Reducing user fees for primary health care in Kenya: Policy on paper or policy in practice?
Reducing user fees for primary health care in Kenya: Policy on paper or policy in practice?
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DOI：
10.1186/1475-9276-8-15
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发表时间：
2009-05-08
影响因子：
4.8
通讯作者：
Molyneux, Catherine
中科院分区：
文献类型：
--
作者：
Chuma, Jane;Musimbi, Janet;Molyneux, Catherine
背景：取消初级保健服务的使用费是非洲正在考虑的最关键的政策问题之一。1980年代，许多非洲国家开始收取使用费，其影响有充分的文献记载。对使用者付费的负面影响的关切导致最近非洲卫生筹资辩论的转变。肯尼亚是实施用户费用减免政策的国家之一。与许多其他情况一样，新政策在实施后不到一年即进行了评估，而这一时期预期的积极影响可能最大。这一早期评估表明，该政策得到了广泛实施，利用率有所提高，在患者中很受欢迎。取消使用费政策的积极影响是否能够持续，几乎没有人探讨过。我们进行了这项研究，以记录在肯尼亚的初级卫生保健设施在何种程度上继续坚持“新”的收费政策3年后，其implementation.Methods：数据收集在两个地区（夸莱和马奎尼）。采用多种数据收集方法，包括横断面调查（n = 184户夸莱; 141名Makueni）、焦点小组讨论（n = 12）和患者离职面谈（n = 175名夸莱; 184名马奎尼）。结果如下：大约三分之一的调查答复者不能正确说明诊所的建议收费，一半的人不知道保健中心的官方收费是多少。这两个地区对这项政策的遵守情况都很差，但马奎尼的设施比夸莱的设施更有可能遵守这项政策。夸莱只有4个设施遵守这项政策，而马奎尼有10个。药品短缺，收入下降，政策设计和执行过程差的主要原因，给坚持的政策。结论：我们的结论是，在肯尼亚的初级卫生保健降低用户费用是一个政策的纸上，尚未得到充分执行。我们建议，在决定如何减少或取消使用费时应谨慎行事，并认真考虑所有可能的后果。
Background: Removing user fees in primary health care services is one of the most critical policy issues being considered in Africa. User fees were introduced in many African countries during the 1980s and their impacts are well documented. Concerns regarding the negative impacts of user fees have led to a recent shift in health financing debates in Africa. Kenya is one of the countries that have implemented a user fees reduction policy. Like in many other settings, the new policy was evaluated less that one year after implementation, the period when expected positive impacts are likely to be highest. This early evaluation showed that the policy was widely implemented, that levels of utilization increased and that it was popular among patients. Whether or not the positive impacts of user fees removal policies are sustained has hardly been explored. We conducted this study to document the extent to which primary health care facilities in Kenya continue to adhere to a 'new' charging policy 3 years after its implementation.Methods: Data were collected in two districts (Kwale and Makueni). Multiple methods of data collection were applied including a cross-sectional survey (n = 184 households Kwale; 141 Makueni), Focus Group Discussions (n = 12) and patient exit interviews (n = 175 Kwale; 184 Makueni). Results: Approximately one third of the survey respondents could not correctly state the recommended charges for dispensaries, while half did not know what the official charges for health centres were. Adherence to the policy was poor in both districts, but facilities in Makueni were more likely to adhere than those in Kwale. Only 4 facilities in Kwale adhered to the policy compared to 10 in Makueni. Drug shortage, declining revenue, poor policy design and implementation processes were the main reasons given for poor adherence to the policy.Conclusion: We conclude that reducing user fees in primary health care in Kenya is a policy on paper that is yet to be implemented fully. We recommend that caution be taken when deciding on how to reduce or abolish user fees and that all potential consequences are carefully considered.