The experience of Ghana in implementing a user fee exemption policy to provide free delivery care
The experience of Ghana in implementing a user fee exemption policy to provide free delivery care
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DOI：
10.1016/s0968-8080(07)30325-x
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发表时间：
2007-11-01
影响因子：
--
通讯作者：
Zakariah-Akoto, Sawudatu
中科院分区：
文献类型：
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作者：
Witter, Sophie;Arhinful, Daniel Kojo;Zakariah-Akoto, Sawudatu
在资源贫乏的国家，分娩的使用费高昂，限制了获得熟练护理的机会，导致孕产妇和新生儿死亡率上升，弱势家庭贫困化。越来越多的国家正在试验不同的办法，以消除孕产妇保健的财政障碍。本文介绍了加纳2003年推出的一项创新计划，免除所有孕妇的分娩费用，其中公共，使命和私人提供者可以根据商定的费率要求收回损失的用户费收入。本文介绍了对国家，地区，地区和设施一级卫生系统65名关键知情人进行访谈的政策评估结果的一部分，包括政策制定者、管理者和提供者。豁免机制被广泛接受，也是适当的，但在资金的支付和维持以及预算编制和管理方面存在重大问题。工作人员的工作量随着参加的妇女人数增加而增加，服务和工作人员的报酬水平对该计划是否被接受很重要。2005年底，加纳启动了一项旨在全面覆盖产妇保健的国家健康保险计划，目前尚不清楚豁免计划如何融入其中。All rights reserved.
In resource-poor countries, the high cost of user fees for deliveries limits access to skilled attendance, and contributes to maternal and neonatal mortality and the impoverishment of vulnerable households. A growing number of countries are experimenting with different approaches to tackling financial barriers to maternal health care. This paper describes an innovative scheme introduced in Ghana in 2003 to exempt all pregnant women from payments for delivery, in which public, mission and private providers could claim back lost user fee revenues, according to on agreed tariff The paper presents part of the findings of an evaluation of the policy based on interviews with 65 key informants in the health system at national, regional, district and facility level, including policymakers, managers and providers. The exemption mechanism was well accepted and appropriate, but there were important problems with disbursing and sustaining the funding, and with budgeting and management. Staff workloads increased as more women attended, and levels of compensation for services and staff were important to the scheme's acceptance. At the end of 2005 a national health insurance scheme, intended to include full maternal health care cover, was starting up in Ghana, and it was not yet clear how the exemptions scheme would fit into it. (c) 2007 Reproductive Health Matters. All rights reserved.