Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis.
Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis.
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DOI：
10.1136/bmjopen-2015-009692
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发表时间：
2016-01-28
期刊：
影响因子：
2.9
通讯作者：
Matthews Z
中科院分区：
文献类型：
--
作者：
Leone T;Cetorelli V;Neal S;Matthews Z
关于取消收费是否会让最贫穷的人受益的证据并不充分。本文的目的是衡量使用费改革对加纳、布基纳法索、赞比亚、喀麦隆和尼日利亚最贫穷人口阶层在机构分娩或进行剖腹产(CS)的可能性的影响。5个非洲国家的女性用户付费体验。通过准实验回归分析，我们检验了使用费改革对布基纳法索和加纳按财富、教育程度和居住地区分的设施生育和CS的影响。对文献进行绘图，然后对关键的信息提供人进行访谈，以核实改革执行的细节，并确认和支持我们各国的选择。我们分析了5个国家的连续调查数据：2个案例国家经历了改革(加纳和布基纳法索)，3个国家没有经历改革(赞比亚、喀麦隆、尼日利亚)。使用费改革与获得便利分娩机会增加的比例很大(27个百分点)有关，对社区卫生服务的影响要小得多(0.7个百分点)。穷人(但不是最穷的)、未受过教育的妇女以及农村地区的妇女从改革中受益最多。与加纳相比，用户收费改革在布基纳法索产生了更大的影响。研究结果显示，取消用户费用对接入有明显的积极影响，但改善CS对最有需要的人的可用性的证据有限。收费改革后，更多来自农村和较低社会经济背景的妇女在医疗机构分娩。执行的速度和质量可能是这两个案例国家之间存在差异的关键原因。这就要求对改革对医疗质量的影响进行更多的研究。
Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Women's experience of user fees in 5 African countries. Using quasi-experimental regression analysis we tested the impact of user fee reforms on facilities’ births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries’ choice. We analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria). User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana. Findings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care.