Jun 3, 2013 | health policy analysis
Valéry Ridde & Jean-Pierre Olivier de Sardan (2013). Abolishing user fees for patients in West Africa: lessons for public policy. À Savoir, (20). [lire en ligne] [pdf]
Résumé
Après trente ans de généralisation du paiement direct par les usagers des services de santé en Afrique, de plus en plus de pays s’engagent dans des politiques d’exemption pour améliorer l’accès aux soins de santé, notamment en faveur des groupes vulnérables liés aux Objectifs du millénaire pour le développement. Rares sont les travaux qui se sont penchés sur ces politiques publiques dans leur globalité, en analysant leurs contradictions, leurs incohérences et leurs perceptions par les acteurs concernés. Ce dossier présente les résultats d’un programme de recherche (2009-2012) qui documente l’émergence, la formulation, la mise en oeuvre et les effets de ces nouvelles politiques de gratuité des soins au Burkina Faso, Mali et Niger. Coordonnée par Valéry Ridde et Jean-Pierre Olivier de Sardan, cette contribution associe techniques quantitatives et approche qualitative de type socio-anthropologique, dans un contexte ouest-africain où ces politiques n’ont pas encore été analysées sous cet angle interdisciplinaire.
Apr 16, 2013 | equity of access to healthcare
Valéry Ridde, Emmanuel Bonnet, Aude Nikiema, Kadidiatou Kadio (2013) A spatial analysis of a community-based selection of indigents in Burkina Faso, 10-19. In Global Health Promotion 20 (1 Suppl). [pdf]
Abstract
Over recent decades, Burkina Faso has improved the geographic accessibility of its health centres. However, patients are still required to pay point-of-service user fees, which excludes the most vulnerable from access to care. In 2010, 259 village committees in the Ouargaye district selected 2649 indigents to be exempted from user fees. The 26 health centre management committees that fund this exemption retained 1097 of those selected indigents. Spatial analysis showed that the management committees retained the indigents who were geographically closer to the health centres, in contrast to the selections of the village committees which were more diversified. Using village committees to select indigents would seem preferable to using management committees. It is not yet known whether the management committees’ selections were due to a desire to maximize the benefits of exemption by giving it to those most likely to use it, or to the fact that they did not personally know the indigents who were more geographically distant from them, or that some villages are not represented at the management committees.
Apr 11, 2013 | equity of access to healthcare, research methodology
Christian Dagenais, Ludovic Queuille, Valéry Ridde (2013) Evaluation of a knowledge transfer strategy from a user fee exemption program for vulnerable populations in Burkina Faso, 70-79. In Global Health Promotion 20 (1 Suppl). [pdf]
Abstract
As part of this special issue contributing to the development of knowledge on vulnerability and health in Africa, this article analyzes one example of a knowledge transfer strategy aimed at improving the use of research results that could help reduce the vulnerability of certain populations. In this case, since September 2008, the Non-Governmental Organization (NGO) Hilfe zur Selbsthilfe e.V. (HELP) has conducted a trial of subsidizing 100% of the costs of health care for vulnerable populations in two health districts of Burkina Faso. A scientific partnership was created to produce evidence on the intervention, and a knowledge transfer strategy was developed to promote the use of that evidence by stakeholders (decision-makers, people working in the health system, funding partners, etc.). The results showed that considerable efforts were invested in knowledge transfer activities and that these led to all types of use (instrumental, conceptual, persuasive). However, considerable variation in use was observed from one setting to another. This article presents some lessons to be drawn from this experience.
Mar 14, 2013 | equity of access to healthcare
Valéry Ridde (2013) Trois vidéos pour dire l’accès aux soins de santé en Afrique de l’Ouest. In Découvrir, le magazine de l’ACFAS. [html]
Feb 28, 2013 | research methodology
Léna D’Ostie-Racine, Christian Dagenais, Valéry Ridde (2013) An evaluability assessment of a West Africa based Non-Governmental Organization’s (NGO) progressive evaluation strategy, 71-9. In Evaluation and program planning 36 (1). [pdf]
Abstract
While program evaluations are increasingly valued by international organizations to inform practices and public policies, actual evaluation use (EU) in such contexts is inconsistent. Moreover, empirical literature on EU in the context of humanitarian Non-Governmental Organizations (NGOs) is very limited. The current article focuses on the evaluability assessment (EA) of a West-Africa based humanitarian NGO’s progressive evaluation strategy. Since 2007, the NGO has established an evaluation strategy to inform its maternal and child health care user-fee exemption intervention. Using Wholey’s (2004) framework, the current EA enabled us to clarify with the NGO’s evaluation partners the intent of their evaluation strategy and to design its program logic model. The EA ascertained the plausibility of the evaluation strategy’s objectives, the accessibility of relevant data, and the utility for intended users of evaluating both the evaluation strategy and the conditions that foster EU. Hence, key evaluability conditions for an EU study were assured. This article provides an example of EA procedures when such guidance is scant in the literature. It also offers an opportunity to analyze critically the use of EAs in the context of a humanitarian NGO’s collaboration with evaluators and political actors.
Feb 28, 2013 | health policy analysis
Valéry Ridde, Seni Kouanda, Maurice Yameogo et al. (2013) Why do women pay more than they should? A mixed methods study of the implementation gap in a policy to subsidize the costs of deliveries in Burkina Faso, 145–152. In Evaluation and program planning 36 (1). [pdf]
Résumé
In 2007, Burkina Faso launched a public policy to subsidize 80% of the cost of normal deliveries. Although women are required to pay only the remaining 20%, i.e., 900 F CFA (1.4 Euros), some qualitative evidence suggests they actually pay more.
The aim of this study is to test and then (if confirmed) to understand the hypothesis that the amounts paid by women are more than the official fee, i.e., their 20% portion.
A mixed method sequential explanatory design giving equal priority to both quantitative (n = 883) and qualitative (n = 50) methods was used in a rural health district of Ouargaye.
Half (50%, median) of the women reported paying more than the official fee for a delivery. Health workers questioned the methodology of the study and the veracity of the women’s reports. The three most plausible explanations for this payment disparity are: (i) the payments were for products used that were not part of the delivery kit covered by the official fee; (ii) the implementers had difficulty in understanding the policy; and (iii) there was improper conduct on the part of some health workers.
Institutional design and organizational practices, as well as weak rule enforcement and organizational capacity, need to be considered more carefully to avoid an implementation gap in this public policy.
