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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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Distribution of GHAs by year of publication of documents. This figure shows the distribution of GHAs by year of publication of documents in which they state that they are in favor of free care at the point of delivery or in favor of abolition of user fees. The size of each year block is proportional to the number of documents published that year. When the number of documents published by a GHA is more than one, the total number is indicated in brackets. The name of the GHA is highlighted when it is the first time it takes a positive stance from 2005.
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Figure 3: Distribution of GHAs by year of publication of documents. This figure shows the distribution of GHAs by year of publication of documents in which they state that they are in favor of free care at the point of delivery or in favor of abolition of user fees. The size of each year block is proportional to the number of documents published that year. When the number of documents published by a GHA is more than one, the total number is indicated in brackets. The name of the GHA is highlighted when it is the first time it takes a positive stance from 2005.

Mentions: The majority of the documents in which the GHAs took a stance in favor of free care or in favor of abolishing user fees were published between 2008 and 2010 (Figure 3). Between 2005 and 2007, 19 documents (29%) were published, six of these (32%) by INGOs, while 43 (66%) were published between 2008 and 2010.


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

Robert E, Ridde V - Global Health (2013)

Distribution of GHAs by year of publication of documents. This figure shows the distribution of GHAs by year of publication of documents in which they state that they are in favor of free care at the point of delivery or in favor of abolition of user fees. The size of each year block is proportional to the number of documents published that year. When the number of documents published by a GHA is more than one, the total number is indicated in brackets. The name of the GHA is highlighted when it is the first time it takes a positive stance from 2005.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Distribution of GHAs by year of publication of documents. This figure shows the distribution of GHAs by year of publication of documents in which they state that they are in favor of free care at the point of delivery or in favor of abolition of user fees. The size of each year block is proportional to the number of documents published that year. When the number of documents published by a GHA is more than one, the total number is indicated in brackets. The name of the GHA is highlighted when it is the first time it takes a positive stance from 2005.
Mentions: The majority of the documents in which the GHAs took a stance in favor of free care or in favor of abolishing user fees were published between 2008 and 2010 (Figure 3). Between 2005 and 2007, 19 documents (29%) were published, six of these (32%) by INGOs, while 43 (66%) were published between 2008 and 2010.

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