From institutionalization of user fees to their abolition in West Africa: a story of pilot projects and public policies

Ridde, Valéry

doi:10.1186/1472-6963-15-s3-s6

Cited by 47 publications

(56 citation statements)

References 69 publications

(79 reference statements)

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“…Many actors undoubtedly welcomed PBF, but it did not seem that a strong advocacy group was formed to sustain it, as was the case in Rwanda or Burundi, which were able to roll out the strategy nationwide. 36 To conclude, we want to stress that unlike user fee exemption policies, 37 successful pilots are of great importance for the national policy agenda of PBF strategies (like in Rwanda or Burundi), because they provide useful lessons about design and implementation. 36,38 This is probably due to the fact that PBF is a more technocratic reform with less visibility at the general population level and user fee exemptions are seen as more politically rewardable.…”

Section: Analysis Of Our Hypothesesmentioning

confidence: 99%

Why Performance-Based Financing in Chad Failed to Emerge on the National Policy Agenda

Kiendrébéogo

Shroff

Berthé

et al. 2017

Health Systems & Reform

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Supported by the World Bank (WB), Chad implemented a performance-based financing (PBF) scheme as a pilot, from October 2011 to May 2013. However, despite promising results and the government's stated commitment to ensure its continuation after the World Bank's departure, PBF failed to come onto the national policy agenda. This article aims to explain why this was the case, an especially interesting question given that several factors were favorable for project continuation. Data for this case study were collected through literature review and key informant interviews. We applied Kingdon's agenda setting theory to explain this failure. We found that though the potential of PBF to address challenges facing the Chadian health system was confirmed by internal and external evaluations of the pilot, it failed to move from the governmental agenda to the decision agenda. The main reason was a lack of dedicated policy entrepreneurs, resulting in a weak actual ownership of the policy by national authorities and key stakeholders. We tried to understand why such policy entrepreneurs failed to emerge.

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Section: Analysis Of Our Hypothesesmentioning

confidence: 99%

Why Performance-Based Financing in Chad Failed to Emerge on the National Policy Agenda

Kiendrébéogo

Shroff

Berthé

et al. 2017

Health Systems & Reform

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“…Quoting his words directly, “There's now just overwhelming evidence that those user fees actually worsened health outcomes. There's no question about it.” The speech was perceived as the much‐awaited last legitimization step for those scientists and policy makers that for decades had been demanding the abolition of user fees across LMICs . Overwhelming evidence on the negative effects of user fees on healthcare utilization and financial protection, especially for the most vulnerable groups, largely fuelled this world movement in favor of the abolition of user fees …”

Section: Introductionmentioning

confidence: 99%

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

Nakovics

Brenner

Robyn

et al. 2019

Health Planning & Management

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Summary Introduction Overwhelming evidence suggests that out‐of‐pocket expenditures (OOPEs) hamper access to care and impose a heavy economic burden across sub‐Saharan Africa (SSA). Still, current user fee reduction and removal policies often target specific groups and services, leaving large sections of the population exposed to OOPE. Methods To estimate the magnitude and the determinants of OOPE for curative services in Burkina Faso, we used data from a household survey conducted in 24 districts between October 2013 and March 2014 (n = 7844). Given a context of medical pluralism, we purposely focused on total OOPE irrespective of type of care sought. We used a two‐part regression model to estimate determinants of OOPE. Results Nearly 60% of those who reported an illness episode incurred a positive expenditure, with an average amount of 9362.52 FRS CFA per episode (1 USD = 577.94 FRS CFA). The first model revealed that the probability of incurring a positive OOPE was positively associated with perceived illness severity (P < .001), hospitalization (P < .001), and negatively associated with age (P = .026), distance (P = .060), and poorest wealth quintile (P = .054). The second model revealed that the magnitude of OOPE was positively associated with age (P = .087), education (P = .025), being household head (P = .015), having a chronic comorbidity (P = .025), perceived illness severity (P = .029), and hospitalization (P < .001) and negatively associated with symptoms unlikely to lead to adverse outcomes if not attended to in time (P = .056). Conclusion Our findings indicate that OOPEs remain a problem in Burkina Faso and that broader spectrum policy reforms are urgently needed to ensure adequate financial protection.

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“…The care package offered is equivalent to that received by bene ciaries of the AMO, excluding the cost of speciality medicines. In contrast to the other forms of user fees exemptions, which are largely funded through international aid [29], the RAMED is nanced exclusively via public funds, with the state providing 65%. It was originally envisaged that the remaining 35% would come from the local authorities but this provision, which was in many cases neither accepted nor applied, was revised in May 2017 and the share payable by the local councils cut to 15%.…”

Section: Access To Care and The Ramedmentioning

confidence: 99%

The emergence of the national medical assistance scheme for the poorest in Mali

Touré¹,

Ridde

2020

Preprint

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Background: Universal health coverage (UHC) is now high up the international agenda. There are still major needs to be met in West Africa, particularly in Mali, where providing health care for the poorest remains a big challenge. The majority of the region’s countries are currently seeking to define the content of their compulsory, contribution-based medical insurance system. However, very few countries apart from Mali have decided to, in parallel, develop a solution for poorest that is not based on contributions.Methods: This qualitative research article examines the historical process that has permitted the emergence of this ground-breaking public policy.Results: The research shows that the process has been very long, chaotic and sometimes suspended for long periods. One of the biggest challenges has been that of intersectoriality and the social construction of the groups to be targeted by this public policy (the poorest), as institutional tensions have evolved in accordance with the political issues linked to social protection. Eventually, the medical assistance scheme for the poorest (RAMED) saw the light of day in 2011, funded entirely by the government.Conclusions: Its emergence would appear to be attributable not so much to any new concern for the poorest in society but rather to a desire to give the social protection policy engaged in a guarantee of universality. The RAMED nonetheless remains an innovation within French-speaking West Africa.

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From institutionalization of user fees to their abolition in West Africa: a story of pilot projects and public policies

Cited by 47 publications

References 69 publications

Why Performance-Based Financing in Chad Failed to Emerge on the National Policy Agenda

Why Performance-Based Financing in Chad Failed to Emerge on the National Policy Agenda

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

The emergence of the national medical assistance scheme for the poorest in Mali

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