In a bold move to increase access to health services and promote equity and the fundamental rights of citizens, the government of Nepal has introduced free basic health care for all, as of 15 January 2008. The decision has been described as momentous by civil society organisations working with the poorest communities in the country, but they add that there is a huge amount of work to be done to make the policy a reality.

In Nepal, 43 per cent of the poorest people have no access to health services of any kind. User fees for health are a huge barrier for the majority, and the government estimates that over half a million people become poor each year as a result of sickness. Oxfam warmly welcomes the government's decision in the light of evidence from other low-income countries, including Uganda, Burundi, Zambia, and Niger, showing how abolishing user fees can have an immediate impact on the take-up of services and literally save lives. In Uganda, removing fees led to an 84 per cent increase in attendance at health clinics.

Nepal, however, is also one of the poorest countries in the world, and with a per capita income of only $270 it simply cannot afford to provide health care free of charge for everyone. While the government must be held to account for its commitment to increase spending and ensure that resources are delivered to even the remotest health posts, rich-country donors must also assist and provide the additional resources required.

The UK government has already provided £30 million in support, direct to the Ministry of Health's budget - exactly the right kind of aid to help the government implement their own progressive policies. But much more is needed. Nepal was one of eight developing countries to sign up to the International Health Partnership, launched last year by international health agencies and a number of bilateral donors, including the UK, France, and Germany. The partnership commits donors to work with governments to support their national health plans and provide the long-term predictable aid required to meet gaps in financing to strengthen health systems . Oxfam considers this country-driven decision to remove health fees the first major test to the signatories of the International Health Partnership to live up to their promises and provide the funding needed to ensure universal health care becomes a reality in Nepal.