Next week on 18th and 19th April *African Health and Finance Ministers* will be meeting at the *World Bank* to discuss health financing options. The President of the World Bank, Jim Kim, will be addressing the Ministers.
The letter below is to be sent from *civil society organisations working on health in Africa* to Jim Kim. The letter asks *Jim Kim* to seek the leadership of African ministers on Universal Health Coverage and to follow financing policies that work. The letter asks Jim Kim to:
1. promote the removal of user fees and offer World Bank support to governments that do
2. promote the need to scale up public financing (and not private financing)
3. clarify the lack of evidence to support health insurance in low and middle income countries
It's really important that Jim Kim hears from civil society. If you would like your organisation to sign the letter please contact Monica Mutesa from Oxfam in Zambia at *mmutesa@oxfam.org.uk*
Please note, to try and increase the impact of the letter, attempts will b made to get it placed in the media - the most likely place will be a health journal like the Lancet.
*Deadline for signing the letter is close of day on Monday 15th April.
Please circulate as widely as possible. *
xxxxx
Dr. Jim Yong Kim, President
The World Bank
9 April 2013
Dear President Kim
On 18th April you will welcome African Ministers of Finance and Ministers of Health for a two day World Bank hosted meeting on financing health care. As civil society organisations working on health in Africa, we urge you to use this excellent opportunity to call for leadership from African Ministers to take concrete steps to accelerate progress towards universal health coverage (UHC). In your welcome address we ask you to highlight the critical importance of both scaling up public investment in health, and removing all financial barriers to accessing services, especially user fees.
There is now a growing consensus that out-of-pocket financing mechanisms, especially user fees, are an inequitable and inefficient way of financing health care. In many African countries user fees continue to deny millions of people, especially women, access to health services. *We urge you to promote the removal of user fees in your speech and offer full World Bank support to those governments that do so.*
Some policy makers are mistakenly equating UHC with health insurance. There is no evidence that health insurance – private, community or social – has been able to fill financing gaps for health in low-income countries. At the same time, insurance premiums act as another barrier to accessing health services for large numbers of African citizens. In contrast the low and middle-income countries that have achieved or approached UHC, including Sri Lanka, Thailand, Costa Rica and Mexico, have done so by scaling up tax-financed public spending on health.
The experience of these and other countries provides compelling evidence of the importance of scaling up public as opposed to private financing for health. Clear links are evident between public spending on health and reductions in inequality and economic growth. New evidence from sub-Saharan Africa also shows public health spending has double the impact of private spending on reducing infant mortality and increasing life expectancy at birth.*
We ask you to encourage African Ministers to prioritise proven routes to financing UHC through increased and improved public funding, mobilised from domestic revenues including via progressive reforms to tax structures. *
Many African countries are committed to the goal of universal and equitable health coverage. It is critical that the World Bank uses the welcome momentum on UHC to promote health financing solutions that will benefit all Africans.
* NOTE THIS REFERENCE IS FOR SIGNATORIES OF LETTER AND WILL NOT BE INCLUDED IN LETTER ITSELF. *The effects of public and private health care expenditure on health status in sub-Saharan Africa: new evidence from panel data analysis. *Novignon J<http://www.ncbi.nlm.nih.gov/pubmed?term=Novignon%20J[Author]&cauthor=true&cauthor_uid=23232089>, Olakojo SA<http://www.ncbi.nlm.nih.gov/pubmed?term=Olakojo%20SA[Author]&cauthor=true&cauthor_uid=23232089>, Nonvignon J<http://www.ncbi.nlm.nih.gov/pubmed?term=Nonvignon%20J[Author]&cauthor=true&cauthor_uid=23232089>\.\*Source *Department of Economics, University of Ibadan, Ibadan, Nigeria.
http://www.ncbi.nlm.nih.gov/pubmed/23232089
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Anna Marriott
mailto:AMarriott@oxfam.org.uk