Some operational lessons good coordination between In most countries, the initiative came from makers and technicians engaging the highest national political level, before into resource-consuming initiatives. sometimes as a result of external pressures. This level of political will translated into wide mobilisation. When African leaders clearly state their When all the costs of accessing services priorities, national and international (transportation etc.) are not taken into partners tend to follow them. account, there is a risk that the poor benefit less than the rich from the exemption policy. This risk can be For the most part, the initiatives suffered avoided by considering the system as a from a lack of preliminary consultation whole, including other financial barriers and inadequate preparation (situation (apart from user fees), as well as other analysis, costing, logistics planning). barriers to access to health care (geographic, cultural, reception and Even though initiatives that have been quality of care) and their determinants studies and documented do tend to (human resources, equipment, supply). respond to some previously neglected needs, they also have the potential of disrupting other health system functions Experience shows that, in order to ensure (for example, national drugs supply). proper financing, additional resources Decision-makers did not always consider should be raised and earmarked for the the interactions between those initiative yet most countries have not yet functions when developing user fee – kept their commitment to allocate 15% of abolition policies. their national budget to the health sector. To mobilise these resources, some The definition of a package of countries strive to get support from other effective services to advance MDGs ministries (Finance, Transport, Social requires analysing the major causes of Welfare, etc.), or other projects aiming to maternal and child mortality in a given reach the MDGs. Some countries began to country, as well as analysing the cost of create new taxes, but they have not been various mechanisms and combinations of The issue of mechanisms to address those causes. It is uniformly “progressive”. governance is central. important to avoid a situation whereby the user fees abolition would happen at the expense of more efficient activities (for example, a preventive care package). This merely underscores the importance of Recommendations for Policy Development Before making a political decision regarding the abolition of user fees, conduct a wide consultation with all concerned line ministries (Health, Economy and Finance, Social Welfare, Transportation etc.), NGOs, technical and financial partners (TFPs), civil society and the community.
Some operational lessons In most countries, the initiative came from the highest national political level, sometimes as a result of external pressures. This level of political will translated into wide mobilisation. When African leaders clearly state their priorities, national and international partners tend to follow them. For the most part, the initiatives suffered from a lack of preliminary consultation and inadequate preparation (situation analysis, costing, logistics planning). Even though initiatives that have been studies and documented do tend to respond to some previously neglected needs, they also have the potential of disrupting other health system functions (for example, national drugs supply). Decision-makers did not always consider the interactions between those functions when developing user fee abolition policies. The definition of a package of services to advance MDGs requires analysing the major causes of maternal and child mortality in a given country, as well as analysing the cost of various mechanisms and combinations of mechanisms to address those causes. It is important to avoid a situation whereby the user fees abolition would happen at the expense of more efficient activities (for example, a preventive care package). This merely underscores the importance of good coordination between and technicians before engaging into resource-consuming initiatives. When all the costs of accessing services (transportation etc.) are not taken into account, there is a risk that the poor benefit less than the rich from the exemption policy. This risk can be avoided by considering the system as a whole, including other financial barriers (apart from user fees), as well as other barriers to access to health care (geographic, cultural, reception and quality of care) and their determinants (human resources, equipment, supply). Experience shows that, in order to ensure proper financing, additional resources should be raised and earmarked for the initiative – yet most countries have not yet kept their commitment to allocate 15% of their national budget to the health sector. To mobilise these resources, some countries strive to get support from other ministries (Finance, Transport, Social Welfare, etc.), or other projects aiming to reach the MDGs. Some countries began to create new taxes, but they have not been uniformly “progressive”. The issue of governance is central. Recommendations for Policy Development Before making a political decision regarding the abolition of user fees, conduct a wide consultation with all concerned line ministries (Health, Economy and Finance, Social Welfare, Transportation etc.), NGOs, technical and financial partners (TFPs), civil society and the community. makers effective
English%20Improving%20Financial%20Access%20Feb%202011.docx