LONDON (AlertNet) - It costs so little to scrap healthcare fees in poor countries that donors and governments have no excuse for letting millions die every year due to charges they can't pay, a joint report by major charities said on Monday.

"User fees for healthcare are a life or death issue for millions of people in poor countries. Too poor to pay, women and children are paying with their lives," said the report.

If fees had been abolished in 2000 when U.N. Millennium Development Goals to fight poverty and improve health were introduced, more than 2.5 million children's lives would be saved by now, it said.

The report -- whose backers include Save the Children, Medecins sans Frontieres and Oxfam -- called on donors to expand free healthcare in poor countries.

Many people who receive care but cannot pay are kept in hospitals until their families can settle the bill, it said.

Paying the bills forces more than 100 million every year into poverty.

The report - "Your Money or Your Life" - was released ahead of a U.N. General Assembly meeting next week to discuss funds to let several developing nations scrap healthcare fees for women and children.

The countries under discussion are Burundi, Ghana, Liberia, Malawi, Mozambique, Nepal and Sierra Leone.

Abolishing healthcare fees for all and financing essential healthcare for mothers and young children would cost less than 1 billion pounds ($1.66 billion) a year -- or 1.38 pounds ($2.28) per person in sub-Saharan Africa.

"For such a small amount there can surely be no justification for governments and aid donors leaving fees in place, blocking access to health care and impoverishing millions of people," the report said.

LIBERIA

In Liberia, one in nine children die before their fifth birthday and only 46 percent of births are attended by a midwife.

Aid group Merlin said many women and children died there because there were too few doctors and nurses in rural areas who could deal with complicated deliveries and minor illnesses.

Some aid experts worry that if free healthcare becomes more widespread, poor countries such as Liberia -- where almost two-thirds of the population survive on less than $1 a day -- will have too few health workers to cope.

As it stands, the West Africa country has 122 doctors and 297 midwives for a population of 3.5 million.

"They need a lot of funding to ensure that they can train more doctors, more nurses, more midwives and more community workers," Merlin country director Lawrence Oduma told AlertNet.

"We also need to have the drugs, we need to have supplies, the equipment and also the infrastructure because a lot of it was destroyed during the war."

The report said fees were introduced in many poor countries in the 1980s and 1990s, often as a condition of lending from the World Bank and International Monetary Fund. But the fees have rarely contributed to more than 5 percent of the running costs for health services.

Here are some key facts from the report:

* In Rwanda, when health fees were introduced in 1996, take-up of medical services halved.

* Charging pregnant women $0.75 for an insecticide-treated bednet in Kenya reduced demand by 75 percent.

* Sierra Leonean women are among the most likely in the world to die in childbirth. One in eight risks death from pregnancy-related causes during their lifetime -- 1,000 times more likely than for women in industrialised countries.

* Burundi introduced fees in 2002. Two years later, a survey found that four out of five patients had gone into debt or had sold some food grown for their family to pay the bills. When patients did not pay, clinics imprisoned them or seized their identity papers. It scrapped charges for under-fives and deliveries in 2006.

*In the run-up to Ugandan elections in 2001, President Yoweri Museveni dropped all health user fees in public facilities. Service use soared with an 84 percent increase in attendance at clinics countrywide.

* Only half of Mozambicans have access to basic health services. There is only one doctor per 50,000 people.

* In Nepal, one newborn baby dies every 20 minutes, and a woman dies of childbirth-related causes every four hours.

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