Browsing by Person "Dieng, Thierno"

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National fee exemption schemes for deliveries: comparing the recent experiences of Ghana and Senegal
(Antwerp: ITG Press, 2008) Witter, Sophie; Armar-Klemesu, Margaret; Dieng, Thierno
Continuing high maternal mortality ratios, especially in Africa, and high discrepancies between richer and poorer households in relation to access to maternal health care and maternal health status have focussed attention on the importance of reducing financial barriers to skilled care. This article compares the findings of two studies on national policies exempting women from user fees for deliveries, conducted in Ghana in 2005-6 and in Senegal in 2006-7. The evaluations used a combination of research methods, including key informant interviews, household surveys, financial flows tracking, health worker incentive surveys, confidential enquiry, clinical case note record extraction, community level interviews and focus group discussions. The detailed findings from each evaluation are presented, followed by the broad lessons learnt from these similar (but not identical) policies. The policies shared goals, and both were implemented in poorer regions initially but then scaled up, using national resources. They demonstrate the potential of fee exemption policies to increase utilisation. The cost per additional assisted delivery was $62 (average) in Ghana and $21 (normal delivery) and $467 (caesarean section) in Senegal. There was also some evidence of reductions in inequalities of access.
The national free delivery and caesarean policy in Senegal: evaluating process and outcomes.
(Oxford University Press, 2010) Witter, Sophie; Dieng, Thierno; Mbengue, Daouda; Moreira, Isabelle; Brouwere, Vincent De
This article presents the results of an evaluation of the free delivery and caesarean policy (FDCP) in Senegal. The policy was introduced into five poor regions in 2005 and in 2006 was extended at regional hospital level to all regions apart from the capital (Dakar). The evaluation was carried out in 2006-7. There were four research components, all focused on selected facilities and districts within the five FDCP regions: a financial analysis of expenditure on the policy and wider health financing in the five regions and nationally; 54 key informant interviews from national down to facility level; 10 focus group discussions and 8 in-depth interviews; and analysis based on clinical record extraction of 761 major obstetric interventions. The evaluation found significant implementation difficulties, especially related to the allocation of funds and kits and the adequacy of their contents. Despite that, significant increases in utilization in normal deliveries (from 40% to 44% of expected deliveries in FDCP areas over 2004-5) and in caesarean rates (rising from 4.2% to 5.6% in FDCP areas) were recorded. National data suggested that these trends were not found in non-FDCP regions. Using the evaluation data, the cost per additional caesarean under the policy was US$467 and the cost per additional supervised normal delivery was US$21. The article concludes that, in order to achieve its full potential, the FDCP requires improved systems for planning and allocating resources, and new channels to reimburse lower level facilities. It is also important that all complicated deliveries (not just caesareans) are included in the package. In the case of Senegal, a complementary strategy of investment in facilities, transportation and staffing is required to bring greater geographical access and upgrade services. These findings are likely to be relevant to other countries currently experimenting with similar approaches to reducing financial barriers to skilled attendance at delivery.