The national free delivery and caesarean policy in Senegal

Evaluating process and outcomes

Dados Bibliográficos

ID11490240
AutoresSophie Witter (0000-0002-7656-6188, Inserm, autor correspondente), T Dieng (Inserm), D Mbengue (Inserm), Isabel Maria Pinheiro Borges Moreira (0000-0002-6371-003X, Inserm), I Moreira, Vincent De Brouwere (0000-0001-8560-6041, Inserm)
Ano2010
Volume25
Fascículo5
Páginas384-392
Data de publicação2010-09-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoHealth Policy and Planning (JOURNAL)
Identificadores do periódicoISSN: 0268-1080 • E-ISSN: 1460-2237
EditoraOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czq013
PMID20360258
OpenAlexW2162439524
IdiomaEN
Citações recebidas30
Referências citadas8

This article presents the results of an evaluation of the free delivery and caesarean policy (FDCP) in Senegal. The policy was introduced into five poor regions in 2005 and in 2006 was extended at regional hospital level to all regions apart from the capital (Dakar). The evaluation was carried out in 2006-7. There were four research components, all focused on selected facilities and districts within the five FDCP regions: a financial analysis of expenditure on the policy and wider health financing in the five regions and nationally; 54 key informant interviews from national down to facility level; 10 focus group discussions and 8 in-depth interviews; and analysis based on clinical record extraction of 761 major obstetric interventions. The evaluation found significant implementation difficulties, especially related to the allocation of funds and kits and the adequacy of their contents. Despite that, significant increases in utilization in normal deliveries (from 40% to 44% of expected deliveries in FDCP areas over 2004-5) and in caesarean rates (rising from 4.2% to 5.6% in FDCP areas) were recorded. National data suggested that these trends were not found in non-FDCP regions. Using the evaluation data, the cost per additional caesarean under the policy was US$467 and the cost per additional supervised normal delivery was US$21. The article concludes that, in order to achieve its full potential, the FDCP requires improved systems for planning and allocating resources, and new channels to reimburse lower level facilities. It is also important that all complicated deliveries (not just caesareans) are included in the package. In the case of Senegal, a complementary strategy of investment in facilities, transportation and staffing is required to bring greater geographical access and upgrade services. These findings are likely to be relevant to other countries currently experimenting with similar approaches to reducing financial barriers to skilled attendance at delivery.

Business · Caesarean section · Economic growth · Economics · Environmental health · Health care · Health facility · Health services · Operations management · Population · Pregnancy · Psychological intervention · Global Health Workforce Issues · Global Maternal and Child Health · Maternal and Perinatal Health Interventions · Medicine · Nursing