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Global health actors no longer in favor of user fees: a documentary study.

Robert E, Ridde V - Global Health (2013)

Bottom Line: None of the GHAs stated that they were in favor of user fees; however, 30% did not take a stand.Production and dissemination of evidence, as well as certain advocacy networks, may have contributed to this change in discourse.They should provide technical and financial support to those countries that have chosen to implement user fee exemption policies, sometimes influenced by a GHA.

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ABSTRACT

Background: Since the advent of health user fees in low- and middle-income countries in the 1980s, the discourse of global health actors (GHAs) has changed to the disadvantage of this type of healthcare financing mechanism. The aim of the study was to identify and analyze the stance of GHAs in the debate on user fees.

Methods: We conducted documentary research using public documents published by and officially attributed to GHAs from 2005 to 2011. We categorized GHAs into four groups: intergovernmental organizations, international non-governmental organizations, government agencies, and working groups and networks. We then classified the GHAs according to their stance relative to the abolition of user fees, and conducted a thematic analysis of their discourse to understand the arguments used by each GHA to justify its stance.

Results: We identified 56 GHAs, for which we analyzed 140 documents. Among them, 55% were in favor of the abolition of user fees or in favor of free care at the point of delivery. None of the GHAs stated that they were in favor of user fees; however, 30% did not take a stand. Only the World Bank declares that it is both in favor of user fees and in favor of free care at point of service. GHAs generally circumscribe their stance to specific populations (pregnant women, children under 5 years, etc.) or to specific health services (primary, basic, essential). Three types of arguments are used by GHAs to justify their stance: economic, moral and ethical, and pragmatic.

Conclusions: The principle of "user pays" seems to have fizzled. Production and dissemination of evidence, as well as certain advocacy networks, may have contributed to this change in discourse. However, GHAs should go a step further and translate their words into action, so that free healthcare at the point of delivery becomes a reality in low- and middle-income countries. They should provide technical and financial support to those countries that have chosen to implement user fee exemption policies, sometimes influenced by a GHA.

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Selection process of the documents.
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Figure 2: Selection process of the documents.

Mentions: We identified 56 GHAs: 18 were intergovernmental organizations, 10 were government agencies, 8 were international non-governmental organizations and 20 were working groups and transnational networks. We screened 203 documents meeting the inclusion criteria 1 to 4 for all GHAs, with the exception of the African Development Bank and International Health Partnership + for which we could not find any relevant documents. Of these documents, 63 were excluded (Figure 2) because they did not meet the inclusion criteria 5 and 6. The stakeholder analysis was carried out using the 140 remaining documents. The list of these documents is available in the Additional file 1. Among them, 38 were published by intergovernmental organizations, 34 were published by government agencies, 27 by international non-governmental organizations, and 41 by working groups and transnational networks. The thematic analysis was performed on the 88 documents belonging to the GHAs who have addressed the issue of access to health care, user fees or exemption policies. Table 2 describes the different types of documents.


Global health actors no longer in favor of user fees: a documentary study.

Robert E, Ridde V - Global Health (2013)

Selection process of the documents.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750575&req=5

Figure 2: Selection process of the documents.
Mentions: We identified 56 GHAs: 18 were intergovernmental organizations, 10 were government agencies, 8 were international non-governmental organizations and 20 were working groups and transnational networks. We screened 203 documents meeting the inclusion criteria 1 to 4 for all GHAs, with the exception of the African Development Bank and International Health Partnership + for which we could not find any relevant documents. Of these documents, 63 were excluded (Figure 2) because they did not meet the inclusion criteria 5 and 6. The stakeholder analysis was carried out using the 140 remaining documents. The list of these documents is available in the Additional file 1. Among them, 38 were published by intergovernmental organizations, 34 were published by government agencies, 27 by international non-governmental organizations, and 41 by working groups and transnational networks. The thematic analysis was performed on the 88 documents belonging to the GHAs who have addressed the issue of access to health care, user fees or exemption policies. Table 2 describes the different types of documents.

Bottom Line: None of the GHAs stated that they were in favor of user fees; however, 30% did not take a stand.Production and dissemination of evidence, as well as certain advocacy networks, may have contributed to this change in discourse.They should provide technical and financial support to those countries that have chosen to implement user fee exemption policies, sometimes influenced by a GHA.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Since the advent of health user fees in low- and middle-income countries in the 1980s, the discourse of global health actors (GHAs) has changed to the disadvantage of this type of healthcare financing mechanism. The aim of the study was to identify and analyze the stance of GHAs in the debate on user fees.

Methods: We conducted documentary research using public documents published by and officially attributed to GHAs from 2005 to 2011. We categorized GHAs into four groups: intergovernmental organizations, international non-governmental organizations, government agencies, and working groups and networks. We then classified the GHAs according to their stance relative to the abolition of user fees, and conducted a thematic analysis of their discourse to understand the arguments used by each GHA to justify its stance.

Results: We identified 56 GHAs, for which we analyzed 140 documents. Among them, 55% were in favor of the abolition of user fees or in favor of free care at the point of delivery. None of the GHAs stated that they were in favor of user fees; however, 30% did not take a stand. Only the World Bank declares that it is both in favor of user fees and in favor of free care at point of service. GHAs generally circumscribe their stance to specific populations (pregnant women, children under 5 years, etc.) or to specific health services (primary, basic, essential). Three types of arguments are used by GHAs to justify their stance: economic, moral and ethical, and pragmatic.

Conclusions: The principle of "user pays" seems to have fizzled. Production and dissemination of evidence, as well as certain advocacy networks, may have contributed to this change in discourse. However, GHAs should go a step further and translate their words into action, so that free healthcare at the point of delivery becomes a reality in low- and middle-income countries. They should provide technical and financial support to those countries that have chosen to implement user fee exemption policies, sometimes influenced by a GHA.

Show MeSH