Health systems standard 4: Health financing

People have access to free primary healthcare services for the duration of the disaster.
 

Key actions (to be read in conjunction with the guidance notes)

• Identify and mobilise financial resources for providing free health services at the point of delivery to the affected population for the duration of the disaster (see guidance note 1).
   
• Where user fees are charged through the government system, make arrangements for their abolition or temporary suspension for the duration of the disaster response (see guidance note 2).
   
• Provide financial and technical support to the health system to cover any financial gaps created by the abolition and/or suspension of user fees and to cope with the increased demand for health services (see guidance note 1).
   

Key indicator (to be read in conjunction with the guidance notes)

• Primary healthcare services are provided to the disaster-affected population free of charge at all government and non-governmental organisation facilities for the duration of the disaster response.
   

Guidance notes

1. Health financing: The cost of providing essential health services varies according to the context. Such a context includes the existing health system, the population affected by the disaster and the specific health needs determined by the disaster. According to the WHOCommission on Macroeconomics and Health, providing a minimum package of essential health services would require expenditure of at least US$ 40/person/year in low-income countries (2008 figures). Providing health services in disaster settings is likely to incur higher costs than in stable settings.
    
2. User fees refers to direct payments by beneficiaries at the point of service delivery. User fees impede access to healthcare and result in poor and vulnerable peoplenot always seeking appropriate healthcare when it is needed. A basic humanitarian principle is that services and goods provided by aid agencies should be free of charge to recipients.In contexts where this is not possible, providing members of the affected population with cash and/or vouchers can be considered to enable access to health services (see Food security – cash and voucher transfers standard 1). Removal of user fees must be accompanied by other measures to support the health system to compensate for the revenue forgone and increase use (e.g. paying incentives to health staff, providing additional supplies of medicine). The accessibility and quality of services must be monitored after the removal of user fees. 

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