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Agenda-setting criteria of abolition of user fees health policies in West Africa

Principal investigator: Valéry Ridde, Université de Montréal

Principal Investigator at IPH: Manuela De Allegri

Funding: Africa Initiative Research Grant 2011 (Canadian Research Council)

Prof. Valery Ridde, CHUM, Université of Montréal, Canada
Dr Aleksandra Torbica, Assistant Professor, CERGAS, Bocconi University, Italy  

Project description:
In July 2010, the African Union pleaded to abolish user fees for women of reproductive age and children below five years of age. This African appeal followed a similar declaration signed by all United Nations agencies and by most international donor countries, including Canada or NGOs. The absence of adequate social health insurance coverage in Africa leaves people with no capacity to pay unable to access health care. This has motivated some African countries to abolish user fees. Target populations as well as the criteria on the basis of which such policy decisions have been made vary considerably across countries. National political contexts as well as the specific relationship with aid donors have influenced this process.

Building on an experience with health policy makers in two French‐speaking West‐African countries (Mali and Burkina Faso), this exploratory research study aimed to identify the agenda‐setting criteria on the basis of which decisions on user fee abolition are made. The study took place in Burkina Faso and in Mali and targeted key policy makers in both countries as primary respondents. It adopted a mixed methods approach, combining qualitative and quantitative methods of data collection and analysis, and entailed two overlapping phases. The first phase was characterized by an exploratory study design, i.e. qualitative methods were used to inform the development of the quantitative tool. The team conducted three Focus Group Discussions (FGD) with key policy makers to elicit the criteria which health policy makers value as important when deciding on policies relevant to the abolition of user fees. During the second phase, the criteria and the balance across criteria identified during the FGD were used to define the attributes needed to compile the scenarios for a Best-Worst Scaling experiment. Health policy makers were asked to choose their preferred options from a set of hypothetical sets.

Findings showed policy makers the importance of considering, when designing health financing reforms, the complexity of factors influencing access to care beyond user fees alone. Findings also highlighted the importance of targeting specific groups of people and/or of medical conditions in a context of limited resource availability.

Status: completed

Contact: Manuela De Allegri (manuela.de.allegri@urz.uni-heidelberg.de)