The sudden removal of user fees
The perspective of a frontline manager in Burundi
Bibliographic Data
| ID | 11490381 |
|---|---|
| Authors | Manassé Nimpagaritse (0000-0002-0760-4048, Ministère de la Santé Publique, corresponding author), Maria Paola Bertone (0000-0001-8890-583X, Ministère de la Santé Publique) |
| Year | 2011 |
| Volume | 26 |
| Issue | Suppl. 2 |
| Pages | ii63-ii71 |
| Publication date | 2011-11-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health Policy and Planning (JOURNAL) |
| Journal identifiers | ISSN: 0268-1080 • E-ISSN: 1460-2237 |
| Publisher | Oxford University Press (PUBLISHER • GB) |
| DOI | 10.1093/heapol/czr061 |
| PMID | 22027921 |
| OpenAlex | W2137081808 |
| Language | EN |
| Citations received | 21 |
| References cited | 20 |
In May 2006, the President of Burundi announced the removal of user fees in all health centres and hospitals for children under 5 and women giving birth. As other studies also point out, the policy was adopted extremely suddenly, without much reflection on its ultimate aims and on the operational dimension of its implementation. From the perspective of a frontline manager, this paper provides a descriptive case study of the abolition of user fees in the Muramvya District and a first-hand account of the effects of the sudden reform in the management of a district and a district hospital. The analysis highlights the challenges that the district and hospital teams faced. The main issues were: the reduction of financial flows, which prevented the possibility of investments and caused frequent drugs stock-outs; the reduced quality of the services and the disruption of the referral system; the motivation of the health staff who saw the administrative workload increase (not necessarily because of increased utilization) and faced 'ethical dilemmas' caused by the imprecise targeting of the reform. Undoubtedly, the removal of user fees for certain groups was an equitable and necessary measure in an extremely poor country such as Burundi. However, the suddenness of the decision and the lack of preparation had critical and long-lasting consequences for the entire health system. This analysis, performed from the frontline perspective, clarifies the importance of a rigorous planning of any reform, as well as of involving peripheral actors and understanding the complex challenges that they face.
Business · Descriptive research · Economics · Perspective (graphical) · Quality (philosophy) · Referral · Sociology · Workload · Finance · Global Maternal and Child Health · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine · Nursing
Global health actors no longer in favor of user fees
Improving financial access to health care in the Kisantu district in the Democratic Republic of Congo
Healthcare seeking for diarrhoea, malaria and pneumonia among children in four poor rural districts in Sierra Leone in the context of free health care
Patient access to health care and medicines across low-income countries
The effects of performance incentives on the utilization and quality of maternal and child care in Burundi
Au-delà du modèle voyageur ? Usage stratégique et hybridation du financement basé sur la performance (FBP) dans la santé au Burundi
Infant Mortality and Desired Fertility
A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002–2012
Implementation of free maternal and child healthcare policies
Physicians’ and nurses’ attitudes towards performance-based financial incentives in Burundi
The effect of performance-based financing on maternal healthcare use in Burundi
Removing user fees for health services in low-income countries
Removing user fees in the health sector
The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi
Decision space and participation of primary healthcare facility managers in the Ideal Clinic Realisation and Maintenance programme in two South African provinces
Exploring health facilities’ experiences in implementing the free health-care policy (FHCP) in Nepal
Studying the link between institutions and health system performance
User fee removal in low-income countries
Performance-based financing in the context of selective free health-care
A critical interpretive synthesis of informal payments in maternal health care
The impact of free healthcare on women's capability
Removing user fees for primary care in Africa
To Retain or Remove User Fees?
Universal health care and the removal of user fees
Financial access to health care in Karuzi, Burundi
Macroeconomics and health
A scoping review of the literature on the abolition of user fees in health care services in Africa
Removing user fees in the health sector
Detention of insolvent patients in Burundian hospitals
Abolition of cost-sharing is pro-poor
Doing' health policy analysis
Power and positionality
We are bitter but we are satisfied
The Experience of Ghana in Implementing a User Fee Exemption Policy to Provide Free Delivery Care
| Citations per year | 1.4 |
|---|---|
| Citation span | 2011 - 2022 (12) |
| Highly cited | No |