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dc.contributor.authorMcPake, Barbara
dc.contributor.authorWitter, Sophie
dc.contributor.authorEnsor, Tim
dc.contributor.authorFustukian, Suzanne
dc.contributor.authorNewlands, D.
dc.contributor.authorMartineau, Tim
dc.contributor.authorChirwa, Yotamu
dc.date.accessioned2018-06-29T22:02:56Z
dc.date.available2018-06-29T22:02:56Z
dc.date.issued2013-09-22
dc.identifierER3260
dc.identifier.citationMcPake, B., Witter, S., Ensor, T., Fustukian, S., Newlands, D., Martineau, T. & Chirwa, Y. (3913) Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health, Human Resources for Health, vol. 11.
dc.identifier.issn1478-4491
dc.identifier.urihttp://dx.doi.org/10.1186/1478-4491-11-46
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/3260
dc.description.abstractThe last decade has seen widespread retreat from user fees with the intention to reduce financial constraints to users in accessing health care and in particular improving access to reproductive, maternal and newborn health services. This has had important benefits in reducing financial barriers to access in a number of settings. If the policies work as intended service utilization rates increase. However this increases workloads for health staff and at the same time, the loss of user fee revenues can imply that health workers lose bonuses or allowances, or that it becomes more difficult to ensure uninterrupted supplies of health care inputs. This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health. Methods We undertook case studies in five countries (Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe). In each we reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors. Results We question a number of common assumptions about the financing and human resource inter-relationships. The impact of fee removal on utilization levels is mostly not sustained or supported by all the evidence. Shortages of human resources for health at the national level are not universal; maldistribution within countries is the greater problem. Low salaries are not universal; most of the countries pay health workers well by national benchmarks. Conclusions The interconnectedness between user fee policy and HRH situations proves difficult to assess. Many policies have been changing over the relevant period, some clearly and others possibly in response to problems identified associated with financing policy change. Other relevant variables have also changed. However, as is now well-recognised in the user fee literature, co-ordination of health financing and human resource policies is essential. This appears less well recognised in the human resources literature. This coordination involves considering user charges, resource availability at health facility level, health worker pay, terms and conditions, and recruitment in tandem. All these policies need to be effectively monitored in their processes as well as outcomes, but sufficient data are not collected for this purpose.
dc.publisherBioMed Central
dc.relation.ispartofHuman Resources for Health
dc.subjectUser Fees
dc.subjectHuman Resources For Health
dc.subjectPolicy Co-Ordination
dc.subjectDistribution
dc.subjectWorkload
dc.subjectPay
dc.titleRemoving financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health
dc.typearticle
dcterms.accessRightspublic
dc.description.facultysch_iih
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dc.description.volume11
dc.identifier.doihttp://10.1186/1478-4491-11-46
dc.description.ispublishedpub
dc.description.eprintid3260
rioxxterms.typearticle
qmu.authorFustukian, Suzanne
qmu.authorMcPake, Barbara
qmu.authorWitter, Sophie
dc.description.statuspub


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