Nine misconceptions about free healthcare in sub-Saharan Africa

As universal healthcare gains political momentum, there is a growing international consensus against charging user fees at the point of healthcare delivery. In 1994, South Africa launched the wave of new user fees abolition policies in Africa. In 2010, both the African Union and the UN Secretary General called for free healthcare at the point of service for children under five and pregnant women. However, dismantling a user fees policy that has been in place for over 30 years is no easy task. Not only does expanding free healthcare policies routinely lead to controversy that generally arises when public policies are badly planned, underfunded, and poorly implemented, but certain groups of actors also perceive this move as a threat. However, in most cases, the continued reluctance to make healthcare free in Africa is based not on strong evidence, but rather on misconceptions around the very notion of free care. In this paper, we address nine such misconceptions about free healthcare and provide recent evidence from Africa showing the benefit of eliminating user fees for patients. Our aim is to demonstrate that when free care is properly financed and implemented, which in itself is a major challenge, certain perceptions about the principle of free healthcare turn out to be misconceptions.