Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for healthReportar como inadecuado

Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Human Resources for Health

, 11:46

First Online: 22 September 2013Received: 17 January 2013Accepted: 29 August 2013


BackgroundThe last decade has seen widespread retreat from user fees with the intention to reduce financial constraints to users in accessing health care and in particular improving access to reproductive, maternal and newborn health services. This has had important benefits in reducing financial barriers to access in a number of settings. If the policies work as intended, service utilization rates increase. However this increases workloads for health staff and at the same time, the loss of user fee revenues can imply that health workers lose bonuses or allowances, or that it becomes more difficult to ensure uninterrupted supplies of health care inputs.

This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health.

MethodsWe undertook case studies in five countries Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe. In each we reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors.

ResultsWe question a number of common assumptions about the financing and human resource inter-relationships. The impact of fee removal on utilization levels is mostly not sustained or supported by all the evidence. Shortages of human resources for health at the national level are not universal; maldistribution within countries is the greater problem. Low salaries are not universal; most of the countries pay health workers well by national benchmarks.

ConclusionsThe interconnectedness between user fee policy and HRH situations proves difficult to assess. Many policies have been changing over the relevant period, some clearly and others possibly in response to problems identified associated with financing policy change. Other relevant variables have also changed.

However, as is now well-recognised in the user fee literature, co-ordination of health financing and human resource policies is essential. This appears less well recognised in the human resources literature. This coordination involves considering user charges, resource availability at health facility level, health worker pay, terms and conditions, and recruitment in tandem. All these policies need to be effectively monitored in their processes as well as outcomes, but sufficient data are not collected for this purpose.

KeywordsUser fees Human resources for health Policy co-ordination Distribution Workload Pay AbbreviationsANCAntenatal care

ANMAuxiliary nurse midwive

CHOCommunity health officer

CIConcentration index

DFIDDepartment of International Development UK

FBOFaith-based organization

FHCPFree Health Care Policy

GDPGross domestic product

GNIGross national income

HDIHuman development index

HMISHealth management information system

HRHuman resource

HRHHuman resources for health

ILOInternational labour organisation

IPCDInternational Conference on Population and Development

LCMLiving Conditions Measurement Survey

MCHMaternal child health

MDGMillennium Development Goals

MNCHMaternal and newborn child health

MNHMaternal and newborn health

NGONon governmental organization

NHISNational Health Insurance Scheme

OPDOut patients

PNCPostnatal care

RMNHReproductive maternal newborn health

SARAService availability and readiness assessment

SBASkilled birth attendant

STDSexually transmitted disease

TBATraditional birth attendant

UHCUniversal health coverage

WHOWorld Health Organization.

Electronic supplementary materialThe online version of this article doi:10.1186-1478-4491-11-46 contains supplementary material, which is available to authorized users.

Download fulltext PDF

Autor: Barbara McPake - Sophie Witter - Tim Ensor - Suzanne Fustukian - David Newlands - Tim Martineau - Yotamu Chirwa


Documentos relacionados