Today in La Presse : Empire of the gene
Gilles Bibeau, Valéry Ridde (2013, 4 juillet). L’empire du gène. La Presse.
Improving equity by removing healthcare fees for children in Burkina Faso
Valéry Ridde, Slim Haddad, Rolf Heinmüller (2013). Improving equity by removing healthcare fees for children in Burkina Faso. J Epidemiol Community Health, Publication Online First : 17 juin 2013, 1–7. [html]
Résumé
Background
This study evaluated the effects on healthcare access inequities of an intervention exempting children under 5 years from user fees in Burkina Faso.
Methods
The design consisted of two complementary studies. The first was an interrupted time series (56 months before and 12 months after) study of daily curative consultations according to distance (<5, 5–9 and ≥10 km) in a stratified random sample of 18 health centres: 12 with the intervention and 6 without. The second was a household panel survey (n=1214) assessing the evolution of health-seeking behaviours. Multilevel regression was used throughout.
Results
Attendance doubled under the intervention, after adjusting for Centres de Santé et de Promotion Sociale size, districts, secular trend and seasonal variation. Utilisation increased for all distance ranges and in all of the 12 health centres of the intervention area. The exemption benefited all children (rate ratios (RR)=1.52 (1.23 to 1.88)), whether their health needs were high (RR=1.69 (1.22 to 2.32)) or not (RR=1.46 (1.10 to 1.93)) and whether the children lived near (RR=1.42 (1.09 to 1.85)) or far from a health centre (RR=1.79 (1.31 to 2.43)). The exemption benefited the children of poor families when health need was high and services near (RR=5.23; (1.30 to 20.99)). The amount saved for a child’s treatment by the exemption was on average and median 2500 F CFA (≈US$5).
Conclusions
Exempting children under five from user fees is effective and helps reduce inequities of access. It benefits vulnerable populations, although their service utilisation remains constrained by limitations in geographic accessibility of services.
What factors influence health policy entrepreneurs in West Africa?
A Torbica, M De Allegri, D Yugbare Belemsaga, A Medina-Lara, V Ridde (2013). What factors influence health policy entrepreneurs in West Africa? (Working paper) [pdf]
Abstract
This paper investigates the agenda-setting criteria used by policy entrepreneurs directly involved in the implementation of user-fee abolition or reduction policies for maternal care services in Africa. The study uses an experimental technique, best-worst scaling (BWS), to identify the criteria that drive their decision making. Results suggest that political commitment and impact on health are identified as the most important criteria, while international pressure and donor money are ranked as the least important. Respondents confirm that a strong leadership role is required at the governmental level in order to effect policy change, but attribute relatively little importance in decision making for increasing equity of health care among population groups or for the ability of the health system capacity to carry out new policy.
“Good intentions are not enough”: analysis of a health policy for the elderly in Senegal
Elhadji Mamadou Mbaye, Valéry Ridde, Ousseynou Kâ (2013).“Good intentions are not enough”: analysis of a health policy for the elderly in Senegal. Santé publique, France), 25, 107–112. [pdf. Article in French]
Abstract
In 2006, the Senegalese government introduced the “Plan Sésame”, an unprecedented policy in West Africa aimed at reducing social vulnerability among the elderly (i.e. people aged over 60 years). This paper examines the process of implementa- tion of the “Plan Sésame”. Using a qualitative approach, the study was based on a unique case study authorized by the Senegalese Ministry of Health. Three methods were used: i) individual inter- views (n = 19), ii) discussion groups (n = 24), and iii) documen- tary study. Despite its social objective, the “Plan Sésame” was ultimately limited to free health care. However, even the health component of the plan has suffered from underfunding. Political obstacles, inadequate accompanying measures and short staffing have resulted in late reimbursements at a local level, thus limiting the implementation of the plan. While both health professionals and elderly people are in favor of free healthcare, they are also critical of the implementation issues surrounding the “Plan Sésame”. Although it appears to be a viable solution, these issues may spell the end of the plan. The task of designing solid tech- nical foundations and developing appropriate accompanying measures should not be overlooked because of the limited interest of international partners in the “Plan Sésame”, the national dimension of the plan and its electoral importance.
An exploratory synthesis of knowledge brokering in public health
Valéry Ridde, Christian Dagenais, Michèle Boileau (2013). An exploratory synthesis of knowledge brokering in public health. Santé publique, 25(2), 137–146. [pdf. article in French]
Abstract
There is a call for public health policies and interventions to be evidence-based. Also, using knowledge brokers to foster the use of research results is increasingly recommended. This article presents an exploratory synthesis of the current state of knowl- edge on this new strategy. We conducted a scoping study by consulting the main databases. Nineteen articles were included in the analysis, which was designed with a grid developed iteratively. The synthesis shows that knowledge brokering initiatives include i) planning activities (stakeholder identification, creation of networks and partnerships, context analysis, problem identifica- tion, needs identification), ii) support to the brokers (training, technical support, development of a practice guide), and iii) the brokerage activities themselves (information management, liaison between knowledge producers and users, training of users). Only four articles presented empirical data on the effects of brokers’ activities. Three were associated with increased knowledge in the target audience. No study showed any impact on clinical behaviours or on public policy content. This synthesis highlights the challenges involved in knowledge brokering activities, as well as the characteristics and skills a broker should possess. While knowledge brokering appears promising, efforts must nowbe made to evaluate it more system- atically to demonstrate its effectiveness.
Recherche originale