User fees abolition policy in Niger: Comparing the under five years exemption implementation in two districts

Ridde, Valéry; Diarra, Aïssa; Moha, Mahaman

doi:10.1016/j.healthpol.2010.09.017

Cited by 21 publications

(17 citation statements)

References 22 publications

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“…The free care policy for childbirth increased the number of child deliveries in the health facilities of Kaya district. This is confirmed by other findings from several countries that eliminated user fees for health services [3,11,15,16].…”

Section: Discussionsupporting

confidence: 88%

“…Living less than 5 km away from a primary health center was an enabling factor for the use of prenatal care services. In 2009, in Nouna health district, 57.9% of pregnant women who did not use a health center for their prenatal visits resided more than 5 km away from the health center, and 72% had given birth in a health center [11,15]. A study carried out in Tanzania highlighted that some women travel longer distances to deliver in health centers that are considered to offer better quality care [26].…”

Section: Discussionmentioning

confidence: 99%

“…Other stakeholders have noted that the lack of a transport plan during prenatal visits is a factor influencing home births [21,29]. De Allegri and others have offered an alternative to this approach, which is to implement a free or low‐cost transportation system for women who live far from health centers [11,15]. One possible solution in remote but accessible areas could be a motorcycle that serves as an ambulance and is supported by the health district.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Home births in the context of free health care: The case of Kaya health district in Burkina Faso

Kouanda

Bado

Meda

et al. 2016

Intl J Gynecology & Obste

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Home births in the context of free health care: The case of Kaya health district in Burkina Faso

Kouanda

Bado

Meda

et al. 2016

Intl J Gynecology & Obste

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“…This may be a missed opportunity, as many of the themes of the interviews reflect problems identified before. This has also been raised in other countries in the region – for example, in Niger or Mali, NGO pilot projects were not taken into account in developing national policies [18], while in Senegal, experiences in the first phase regions were not evaluated before scaling up [9]. …”

Section: Discussionmentioning

confidence: 99%

An exploratory study of the policy process and early implementation of the free NHIS coverage for pregnant women in Ghana

Witter

Garshong

Ridde

2013

International Journal for Equity in Health

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118

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BackgroundPregnant women were offered free access to health care through National Health Insurance (NHIS) membership in Ghana in 2008, in the latest phase of policy reforms to ensure universal access to maternal health care. During the same year, free membership was made available to all children (under-18). This article presents an exploratory qualitative analysis of how the policy of free maternal membership was developed and how it is being implemented.MethodsThe study was based on a review of existing literature – grey and published – and on a key informant interviews (n = 13) carried out in March-June 2012. The key informants included representatives of the key stakeholders in the health system and public administration, largely at national level but also including two districts.ResultsThe introduction of the new policy for pregnant women was seen as primarily a political initiative, with limited stakeholder consultation. No costing was done prior to introduction, and no additional funds provided to the NHIS to support the policy after the first year. Guidelines had been issued but beyond collecting numbers of women registered, no additional monitoring and evaluation have yet been put in place to monitor its implementation. Awareness of the under-18 s policy amongst informants was so low that this component had to be removed from the final study. Initial barriers to access, such as pregnancy tests, were cited, but many appear to have been resolved now. Providers are concerned about the workload related to services and claims management but have benefited from increased financial resources. Users still face informal charges, and are reported to have responded differentially, with rises in antenatal care and in urban areas highlighted. Policy sustainability is linked to the survival of the NHIS as a whole.ConclusionsGhana has to be congratulated for its persistence in trying to address financial barriers. However, many themes from previous evaluations of exemptions policies in Ghana have recurred in this study – particularly, the difficulties of getting timely reimbursement to facilities, of controlling charging of patients, and of reaching the poorest. This suggests that providing free care through a national health insurance system has not solved systemic weaknesses. The wider concerns about raising the quality of care, and ensuring that all supply-side and demand-side elements are in place to make the policy effective will also take a longer term and bigger commitment.

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“…Les avantages électoraux du Plan ont probablement encouragé le président du Niger à vouloir instituer une politique similaire. Cependant, au-delà de l'affichage politique, ces programmes souffrent de leur manque de financement, comme c'est le cas au Niger [20].…”

Section: Discussionunclassified

« Les bonnes intentions ne suffisent pas » : analyse d'une politique de santé pour les personnes âgées au Sénégal

Mbaye¹,

Ridde²,

Kâ³

2013

Santé Publique

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In 2006, the Senegalese government introduced the "Plan Sésame", an unprecedented policy in West Africa aimed at reducing social vulnerability among the elderly (i.e. people aged over 60 years). This paper examines the process of implementation of the "Plan Sdsame': Using a qualitative approach, the study was based on a unique case study authorized by the Senegalese Ministry of Health. Three methods were used: i) individual interviews (n = 19), ii) discussion groups (n = 24), and iii) documentary study. Despite its social objective, the "Plan Sésame" was ultimately limited to free health care. However, even the health component of the plan has suffered from under funding. Political obstacles, inadequate accompanying measures and short staffing have resulted in late reimbursements at a local level, thus limiting the implementation of the plan. While both health professionals and elderly people are in favor of free healthcare, they are also critical of the implementation issues surrounding the "Plan Sésame": Although it appears to be a viable solution, these issues may spell the end of the plan. The task of designing solid technical foundations and developing appropriate accompanying measures should not be overlooked because of the limited interest of international partners in the "Plan Sésame" the national dimension of the plan and its electoral importance.

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User fees abolition policy in Niger: Comparing the under five years exemption implementation in two districts

Cited by 21 publications

References 22 publications

Home births in the context of free health care: The case of Kaya health district in Burkina Faso

Home births in the context of free health care: The case of Kaya health district in Burkina Faso

An exploratory study of the policy process and early implementation of the free NHIS coverage for pregnant women in Ghana

« Les bonnes intentions ne suffisent pas » : analyse d'une politique de santé pour les personnes âgées au Sénégal

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