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dc.rights.licenseCreative Commons Attribution 4.0 International License
dc.contributor.authorWitter, Sophie
dc.contributor.authorBoukhalfa, C.
dc.contributor.authorCresswell, Jenny A.
dc.contributor.authorDaou, Z.
dc.contributor.authorFilippi, Veronique
dc.contributor.authorGanaba, Rasman
dc.contributor.authorGoufodji, Sourou B.
dc.contributor.authorLange, Isabelle
dc.contributor.authorMarchal, Bruno
dc.contributor.authorRichard, Fabienne
dc.date.accessioned2018-06-29T22:02:19Z
dc.date.available2018-06-29T22:02:19Z
dc.date.issued2016-08-02
dc.identifierER4430
dc.identifier.citationWitter, S., Boukhalfa, C., Cresswell, J., Daou, Z., Filippi, V., Ganaba, R., Goufodji, S., Lange, I., Marchal, B. & Richard, F. (2016) Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco, International Journal for Equity in Health, 15, pp. 123-142.
dc.identifier.issn1475-9276
dc.identifier.urihttps://doi.org/10.1186/s12939-016-0412-y
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/4430
dc.description.abstractBackground: 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.
dc.format.extent123-142
dc.publisherBioMed Central
dc.relation.ispartofInternational Journal for Equity in Health
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectExemptions
dc.subjectUser Fees
dc.subjectDeliveries
dc.subjectCaesareans
dc.subjectMaternal Health
dc.subjectBenin
dc.subjectBurkina Faso
dc.subjectMali
dc.subjectMorocco
dc.titleCost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco
dc.typearticle
dcterms.accessRightspublic
dc.date.updated2019-04-07
dc.description.facultysch_iih
dc.description.volume15
dc.identifier.doi10.1186/s12939-016-0412-y
dc.description.ispublishedpub
dc.description.eprintid4430
rioxxterms.typearticle
refterms.dateAccepted2016-07-24
refterms.dateFCA2016-08-16
refterms.dateFCD2016-08-16
refterms.depositExceptionpublishedGoldOA
qmu.authorWitter, Sophie
qmu.centreInstitute for Global Health and Development
dc.description.statuspub
dc.description.number1
refterms.versionVoR


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Creative Commons Attribution 4.0 International License
Except where otherwise noted, this item's license is described as Creative Commons Attribution 4.0 International License