Fee exemption policies for maternal health services
This presentation is the property of its rightful owner.
Sponsored Links
1 / 18

Fee exemption policies for maternal health services PowerPoint PPT Presentation


  • 87 Views
  • Uploaded on
  • Presentation posted in: General

Fee exemption policies for maternal health services. A Review of 11 African countries Benin, Burkina Faso, Burundi, Ghana, Mali, Morocco, Niger, Nigeria, Kenya, Senegal, Sierra Leone Fabienne Richard, ITM Antwerp & Matthieu Antony, CERDI Clermont-Ferrand. Purpose of the review.

Download Presentation

Fee exemption policies for maternal health services

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Fee exemption policies for maternal health services

A Review of 11 African countries

Benin, Burkina Faso, Burundi, Ghana, Mali, Morocco, Niger, Nigeria, Kenya, Senegal, Sierra Leone

Fabienne Richard, ITM Antwerp & Matthieu Antony, CERDI Clermont-Ferrand


Purpose of the review

  • 1st objective:Compare the benefits package covered by the fee exemption policies across the three dimensions of universal coverage:

    • The breadth (percentage of population covered )

    • The depth (range of services covered)

    • The height (proportion of coveredcosts)

2


The three dimensions of universalcoverage:

Exemption policy coverage

Couverture de la politique d’exemption

3


Purpose of the review (part 2)

  • 2nd objective :

    Compare the funding modalities of these targeted policies

    • Reimbursement system for health facilities

    • Estimation of the budget envelope at national level

    • Forecast versus disbursed budget

4


Methodology

  • Questionnaire developed by the FEM Health team with validation by the workshop organizing committee (2 parts: content and funding)

  • Pre-test in Burkina Faso

  • Sent to all countries that participated at the workshop by email to a key informant at central level

  • Follow-up by telephone and email

  • Comparative analysis of 11 sheets

5


Result of part 1


Chronology of the policies introduction

Kenya

Phase 1

Senegal

Phase 2

Nigeria

Phase 1

Ghana

Phase 2

Burundi

Child under 5, Delivery, C-.Section

Kenya

Phase 2

Burundi

Pregnancy-related diseases

Senegal

Phase 1

Niger

Ghana

Phase 3

Nigeria

Phase 2

Ghana

Phase 1

Mali

Burkina Faso

C-section

Burkina Faso

Delivery

Morocco

Benin

Sierra Leone

Kenya

Phase 3

2004

2005

2006

2007

2008

2009

2010

2011

7


Benin

Mali

Senegal

Burkina Faso

Burundi

Ghana

Kenya (according to income)

Morocco

Niger

Nigeria

Sierra Leone (+ breastfeeding women)

Who is covered?

8


Kenya: some regions only

Nigeria: some regions only

Senegal: Dakar not covered

Benin

Burkina Faso

Burundi

Ghana

Morocco

Mali

Niger

Sierra Leone

In what area of the country?

Targeted regions

Everywhere

9


In which hospitals?

KenyaGhanaNigeria*

* except at tertiary level hospitals

Benin Burkina Faso

Burundi

10


Which services are covered?

Covered by another exemption or subsidy policy

DC = Directs obstetric Complications

Hyster= hysterectomy

Ect.P = Ectopic Pregnancy

+++

++

+

11


Costs covered by the fee exemption or subsidy policies

* Emergency Medical Services (EMS) rural in Morocco in isolated areas

12


Proportion of covered costs

  • The majority of countries cover 100% of the costs of target services under the policy

  • 2 countries require some co-pay for direct costs of targeted services

    • Burkina Faso (80% of directs costs)

    • Kenya (ticket between 1 to 2 $)

13


System set up to comply with different referral levels

  • Burkina Faso:

    • Delivery reimbursement = 80% in health centre and district hospitals

    • Reimbursement = 60% in regional and national hospitals

  • Morocco:

    • Exemption policy applied in UHC only for referred women

14


A multitude of targeted exemption policies

Most countries also have a national policy to cover the indigent, but they are not always implemented in practice.

* Ghana has exemption for Children under 18 enrolling onto the NHIS.

15


Synthesis

  • The minimum in common in the 11 countries is the management of Caesarean section

  • Other obstetric complications:

    • 2 countries do not cover other obstetric complications during labour and interventions other than Caesarean section

    • 4 countries do not cover postnatal complications

  • Transport costs:

    • Only Morocco covers transport from home to the health facility through rural EMS (in 24 provinces with difficult access)

    • Only 5 of 11 countries cover the costs of transportation between health facilities

  • Targeting the poorest:

    • The majority of policies apply to the entire population of pregnant women regardless of their income except for Kenya (policy targets poor pregnant women).

16


Complexity and variety of strategies

  • There is no single common strategy for fee exemption policies for maternal and child health care = no cut and paste, each country has a different system.

  • The majority of these policies do not cover all maternal and neonatal care so it is always partially paid for by the patient/family.

  • Exemption policies for maternal and neonatal care are not unique:

    • Several other exemption policies target other diseases or populations.

    • Several countries are simultaneously developing a national health insurance system

  • Complex architecture for fee exemption policies:

    • Do health personnel see their place in it? Do populations?

    • Is there coordination among these different targeted exemption policies?

    • Is there coordination among these fee exemption policies and institutional framework being set up for health insurance ?

17


Targeted exemption policies :can we do better?

Pregnant womenUnder fiveElderly…

C-section & DeliveriesTB, Malaria, HIVFamily Planning

Health centre

Hospitals, 1st, 2nd, 3rd level?


  • Login