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How to remove user fees

The Policy Process of Removing user fees in health services in low-income countries: a framework for a multi country review. How to remove user fees. David Hercot, Bruno Meessen, Valery Ridde & Lucy Gilson. Rationale for the review Methodology for the review

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How to remove user fees

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  1. The Policy Process of Removing user fees in health services in low-income countries: a framework for a multi country review How to remove user fees David Hercot, Bruno Meessen, Valery Ridde & Lucy Gilson

  2. Rationale for the review Methodology for the review The Five Elements of The Framework Discussion Outline

  3. Rationale for the Review

  4. Rationale for the Review

  5. Methodology for the review

  6. Unintendedpositiveimpact Intended impact Unintendednegativeimpact process context content actors Five Elements of the Policy Process

  7. Methodology for the Review • Good Practice Hypothesis a well-documented and assessed practice that provide evidence of success/impact and which are valuable for replication, scaling up and further study

  8. Unintendedpositiveimpact Intended impact Unintendednegativeimpact process context content actors Five Elements of the Policy Process

  9. Process: The Rational Planning cycle

  10. Process: Preliminary situation analysis • 1. Thorough Situation Analysis

  11. Process: Priority Setting • 2. Clear Policy Objectives • 3. Vision, ownership and leadership

  12. Process: Option Appraisal • 4. Use of International and National Scientific evidence • 5. Considering different policy options • 6. Thorough assessment of the option • 7. Early identification of accompanying measures • 8. Preferences of key stakeholders met • Involve Stakeholders when designing

  13. Replace lost revenues: • increased salaries, • PHC funds, • special additional funds for drugs. • Revision of incurred costs Did Senegal consider the expected increase in utilisation?

  14. Process: Programming • 9. Testing the reform • 10. Planning implementations steps • 11. Commitment on budgetary burden • 12. Clear and robust rules for transferring resources

  15. In both countries, No assessment of first stage before phase 2

  16. Process: The Rational Planning cycle

  17. Process: Implementation • 13. Technical leadership • 14. Coordination unit • 15. Capacity building • 16. Communication strategies • 17. Actors abide by the new rules

  18. An existing task force took the responsibility to follow up implementation issues The coordination unit did not produce procedure manual nor policy paper in 6 months

  19. Process:Monitoring and Evaluation • 18. Monitoring and Evaluation • Indicators: • utilization rate, the disbursement rate, drugs stock out, • Longer term evaluation • patient satisfaction, financial protection, quality of care,

  20. Unintendedpositiveimpact Intended impact Unintendednegativeimpact process context content actors Five Elements of the Policy Process

  21. Context

  22. Context

  23. Actors

  24. Content : Analyzing contracts • Government – users • Free Care • Government – Facilities • Access to resource and their use

  25. Content over time

  26. Unintendedpositiveimpact Intended impact Unintendednegativeimpact process context content actors Five Elements of the Policy Process

  27. Impact

  28. Discussion

  29. Thank you http://www.itm.eu/unicef

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