Transcript Removal of User fees.. - African Health Economics and Policy

Removal of user fees for maternal and
child health services in Enugu, South East
Nigeria: Experiences of the community and
Health care providers
Benjamin SC Uzochukwu, Ogoamaka Chukwuogo
Obinna Onwujekwe,
.
Health Policy Research Group, College of Medicine, University
of Nigeria, Enugu-campus
2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Introduction
 Enugu state in south East Nigeria launched
free maternal and child health (MCH) services
in 2007.
 The programme is for all pregnant women to
have free antenatal, delivery and post natal
services including laboratory tests and blood
transfusions.
 Children under 5 receive free medical
treatment
2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Objectives

To determine the experiences and the
perceptions of the community and health care
providers on the removal of user fees for the
MCH services
2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Methods
Cross sectional descriptive study
 Exit interviews with 150 WRA from 10 health
centers to elicit information on their awareness,
attitude, utilization and factors affecting
utilization of MCH services and willingness to
continue use of this service.
 Questionnaire interview with 50 healthcare
providers from 10 health centers
 In-dept interviews with 10 heads of health
centers

2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Results (Consumers)
A majority (62.6%) of the women were aged
between 21 and 30 years
 Most had one form of formal education or the
other.
 High awareness of free MCH services (86%)

2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Service utilization
 ANC services most utilised (55%),
 Immunization services (47.3%),
 Nutritional education (35.3%)
 Growth monitoring (32%).
 Family planning services were the least utilized
(12%)
2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Payment for services
 80% of respondents said they accessed these
services absolutely free of charge
 20% paid for services like ANC, delivery, family
planning and immunization
2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Waiting Time
 28.7% of the respondents were able to receive
medical care within 30 minutes of arrival
 33% waited between 30 minutes to an hour
 32% waited between 1 to 3 hours
 Only very few 9% experienced a waiting time of
more than 3 hours.
2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Receipt of prescribed drugs
 23% of respondents received all prescribed
drugs
 48% of respondents received some of the
prescribed drugs
 29% received no drugs.
2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Factors affecting utilization
 lack of approval from spouse,
 inadequate skilled personnel,
 long waiting time
 distance to the health facility.
2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Willingness to continue use of services
 84.7% would continue to utilize the services
rendered at the health centre because:
 services
were free 33.1%,
 easily accessible 26.0%
 drugs were available 19.7%

15.3% would not continue because:
 Required
services not available 43.5%
 No drugs 30.4%
 Delayed attention 17.4%
 Distance 8.7%
2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Results: Health Workers Perspective
96% of health workers opined that the MCH
services were absolutely free
 From health workers perspective, treatment of
under 5s (94%), ANC (76%) and delivery
services (68%) were the most frequently used
services

2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Although the health workers were receptive of
the free services, they opined that their
workload had increased without any
corresponding increase in their remuneration
 that patients were making unnecessary visits to
the health facilities and demand on drugs
(moral hazard). Hence drug demand does not
match supply.

2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Conclusions
Removal of user fees for MCH services have
enhanced utilization of health services.
 However this has greatly increased the
workload of health providers and consumers
still pay for MCH services.
 Problems with drugavailability and waiting time

2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011
Recommendations



Provision of adequate personnel and infrastructure to
cater for this increase
In the interim there should be better remuneration of
health workers to motivate them to continue providing
health services despite the increased workload.
There is also need to check the reported moral
hazards that have been created by the removal of fees
and mechanisms should be put in place to ensure
that the free services are really free.
2nd Conference of the African Health Economics and Policy Association (AfHEA)
Saly – Senegal, 15th - 17th March 2011