Browsing by Person "Richard, Fabienne"

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Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn.
(Wiley-Blackwell, 2010-08) Witter, Sophie; Richard, Fabienne; De Brouwere, Vincent
Summary The huge majority of the annual 6.3 million perinatal deaths and half a million maternal deaths take place in developing countries and are avoidable. However, most of the interventions aiming at reducing perinatal and maternal deaths need a health care system offering appropriate antenatal care and quality delivery care, including basic and comprehensive emergency obstetric care facilities. To promote the uptake of quality care, there are two possible approaches: influencing the demand and/or the supply of care. Five lessons emerged from experiences. First, it is difficult to obtain robust evidence of the effects of a particular intervention in a context, where they are always associated with other interventions. Second, the interventions tend to have relatively modest short-term impacts, when they address only part of the health system. Third, the long-term effects of an intervention on the whole health system are uncertain. Fourth, because newborn health is intimately linked with maternal health, it is of paramount importance to organise the continuum of care between mother and newborn. Finally, the transfer of experiences is delicate, and an intervention package that has proved to have a positive effect in one setting may have very different effects in other settings. L'accs aux services de sant maternelle et prinatale: leons tires d'exemples russies et moins russies de l'amlioration de l'accs un accouchement et des soins srs pour le nouveau-n L'immense majorit des 6,3 millions de dcs prinataux et du demi-million de dcs maternels surviennent dans les pays en dveloppement et sont vitables. Cependant, la plupart des interventions visant rduire la mortalit prinatale et maternelle ont besoin d'un systme de soins de sant offrant des prestations de soins prnataux appropris et de qualit, y compris des services complets de soins obsttriques d'urgence de base. Afin de promouvoir l'adoption de soins de qualit, il y a deux approches possibles: influencer la demande et/ou l'offre de soins. Cinq leons ont t dgages de certaines expriences. D'abord, il est difficile d'obtenir des preuves solides des effets d'une intervention particulire dans un contexte o_ ils sont toujours associs d'autres interventions. Deuximement, les interventions ont tendance avoir des impactes relativement modestes court terme quand elles ne visent qu'une partie du systme de sant. Troisimement, les effets long terme d'une intervention sur l'ensemble du systme de sant sont incertains. Quatrimement, comme la sant du nouveau-n est intimement lie celle de la mre, il est d'une importance primordiale d'organiser la continuit des soins entre la mre et le nouveau-n. Enfin, le transfert d'expriences est dlicat et une trousse d'intervention qui s'est avre positive dans un contexte peut avoir des effets trs diffrents dans d'autres contextes. Punto de vista Acceso a servicios maternos y perinatales: lecciones de ejemplos exitosos y menos exitosos en la mejora del acceso a un parto seguro y cuidados neonatales La gran mayor_a de las 6.3 millones de muertes perinatales y el medio mill_n de muertes maternas suceden en pa_ses en v_as de desarrollo y son inevitables. Sin embargo, la mayor_a de las intervenciones que buscan reducir las muertes maternas y perinatales requieren de un sistema sanitario que ofrezca unos cuidados prenatales apropiados y unos cuidados de calidad durante el parto, incluyendo el acceso a instalaciones obsttricas bsicas y de emergencia. A la hora de promover la mejora del servicio hay dos posibilidades: influenciar la demanda y/o la oferta de cuidados. Se obtuvieron cinco lecciones como resultado de las diferentes experiencias. Primero, es dif_cil obtener una evidencia robusta de los efectos que tiene una intervenci_n en particular dentro de un contexto en el cual siempre hay otras intervenciones asociadas. Segundo, las intervenciones tienden a tener impactos con ventanas de tiempo relativamente cortas cuando solo han sido dirigidas hacia una parte del sistema sanitario. Tercero, los efectos a largo plazo de una intervenci_n, sobre todo en el sistema de salud, son inciertos. Cuarto, puesto que la salud neonatal est_ntimamente ligada a la salud materna, es muy importante ligar los cuidados continuos de la madre y del neonato. Finalmente, la transferencia de experiencias es delicada y un tipo de intervenci_n que ha tenido un efecto positivo en un lugar puede tener efectos muy diferentes en otro.
Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco
(BioMed Central, 2016-08-02) Witter, Sophie; Boukhalfa, C.; Cresswell, Jenny A.; Daou, Z.; Filippi, Veronique; Ganaba, Rasman; Goufodji, Sourou B.; Lange, Isabelle; Marchal, Bruno; Richard, Fabienne
Background: Across the Africa region and beyond, the last decade has seen many countries introducing policies aimed at reducing financial barriers to obstetric care. This article provides evidence of the cost and effects of national policies focussed on improving financial access to caesarean and facility deliveries in Benin, Burkina Faso, Mali and Morocco. Methods: The study uses a comparative case study design with mixed methods, including realist evaluation components. This article presents results across 14 different data collection tools, used in 4-6 research sites in each of the four study countries over 2011-13. The methods included: document review; interviews with key informants; analysis of secondary data; structured extraction from medical files; cross-sectional surveys of patients and staff; interviews with patients and observation of care processes. Results: The article finds that the policies have contributed to continued increases in skilled birth attendance and caesarean sections and a narrowing of inequalities in all four countries, but these trends were already occurring so a shift cannot be attributed solely to the policies. It finds a significant reduction in financial burdens on households after the policy, suggesting that the financial protection objectives may have been met, at least in the short term, although none achieved total exemption of targeted costs. Policies are domestically financed and are potentially sustainable and efficient, and were relatively thoroughly implemented. Further, we find no evidence of negative effects on technical quality of care, or of unintended negative effects on untargeted services. Conclusions: We conclude that the policies were effective in meeting financial protection goals and probably health and equity goals, at sustainable cost, but that a range of measures could increase their effectiveness and equity. These include broadening the exempted package (especially for those countries which focused on caesarean sections alone), better calibrated payments, clearer information on policies, better stewardship of the local health system to deal with underlying systemic weaknesses, more robust implementation of exemptions for indigents, and paying more attention to quality of care, especially for newborns.
Fee Exemption for Maternal Care in Sub-Saharan Africa: A Review of 11 Countries and Lessons for the Region
(2013-07) Richard, Fabienne; Antony, Matthieu; Witter, Sophie; Kelley, Allison; Sieleunou, Isidore; Kafando, Yamba; Meessen, Bruno
Several countries have recently introduced maternal health care fee exemptions as a quick win approach to reach MDG 5 goals. It has also been argued that these policies were relevant first steps towards universal health coverage (UHC). The scope and contents of the benefits package covered by these policies vary widely. First evaluations raised questions about efficiency and equity. This article offers a more comprehensive view of these maternal health fee exemptions in Africa. We document the contents and the financing of 11 of these policies. Our analysis highlights (1) the importance of balancing different risks when a service is the target of the policy - C-sections address some of the main catastrophic costs, but do not necessarily address the main health risks to women, and (2) the necessity of embedding such exemptions in a national framework to avoid further health financing fragmentation and to reach UHC.
Innovative Approaches to Reducing Financial Barriers to Obstetric Care in Low-Income Countries.
(American Public Health Association, 2010-10) Witter, Sophie; Richard, Fabienne; Brouwere, Vincent de
Lack of access to quality care is the main obstacle to reducing maternal mortality in low-income countries. In many settings, women must pay out-of-pocket fees, resulting in delays, some of them fatal, and catastrophic expenditure that push households into poverty. Various innovative approaches have targeted the poor or exempted specific services, such as cesarean deliveries. We analyzed 8 case studies to better understand current experiments in reducing financial barriers to maternal care. Although service utilization increased in most of the settings, concerns remain about quality of care, equity between rich and poor patients and between urban and rural residents, and financial sustainability to support these new strategies.
Learning lessons and moving forward: how to reduce financial barriers to obstetric care in low-income contexts
(Antwerp: ITG Press., 2008) Witter, Sophie; Richard, Fabienne; De Brouwere, Vincent; De Brouwere, V.; Richard, F.; Witter, Sophie
The obstetric care subsidy policy in Burkina Faso: what are the effects after five years of implementation? Findings of a complex evaluation
(BioMed Central, 2016-04-21) Ganaba, Rasman; Ilboudo, Patrick G. C.; Cresswell, Jenny A.; Yaogo, Maurice; Diallo, Cheick Omar; Richard, Fabienne; Cunden, Nadia; Filippi, Veronique; Witter, Sophie
Background Burkina Faso, like many low and middle income countries, has been taking a range of actions to address its poor maternal and neonatal health indicators. In 2006 the government introduced an innovative national subsidy scheme for deliveries and emergency obstetric care in public facilities. This article reports on a complex evaluation of this policy, carried out 5 years after its introduction, which examined its effects on utilisation, quality of care, equity and the health system as a whole, as well as its cost and sustainability. Methods The evaluation was carried out in six purposively selected districts, as well as at national level, using a case study approach. Data sources included: national and district routine and survey data, household interviews with women who had recently given birth, data extraction from hospital and medical records, and key informant and health worker interviews. Results The underlying secular trend of a 1 % annual increase in the facility-based delivery rate (1988-2010) was augmented by an additional 4 % annual increase from 2007 onwards (after the policy was introduced), especially in rural areas and amongst women from poor households. The absence of baseline quality of care data made it difficult to assess the impact of the policy on quality of care, but hospitals with the best level of implementation of the subsidy offered higher quality of care (as measured by health care near-misses), so there is no evidence of a negative impact on quality (as is often feared). Similarly, there is little evidence of unintended negative effects on untargeted services. Household payments for facility-based deliveries have reduced significantly, compared with payments before the policy, and the policy as a whole is affordable, costing about 2 % of total public health expenditure. Concerns include that the amounts paid by households are higher than the rates set by the policy, and also that 7 % of households still say that they cannot afford to pay. Wealthier women have higher utilisation of services, as before, and the policy of fully exempting indigents is not being put into practice. Conclusions These findings highlight the importance of maintaining the subsidy policy, given the evidence of positive outcomes, but they also point out areas where attention is needed to ensure the poor and most vulnerable population benefit fully from the policy.