India. Photo by Peton Jacques, TDH CH-Geneva

Based on field experience conducted by TDH, achieving universal health coverage in low and middle income countries is possible. This requires bold steps by the international community and budgetary increases in national health budgets.

The focus must be on the mother, the child and reproductive health. In addition, a set of basic measures must be conducted. They include:

  • The removal of financial barriers to accessing services, especially user fees.
  • Sustained public funding for public health systems. Funding should come predominantly from general public revenues, international aid, and innovative financing mechanisms.
  • Investing in quality of care. This means investing in each element of the health system: health workers, primary and secondary care facilities, information systems, and drug supply chains, especially for affordable generic medicines. This also means ensuring accountability for measurable improvement in health outcomes, including through civil society participation in policy development and oversight of service delivery.


6.9 million children around the world die each year before the age of 5. In 2011, 19.000 children under-five died every day. The risk of a child dying before its fifth birthday in low-income countries is 18 times higher than in high-income countries.

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In Burkina Faso, 500.000 out of three million children do not live beyond five years old. The majority of these deaths could be avoided with a more accessible health system; exemption of payment for health is one successful solution. In the health district of Tougan and Seguenega (Burkina Faso), Terre des Hommes has built alliances to advocate for the exemption of payment for health care for all children under five and for expectant mothers. Fee exemption is the key to facilitate access to basic health for poor populations.

This has proved to be one of the most efficient solutions to allow extremely poor populations to benefit from health services. The results in Burkina Faso are that consultation rates for children under five have risen six-fold while the costs of consultations and treatment of childhood diseases have decreased by 36%.

Terre des Hommes work to contribute to universal access to health in Burkina Faso is well documented. This represents a relevant experience shown in different debates in national, regional and global debates on health policy. Starting from this successful experience in Burkina Faso, Terre des Hommes advocates for a fee exemption system to ensure free and universal access to health. We advocate it to States, in the UN Human Rights Council, to the EU, to donors and to the World Bank.