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dc.contributor.authorWitter, Sophie
dc.contributor.authorIlboudo, Patrick G. C.
dc.contributor.authorCunden, Nadia
dc.contributor.authorBoukhalfa, C.
dc.contributor.authorMakoutode, Patrick
dc.contributor.authorDaou, Z.
dc.date.accessioned2018-06-29T22:02:50Z
dc.date.available2018-06-29T22:02:50Z
dc.date.issued2016-08-30
dc.identifierER4351
dc.identifier.citationWitter, S., Ilboudo, P., Cunden, N., Boukhalfa, C., Makoutode, P. & Daou, Z. (2016) Delivery fee exemption and subsidy policies: how have they affected health staff? Findings from a four-country evaluation, Health Policy and Planning, vol. 32, , pp. 236-247,
dc.identifier.issn2681080
dc.identifier.urihttp://doi.org/10.1093/heapol/czw116
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/4351
dc.description.abstractMany countries, especially in Africa, have in recent years introduced fee exemptions or subsidies targeting deliveries and emergency obstetric care. A number of aspects of these policies have been studied but there are few studies which look at how staff have been affected and how they have responded. This article focuses on this question, comparing data from Benin, Burkina Faso, Mali and Morocco. It is nested in wider evaluation of the policies. The article analyses responses to a health worker survey, carried out in 2012 on 683 health staff (doctors, nurses, midwives and others such as auxiliaries) across the four countries. The survey focused on working hours, workloads, pay, motivation and perceptions of the policies, as well as reported changes in workload and remuneration over the period of policy introduction. Self-reported staff output ratios suggest that midwives are over-worked across all settings, but facility data presents lower estimates, making it hard to judge the adequacy of workforces. Staff are generally positive about the policies' effects on the health system (increasing supervised delivery rates, benefiting the poor, improving access to medicines and supplies and improving quality of care). In personal terms, staff in Mali and Burkina Faso report increased satisfaction with work as a result of the policies, while in Benin, there is little change and in Morocco a deterioration (which correlated with recommendations about extending exemption policies in future). Awareness of policies was high amongst staff but only a small minority had received any written guides or training on policy implementation. It is crucial that planned health financing changes engage with their implications for staffing - estimating whether specific cadres can absorb increase demand, for example, as well as how to engage them in the policy implementation such that their personal needs are met and their professionalism enhanced.
dc.format.extent236-247
dc.publisherOxford University Press
dc.relation.ispartofHealth Policy and Planning
dc.subjectdeliveries
dc.subjectcaesareans
dc.subjectfee exemption
dc.subjecthealth workers
dc.subjectevaluation
dc.subjectBenin
dc.subjectBurkina Faso
dc.subjectMali
dc.subjectMorocco
dc.titleDelivery fee exemption and subsidy policies: how have they affected health staff? Findings from a four-country evaluation
dc.typearticle
dcterms.accessRightsrestricted
dc.description.facultysch_iih
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dc.description.volume32
dc.identifier.doihttp://doi:10.1108/IJBM-09-2014-0124
dc.description.ispublishedpub
dc.description.eprintid4351
rioxxterms.typearticle
refterms.dateAccepted2016-08-05
refterms.dateFCA2017-08-30
refterms.dateFCD2016-08-23
qmu.authorWitter, Sophie
qmu.centreInstitute for Global Health and Development
dc.description.statuspub
dc.description.number2


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