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Blogs, Macroeconomic policies

The ghosts of user fees past: Accountability for victims of a 30-year economic policy mistake

On May 21st, World Bank Group President Jim Yong Kim’s speech at the World Health Assembly in Geneva was notable for his sharp condemnation of health user fees as “both unjust and unnecessary” and for noting that “Anyone who has provided health care to poor people knows that even tiny out-of-pocket charges can drastically reduce their use of needed services.”

In a report released in the wake of the global financial crisis, the World Health Organization stated that, “financial catastrophe (for households) is associated with direct payments for health services” and that “even when relatively low, any kind of charge imposed directly on households may discourage using health care services or push people close to poverty under the poverty line.”

In contrast to the untested economic theories of the World Bank’s health economists in the 1980s, it turns out the critics had been correct all along: user fees do not raise substantial revenue for the health sector, nor do they make public health interventions more effective. Rather, they turned out to be inequitable and sharply limited access to health care for the poor.

So Mr. Kim is right to decide a change of course. But, if user fees are unjust and unnecessary today, then arguably they were also unjust and unnecessary in the past.

A new article published in the journal Health and Human Rights suggests the World Bank’s previous conditioning of loans on the implementation of untested user fees could constitute gross negligence and a violation of human rights (the right to health) under international law, and that the Bank may be legally liable for damages and obligated to provide compensation to survivors.

While the new consensus emerging today in favour of publically financed universal health coverage (UHC) and against user fees is to be welcomed, the many victims of “unjust and unnecessary” health user fees across many developing countries over the last 30 years deserve to have their voices heard and receive adequate and just compensation, while those responsible for the harmful policies are held accountable under international human rights law.

The article proposes that a representative group of previous victims of World Bank health user fees be established and, with the support of NGOs and international lawyers, the World Bank’s currently unclear liability under international law be tested and clarified with a class action lawsuit against the Bank.

Rick Rowden is a candidate in Economic Studies and Planning at Jawaharlal Nehru University (JNU) in New Delhi.  

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