Global health actors no longer in favor of user fees: a documentary study
Tóm tắt
Since the advent of health user fees in low- and middle-income countries in the 1980s, the discourse of global health actors (GHAs) has changed to the disadvantage of this type of healthcare financing mechanism. The aim of the study was to identify and analyze the stance of GHAs in the debate on user fees. We conducted documentary research using public documents published by and officially attributed to GHAs from 2005 to 2011. We categorized GHAs into four groups: intergovernmental organizations, international non-governmental organizations, government agencies, and working groups and networks. We then classified the GHAs according to their stance relative to the abolition of user fees, and conducted a thematic analysis of their discourse to understand the arguments used by each GHA to justify its stance. We identified 56 GHAs, for which we analyzed 140 documents. Among them, 55% were in favor of the abolition of user fees or in favor of free care at the point of delivery. None of the GHAs stated that they were in favor of user fees; however, 30% did not take a stand. Only the World Bank declares that it is both in favor of user fees and in favor of free care at point of service. GHAs generally circumscribe their stance to specific populations (pregnant women, children under 5 years, etc.) or to specific health services (primary, basic, essential). Three types of arguments are used by GHAs to justify their stance: economic, moral and ethical, and pragmatic. The principle of “user pays” seems to have fizzled. Production and dissemination of evidence, as well as certain advocacy networks, may have contributed to this change in discourse. However, GHAs should go a step further and translate their words into action, so that free healthcare at the point of delivery becomes a reality in low- and middle-income countries. They should provide technical and financial support to those countries that have chosen to implement user fee exemption policies, sometimes influenced by a GHA.
Tài liệu tham khảo
Rodin J, De Ferranti D: Universal health coverage: The third global health transition?. Lancet. 2012, 380: 861-862. 10.1016/S0140-6736(12)61340-3.
Appiah B: Universal health coverage still rare in Africa. CMAJ. 2012, 184: E125-126.
Knaul FM, Wong R, Arreola-Ornelas H, Mendez O: Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean Countries. Salud Publica Mex. 2011, 53: S85-S95.
Tangcharoensathien V, Patcharanarumol W, Ir P, Aljunid SM, Mukti AG, Akkhavong K, Banzon E, Huong DB, Thabrany H, Mills A: Health-financing reforms in southeast Asia: challenges in achieving universal coverage. Lancet. 2011, 377: 863-873. 10.1016/S0140-6736(10)61890-9.
Gilson L, McIntyre D: Removing user fees for primary care in Africa: the need for careful action. BMJ. 2005, 331: 762-765. 10.1136/bmj.331.7519.762.
De Ferranti D: Paying for health services in developing countries: An overview. 1985, Washington: The World Bank
Akin J, Birdsall N, De Ferranti D: Financing health services in developing countries: An agenda for reform. 1987, Washington: The World Bank
Ridde V: Is the Bamako Initiative still relevant for West African health systems?. Int J Health Serv. 2011, 41: 175-184. 10.2190/HS.41.1.l.
Deschamps J-P: Les enjeux de santé publique dans les pays en voie de développement: Sciences, société et éthique. Médecine sciences. 2000, 16: 1211-1217.
Canadian Public Health Association: Sustainability and equity: primary health care in developing countries (position paper). 1990, Ottawa: CPHA
James CD, Hanson K, McPake B, Balabanova D, Gwatkin D, Hopwood I, Kirunga C, Knippenberg R, Meessen B, Morris SS, Preker A, Souteyrand Y, Tibouti A, Villeneuve P, Xu K: To retain or remove user fees? Reflections on the current debate in low- and middle-income countries. Appl Health Econ Health Policy. 2006, 5: 137-153. 10.2165/00148365-200605030-00001.
Gilson L: The lessons of user fee experience in Africa. Health Policy Plan. 1997, 12: 273-285. 10.1093/oxfordjournals.heapol.a018882.
Ridde V, Girard JE: Douze ans après l’initiative de Bamako: Constats et implications politiques pour l’équité d’accès aux services de santé des indigents Africains. Sante Publique. 2004, 1: 37-51.
Whitehead M, Dahlgren G, Evans T: Equity and health sector reforms: Can low-income countries escape the medical poverty trap?. Lancet. 2001, 358: 833-836. 10.1016/S0140-6736(01)05975-X.
Lagarde M, Palmer N: The impact of user fees on access to health services in low and middle-income countries. Cochrane Database Syst Rev. 2011, 4: CD009094
United Nations: Millennium Development Goals: 2012 Progress Chart. 2012, New York: United Nations
McIntyre D, Thiede M, Dahlgren G, Whitehead M: What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?. Soc Sci Med. 2006, 62: 858-865. 10.1016/j.socscimed.2005.07.001.
Ridde V, Robert E, Meessen B: A literature review of the disruptive effects of user fee exemption policies on health systems. BMC Publ Health. 2012, 12: 289-10.1186/1471-2458-12-289.
Robert E, Samb OM: Pour une cartographie des soins de santé gratuits en Afrique de l'Ouest. Afrique Contemporaine. 2012, 100-101.
Yates R: Universal health care and the removal of user fees. Lancet. 2009, 373: 2078-2081. 10.1016/S0140-6736(09)60258-0.
Hutton G: Charting the path to the World Bank’s “No blanket policy on user fees”: a look over the past 25 years at the shifting support for user fees in health and education, and reflections on the future. 2004, London: DFID
Editorial: The struggle for universal health coverage. Lancet. 2012, 380: 859-10.1016/S0140-6736(12)61485-8.
Stone D: Global public policy, transnational policy communities, and their networks. Policy Stud J. 2008, 36: 19-38. 10.1111/j.1541-0072.2007.00251.x.
Kapiriri L: Priority setting in low income countries: the roles and legitimacy of Development Assistance Partners. Public Health Ethics. 2012, 5: 67-80. 10.1093/phe/phs004.
Varvasovszky Z, Brugha R: How to do (or not to do)… A stakeholder analysis. Health Policy Plan. 2000, 15: 338-345. 10.1093/heapol/15.3.338.
Cellard A: L'analyse documentaire. La recherche qualitative : Enjeux épistémologiques et méthodologiques. Edited by: Poupart J, Deslauriers JP, Groulx LH, Laperrière A, Mayer R, Pires A. 1997, Montréal: gaëtan morin éditeur, 85-111.
Evans G, Newnham J: The Penguin dictionary of international relations. 1998, London: Penguin Books
Szlezak NA, Bloom BR, Jamison DT, Keusch GT, Michaud CM, Moon S, Clark WC: The global health system: Actors, norms, and expectations in transition. PLoS Med. 2010, 7: 10.1371/journal.pmed.1000183.
White C, Raman N: The World Wide Web as a public relations medium: the use of research, planning, and evaluation in web site development. Public Relat Rev. 1999, 25: 405-419. 10.1016/S0363-8111(99)00027-2.
Brugha R, Varvasovszky Z: Stakeholder analysis: a review. Health Policy Plan. 2000, 15: 239-246. 10.1093/heapol/15.3.239.
Gilson L, Erasmus E, Borghi J, Macha J, Kamuzora P, Mtei G: Using stakeholder analysis to support moves towards universal coverage: lessons from the SHIELD project. Health Policy Plan. 2012, 27: i64-i76. 10.1093/heapol/czs007.
Hyder A, Syed S, Puvanachandra P, Bloom G, Sundaram S, Mahmood S, Iqbal M, Hongwen Z, Ravichandran N, Oladepo O, Pariyo G, Peters D: Stakeholder analysis for health research: case studies from low- and middle-income countries. Public Health. 2010, 124: 159-166. 10.1016/j.puhe.2009.12.006.
Freelon D: ReCal: intercoder reliability calculation as a web service. International J Internet Sci. 2010, 5: 20-33.
Joint United Nations Programme on HIV/AIDS: Countdown to zero: Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. 2011, Geneva: UNAIDS
The World Bank: Healthy development: The World Bank strategy for health, nutrition and population results. 2007, Washington: The World Bank
World Vision: Who’s counting? 9.2 million children – the cost of inaction on child health. 2009, Monrovia: World Vision
Countdown to 2015: Countdown to 2015 decade report (2000–2010): Taking stock of maternal, newborn and child survival. 2010, Washington: WHO and UNICEF
Merlin: All mothers matter. Investing in health sector to save lives in fragile states. 2009, London: Merlin
Save the Children UK: No child born to die: Closing the gaps. 2011, London: Save the Children UK
Coordination Sud: Préparation du G8 de Hokkaido, Toyako, Japon 7–9 Juillet 2008. 2008, Paris: Propositions des ONG françaises
The Global Campaign for the Health Millennium Development Goals: Leading by example – Protecting the most vulnerable during the economic crisis. 2009, Oslo: Office of the Prime Minister of Norway
Action for Global Health: 2010 reality check: Time is running out to meet the health MDGs. 2010, Brussels: Action for Global Health
Department for International Development: Eliminating world poverty. Making governance work for the poor. A white paper on international development. 2006, London: DFID
Merlin: Merlin's role in health financing. 2007, London: Merlin
Commission for Africa: Our common interest: report of the Commission for Africa. 2005, London: Commission for Africa
UN Millennium Project: Who's got the power? Transforming health systems for women and children. Achieving the Millennium Development Goals. 2005, London: Earthscan
Department for International Development: Working together for better health. 2007, London: DFID
Save the Children UK: An unnecessary evil? User fees for healthcare in low-income countries. 2005, London: Save the Children UK
MDG Africa Steering Group: Achieving the Millennium Development Goals in Africa. 2008, New York: United Nations Department of Public Information
World Health Organization: The world health report 2008: Primary health care now more than ever. 2008, Geneva: WHO
Médecins du Monde: L'accès gratuit aux soins de santé primaire : Une stratégie payante. Appel au G8. 2008, Paris: Médecins du Monde France
Council of the European Union: The EU as a global partner for pro-poor and pro-growth development: EU Agenda for Action on MDGs. 2008, Brussels: Council of the European Union
Federal Ministry for Economic Cooperation and Development: Promoting Health - Fighting HIV / AIDS. 2007, Berlin: Federal Ministry for Economic Cooperation and Development
Médecins Sans Frontières: Full prescription. Better malaria treatment for more people, MSF's experience. 2008, Brussels: Médecins Sans Frontières
Action Mondiale Contre la Pauvreté - France: Health for development: Challenges and responsibilities: At the midway point in the Millennium development goals, where do we stand on health? The French civil society recommendations. 2008, Paris: Action Mondiale Contre la Pauvreté - France
G8: G8 Hokkaido Toyako Summit Leaders Declaration. 2008, Toyako: G8
Action for Global Health: Improving the health of children across the world needs to be made a priority by governments. 2010, Strasbourg: Action for Global Health
The World Bank: The World Bank's reproductive health action plan 2010–2015. 2010, Washington: The World Bank
ECHO: DG ECHO position paper on user fees for primary health services in humanitarian crises. 2009, Brussels: ECHO
G8: Responsible leadership for a sustainable future. 2009, L'Aquila: G8
Save the Children UK: Health user fees - The case against. 2009, London: Save the Children UK
Ministry of Foreign Affairs of Denmark: Health and development: A guidance note to Danish development assistance to health. 2009, Copenhagen: Ministry of Foreign Affairs of Denmark
African Union: The new partnership for Africa's development (NEPAD): health strategy. 2007, Addis Ababa: African Union
Council of the European Union: Council conclusions on the EU role in Global Health. 2010, Brussels: Council of the European Union
Sixty-fourth World Health Assembly: Sustainable health financing structures and universal coverage. 2011, New York: World Health Assembly
World Health Organization: Health systems financing: The path to universal coverage. 2010, Geneva: WHO
African Union: Africa Health Strategy: 2007–2015. 2007, Addis Ababa: African Union
Oxfam International: Blind optimism: Challenging the myths about private health care in poor countries. 2009, Oxford: Oxfam International
Task Force on Global Action for Health System Strengthening: Global Action for Health System Strengthening. 2009, Tokyo: Japan Center for International Exchange
Council of the European Union: Council Conclusions on the promotion and protection of the rights of the child in the European Union's external action - the development and humanitarian dimensions. 2008, Brussels: Council of the European Union
Médecins Sans Frontières: No cash, no care: How "user fees" endanger health. An MSF briefing paper on financial barriers to healthcare. 2008, Brussels: Médecins Sans Frontières
Oxfam International: In the public interest: Health, education, and water and sanitation for all. 2006, Oxford: Oxfam International
Global Health Watch: Global Health Watch 2005-2006: An alternative world health report. 2005, London: Zed Books Ltd
Save the Children UK: Saving children's lives: Why equity matters. 2008, London: Save the Children UK
People's Health Movement: People's Charter for Health. 2009, Cape Town: People's Health Movement
Commission of the European Communities: A European Programme for Action to Confront HIV/AIDS, Malaria and Tuberculosis through External Action (2007–2011). 2005, Brussel: Commission of the European Communities
Save the Children UK: Paying with their live: The cost of illness for children in Africa. 2006, London: Save the Children UK
World Vision: Child health now: Together we can end preventable deaths. 2009, Monrovia: World Vision
International Labour Office: World social security report. 2010, Geneva: International Labour Organization
Oxfam International: Oxfam International strategic plan 2007–2012: Demanding justice. 2007, The Hague: Oxfam International
Save the Children: Investing in impact for children: Save the Children 2013–2015 strategic plan. 2013, Westport: Save the Children
Doctors without borders / Médecins sans frontières: History and principles. http://www.doctorswithoutborders.org/aboutus/?id=5226%26;cat=about-us-pages,
Doctors of the world / Médecins du Monde: The principles and values of the network. http://www.mdm-international.org/spip.php?article79,
King NB: Security, disease, commerce: ideologies of postcolonial global health. Soc Stud Sci. 2002, 32: 763-789.
Feldbaum H, Michaud J: Health diplomacy and the enduring relevance of foreign policy interests. PLoS Med. 2010, 7: 10.1371/journal.pmed.1000226.
Fournier P, Haddad S, Mantoura P: Réformes des systèmes de santé dans les pays en développement : l'irrésistible emprise des agences internationales et les dangers de la pensée unique. La santé au risque du marché : incertitudes à l'aube du XXIème siècle. Edited by: Nouveaux Cahiers De l'IUED . 2001, Paris: Presses Universitaires de France, 71-84.
Lee K, Goodman H: Global policy networks: The propagation of health care financing reform since the 1980s. Health Policy in a Globalising World. Volume 2. Edited by: Kelley L, Buse K, Fustukian S. 2002, Cambridge: Cambridge University Press, 97-119.
Serre M, Pierru F: Les organisations internationales et la production d'un sens commun réformateur de la politique de protection Maladie. Lien social et Politiques. 2001, 105-128.
Kickbusch I: The development of international health policies–accountability intact?. Soc Sci Med. 2000, 51: 979-989. 10.1016/S0277-9536(00)00076-9.
Kim JY: Poverty, health and the human future. 2013, Geneva: World Health Assembly, http://www.worldbank.org/en/news/speech/2013/05/21/world-bank-group-president-jim-yong-kim-speech-at-world-health-assembly,
Bryant T: Role of knowledge in public health and health promotion policy change. Health Promot Int. 2002, 17: 89-98. 10.1093/heapro/17.1.89.
Touré L: La baisse de qualité, prix à payer pour un meilleur accès aux soins ?. Afrique Contemporaine. 2012, 243: 49-63. 10.3917/afco.243.0049.
Edwards M: 'Does the doormat influence the boot?': critical thoughts on UK NGOs and international advocacy. Dev Pract. 1993, 3: 163-175. 10.1080/096145249100077281.
Whitehead M, Dahlgren G, Gilson L: Developing the policy response to inequities in health: a global perspective. Challenging inequities in health: From ethics to action. Edited by: Evans T, Whitehead M, Diderichsen F, Bhuiya A, Wirth M. 2001, New York: Oxford University Press, 309-323.
Niessen LW, Grijseels EW, Rutten FF: The evidence-based approach in health policy and health care delivery. Soc Sci Med. 2000, 51: 859-869. 10.1016/S0277-9536(00)00066-6.
Save the Children UK: Killer bills: Make child poverty history - abolish user fees. 2005, London: Save the Children UK
Thelen K: Historical institutionalism in comparative politics. Annual Review of Political Science. 1999, 2: 369-404. 10.1146/annurev.polisci.2.1.369.
Sabatier PA: Knowledge, policy-oriented learning, and policy change: an advocacy coalition framework. Sci Commun. 1987, 8: 649-692. 10.1177/0164025987008004005.
Keck ME, Sikkink K: Transnational advocacy networks in international and regional politics. Int Soc Sci J. 1999, 51: 89-101. 10.1111/1468-2451.00179.
Hassenteufel P: Sociologie politique : l'action publique. 2008, Paris: A. Colin
Richard F, Hercot D, Ouédraogo C, Delvaux T, Samaké S, Van Holmen J, Conombo G, Hammonds R, Vandemoortele J: Sub-Saharan Africa and the health MDGs: the need to move beyond the "quick impact" model. Reprod Health Matters. 2011, 19: 42-55.
Ousseini A: Une politique publique de santé au Niger: La mise en place d'exemptions de paiement des soins en faveur des femmes et des enfants. 2011, Niamey: LASDEL
Meessen B, Hercot D, Noirhomme M, Ridde V, Tibouti A, Tashobya CK, Gilson L: Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries. Health Policy Plan. 2011, 26 (Suppl 2): ii16-29.
Nimpagaritse M, Bertone MP: The sudden removal of user fees: the perspective of a frontline manager in Burundi. Health Policy Plan. 2011, 26 (Suppl 2): 63-71.
Chuma J, Musimbi J, Okungu V, Goodman C, Molyneux C: Reducing user fees for primary health care in Kenya: policy on paper or policy in practice?. International journal for equity in health. 2009, 8: 15-10.1186/1475-9276-8-15.
Witter S, Armar-Klemesu M, Dieng T: National fee exemption schemes for deliveries: comparing the recent experiences of Ghana and Senegal. Reducing Financial Barriers to Obstetric Care in Low-Income Countries. Edited by: Richard F, Witter S, De Brouwere V. 2008, Antwerp: Institute of Tropical Medicine, 167-198.
Atim C, Wang H: How should we track progress toward universal health coverage in low-income countries?. African Journal of Health Economics. 2012, 2: E-publication ahead of print
Penfold S, Harrison E, Bell J, Fitzmaurice A: Evaluation of the delivery fee exemption policy in Ghana: population estimates of changes in delivery service utilization in two regions. Ghana Med J. 2007, 41: 100-109.
Pariyo GW, Ekirapa-Kiracho E, Okui O, Rahman MH, Peterson S, Bishai DM, Lucas H, Peters DH: Changes in utilization of health services among poor and rural residents in Uganda: Are reforms benefitting the poor?. IJEH. 2009, 8: 39-
Witter S, Dieng T, Mbengue D, Moreira I, De Brouwere V: The national free delivery and caesarean policy in Senegal: evaluating process and outcomes. Health Policy Plann. 2010, 25: 384-392. 10.1093/heapol/czq013.
Meessen B: Free health care as a step towards Universal Health Coverage? Maybe, but only if we learn from the recent past. http://www.healthfinancingafrica.org/3/post/2013/03/free-health-care-as-a-step-towards-universal-health-coverage-maybe-but-only-if-we-learn-from-the-recent-past.html,