Maternal fee exemption in Senegal: is the policy a success

Abstract

This article describes a qualitative research component of an evaluation of the national free delivery and caesarean policy (FDCP) in Senegal. Its aim was to establish community awareness and views on the policy, as well as perceived changes to cost and quality of services. 106 community representatives participated in in-depth interviews and focus group discussions in four FDCP regions in November and December 2006. Awareness of the policy was patchy and respondents found that the concept of 'free' services was inappropriate even in theory, given that only certain costs were covered by the policy. In practice most reported that costs had not reduced significantly as a result of the policy, with the exception of caesareans in some areas. Transport and drugs are the major costs for households and neither is adequately covered by the FDCP. In some cases drugs costs have even risen. Moreover those living in remote areas are unable to benefit from this facility-based subsidy. Gender differences in relation to payment and decision making around delivery were also found. Policies to increase access to skilled care at delivery by reducing household costs need to target the core costs, such as drugs, and also to increase the predictability of charges. Extending infrastructure and addressing demand side costs are additional essential elements to reach the poorest in the community.