full costs".

Meanwhile, the head of MSF-Belgium in Cote d'Ivoire, Christophe Vavasseur, has expressed concern over the government plans to return to a full cost recovery system by 2008. "This will exclude a large percentage of the population." Health care fees "lead to exclusion", he says. "This has been well documented and our experience in Man confirms it."

In Man, treatment for severe malaria can cost more than two months' average income, according an unpublished MSF report. A Caesarean section costs eight months' income.

According to Vavasseur, health fees also diminish the public's use of health services. MSF found that in 2006, the number of consultations in four facilities in the west, where it provided free services, were 20 percent higher than the number of consultations in all the 79 centers in the region before the war when people used to pay.

"We [at MSF] try as much as possible to provide the data to point out that the real need is revealed by free health care," Vavasseur said. MSF says governments need to keep health costs to a minimum in part by increasing the percentage of their budgets for health services.

Vavasseur argues that when hospitals become dependent on patients' fees they fail to seek other financing mechanisms. "In many countries people stick to this way of thinking that people must pay. They think that people must participate in their health care, and that this way [the health system] will become sustainable. But this is not the case. It can even be counterproductive", he warns.


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