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During the 2000s, free healthcare became a major focus of discourse surrounding health policies in Africa. To defend it, however, it is not sufficient to show that exemption from payment instead of dispensation increases the use of healthcare. It is also necessary to prove that those who benefit are first and foremost the poor and certain vulnerable groups. Moreover, it is not certain that the chosen qualitative observations make it possible to draw macroeconomic conclusions. Finally, free care imposed based on guidelines defined at the international level creates alarming inequalities and runs counter to all aims for local democracy.