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

McPake, Barbara, Witter, Sophie, Ensor, Tim, Fustukian, Suzanne, Newlands, David, Martineau, Tim ORCID: https://orcid.org/0000-0003-4833-3149 and Chirwa, Yotamu (2013) 'Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health'. Human Resources for Health, Vol 11, e46.

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Abstract

Background

The 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.

Methods

We 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.

Results

We 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.

Conclusions

The 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.

Item Type:	Article
Additional Information:	The electronic version of this article is the complete one and can be found online at: http://www.human-resources-health.com.ezproxy.liv.ac.uk/content/11/1/46
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Problems of Special Population Groups > WA 320 Child Welfare. Child Health Services. WA Public Health > Health Administration and Organization > WA 525 General works WA Public Health > Health Administration and Organization > WA 550 Family planning
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/1478-4491-11-46
Depositing User:	Lynn Roberts-Maloney
Date Deposited:	02 Mar 2015 09:45
Last Modified:	13 Sep 2019 10:12
URI:	https://archive.lstmed.ac.uk/id/eprint/4966

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