Health worker perspectives on user fee removal in Zambia
Health worker perspectives on user fee removal in Zambia
复制标题
DOI：
10.1186/1478-4491-10-40
复制
发表时间：
2012-10-30
影响因子：
4.5
通讯作者：
Palmer, Natasha
中科院分区：
文献类型：
--
作者：
Carasso, Barbara S.;Lagarde, Mylene;Palmer, Natasha
背景：2006年，赞比亚农村地区取消了初级保健服务的使用费。其他国家的经验表明，卫生工作者在决定取消收费政策是否成功方面发挥着关键作用，但也发现执行这种政策具有挑战性。该政策是在一个重大短缺的背景下，在合格的卫生工作人员。方法：作为一个更大的研究的一部分，在赞比亚的经验和用户费去除的影响，在设施一级进行了一些案例研究。作为其中的一部分，定量和定性的数据收集，以评估卫生工作者的满意度和经验，在充电和非充电facility.Results：我们的研究结果表明，卫生保健工作者有复杂的感情的政策变化及其后果。我们发现一些证据表明，与仍在收费的设施相比，非收费设施的人员动机更高。然而，不清楚这种影响是由于用户收费政策的差异，还是由于在非收费设施接受访谈的许多工作人员在使命设施工作，我们发现那里的积极性要高得多。保健工作者对到这些设施就诊的病人人数明显增加以及消除了阻碍许多贫困病人的因素表示满意，但也抱怨工作量增加。此外，据说工作条件恶化，工作人员认为这与没有额外资源来应付增加的需求或弥补收费造成的收入损失有关。这些调查结果突出表明，在消除用户收费等需求方障碍时，需要注意供应方措施，特别是需要关注需求增加可能给已经过度依赖的国家带来的负担。紧张的卫生工作者。
Background: User fees for primary care services were removed in rural districts in Zambia in 2006. Experience from other countries has suggested that health workers play a key role in determining the success of a fee removal policy, but also find the implementation of such a policy challenging. The policy was introduced against a backdrop of a major shortage in qualified health staff.Methods: As part of a larger study on the experience and effect of user fee removal in Zambia, a number of case studies at the facility level were conducted. As part of these, quantitative and qualitative data were collected to evaluate health workers' satisfaction and experiences in charging and non-charging facilities.Results: Our findings show that health-care workers have mixed feelings about the policy change and its consequences. We found some evidence that personnel motivation was higher in non-charging facilities compared to facilities still charging. Yet it is unclear whether this effect was due to differences in the user fee policy or to the fact that a lot of staff interviewed in non-charging facilities were working in mission facilities, where we found a significantly higher motivation. Health workers expressed satisfaction with an apparent increase in the number of patients visiting the facilities and the removal of a deterring factor for many needy patients, but also complained about an increased workload. Furthermore, working conditions were said to have worsened, which staff felt was linked to the absence of additional resources to deal with the increased demand or replace the loss of revenue generated by fees.Conclusion: These findings highlight the need to pay attention to supply-side measures when removing demand-side barriers such as user fees and in particular to be concerned about the burden that increased demand can place on already over-stretched health workers.