TY - JOUR
T1 - Removal of user fees for caesareans and under-fives in northern Sudan
T2 - a review of policy implementation and effectiveness
AU - Witter, Sophie
AU - Khalid Mousa, Khalda
AU - Abdel-Rahman, Manar E
AU - Hussein Al-Amin, Rania
AU - Saed, Mohammed
N1 - Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2013/1
Y1 - 2013/1
N2 - In 2008, the Government of Sudan launched a policy of free curative care for under-fives and caesareans. This paper presents the findings of a review of this policy, on the basis of research conducted in five focal states of northern Sudan in 2010. Policy implementation was assessed using four research tools: key informant interviews, exit interviews, a facility survey, and analysis of facility finances and the cost of the package of care. The findings point to important weaknesses in implementation, such as unclear specification of the exact target group and package of care and inadequate funding. Despite this, service utilisation appears to have responded, at least in the short term. The findings also highlight the urgent need for improved access to basic health care and financial protection against health care costs in northern Sudan (for those with and without national health insurance membership). This review contributes to the growing literature on the selective removal of user fees for priority services. It indicates the range of challenges to effective implementation (strategic, financial and organisational). Some of these are particular to Sudan, but many are shared, and indicate important lessons for improving access to and quality of care for women and children in Africa.
AB - In 2008, the Government of Sudan launched a policy of free curative care for under-fives and caesareans. This paper presents the findings of a review of this policy, on the basis of research conducted in five focal states of northern Sudan in 2010. Policy implementation was assessed using four research tools: key informant interviews, exit interviews, a facility survey, and analysis of facility finances and the cost of the package of care. The findings point to important weaknesses in implementation, such as unclear specification of the exact target group and package of care and inadequate funding. Despite this, service utilisation appears to have responded, at least in the short term. The findings also highlight the urgent need for improved access to basic health care and financial protection against health care costs in northern Sudan (for those with and without national health insurance membership). This review contributes to the growing literature on the selective removal of user fees for priority services. It indicates the range of challenges to effective implementation (strategic, financial and organisational). Some of these are particular to Sudan, but many are shared, and indicate important lessons for improving access to and quality of care for women and children in Africa.
KW - Sudan
KW - exemption policies
KW - user fees
KW - emergency obstetric care
KW - child health
KW - health financing
UR - http://www.scopus.com/inward/record.url?scp=84867894503&partnerID=8YFLogxK
U2 - 10.1002/hpm.2146
DO - 10.1002/hpm.2146
M3 - Article
C2 - 23108997
AN - SCOPUS:84874564018
SN - 0749-6753
VL - 28
SP - e95-e120
JO - International Journal of Health Planning and Management
JF - International Journal of Health Planning and Management
IS - 1
ER -