Today, with the official hand over of its program of support for the Bangolo general hospital to the Ministry of Health in Ivory Coast, the organization Médecins Sans Frontières (MSF) concluded the gradual handover of its activities to the Ivorian authorities. MSF took the opportunity to call for continued free healthcare, without which patients cannot seek treatment.

MSF has been present in Ivory Coast since 1990, primarily working amongst refugees fleeing neighbouring Liberia’s civil war, but also intervening in prisons and responding to a series of emergencies affecting the country during the 1990s. 

MSF’s most consequential intervention in the country took place after the outbreak of conflict in 2002. MSF assisted people affected by the crisis and supported various medical facilities, in both the governmental and rebel zones, and in the buffer zone established during the conflict that divided the country in two.   

Following the peace accords signed in 2007, the dismantling of this zone, and the gradual return of personnel to medical facilities, MSF has been able to stage successive withdrawals from Bouaké, Guiglo, Man, Danané and today, Bangolo.

“MSF is a medical organization that intervenes during humanitarian crises,” explains Nathalie Cartier, head of mission for MSF in Ivory Coast. “As things stand, the situation in the country has improved, and national and local authorities can ensure the continuity of healthcare, which is encouraging. We do have concerns, however, about the disastrous impact that a reintroduction of cost recovery would have following MSF’s departure from Bangolo. The population, here as elsewhere in the region, cannot yet afford to pay for its care.”

In Bangolo, the 400 or more hospitalizations, 8,000 consultations and 130 infant deliveries per month are largely due to free healthcare for the patients.

Making patients pay risks generating the same disastrous outcome as seen in Man following MSF’s departure. One year after the re-introduction of cost recovery, hospitalizations had dropped by 60 per cent and there were four times fewer surgical interventions. The treatment of a severe case of malaria, for example, represents the equivalent of three months of an average person’s income — quite simply out of reach for many people, who resign themselves to going without.

“At present, the health facilities in the north and west of the country have still not received a state budget for covering their overheads,” says Cartier. “Their only source of revenue is the money paid by patients. If we want to avoid the hospitals emptying again, it is critical that the health authorities and international donors provide the funds required to run health facilities and provide free care for the population.”

During the years of conflict, MSF offered healthcare to the wounded and to victims of violence and rape, as well as to people indirectly affected by the conflict whose healthcare diminished considerably. The organization set up primary healthcare and hospital programs, with a particular focus on surgery (including reparatory surgery for women with fistulas), nutrition, maternal health, mental health, AIDS and emergency response. At the peak of the crisis, the MSF team consisted of more than 900 Ivorian and international staff.

This departure marks the end of MSF’s programs in Ivory Coast, but the organization will continue to keep a close eye on the situation in the country, in order to intervene if necessary. There is currently a short-term intervention taking place in the northwest of the country (Odienné) to respond to a limited nutritional crisis.

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