Reimbursement amounts are separated into service costs (based on agreed rates of fee per episode) and drugs, which are charged according to use. Users still face informal charges, and are reported to have responded differentially, with rises in antenatal care and in urban areas highlighted. Durant ces années de collaboration, ils ont fait montre d’un dévouement et d’un professionnalisme qui méritent d’être salués. SANATA ALY has 1 job listed on their profile. They think it’s inadequate, health insurance also thinks that whatever we put in is also inadequate so for money, it’s never enough, we just have to manage and see that the policy is carried out’ (respondent 5). Roughly half of women receive post-natal care (56% in 2009)[3]. Indispensable aux agronomes et techniciens de terrain, cette nouvelle version du Mémento de l'agronome, totalement remaniée et adaptée aux nouveaux enjeux du développement des pays du Sud, se compose d'un livre et de deux cédéroms ... Trouvé à l'intérieur – Page 2R. - Mon père Demba Coulibaly R. Q. Votre mère ? L'acheteur pesait son achat inscrivait le poids dessus . A l'arrivée , la maison payait le transport au tarif fixé pour tout le monde . Cela pour le train . R. Ma Diarra Q. Votre age ? Community of Practice Financial Access to Health Services: Maternal health exemptions: policy brief. People should contribute and I think we have the platform’ (respondent 6). 1997, Ho, Ghana: Regional Health Administration. ‘If there are delays, it’s just the delays in payment of general health insurance claims and not on maternity alone’ (respondent 11), ‘My main concern is the arbitrariness with which the facilities can decide that this month I won’t do it because I haven’t been paid. 2012, Bamako: CoP FAHS. Witter S, Richard F, De Brouwere V: Learning lessons and moving forward: how to reduce financial barriers to obstetric care in low-income contexts. The announcement followed a visit by the President to the UK in April where it was agreed that UK funds would be used to support the policy. Câest le même tarif qui est appliqué sur le trajet Bamako-Ségou (235 km). Prenant la parole, le secrétaire général du conseil local des jeunes de Kita, Modibo Boucoum dira que leur doléance ne vise pas la faillite des compagnies, mais que comparativement aux autres localités, sur le trajet Kita-Bamako (187 km) le voyageur paye 3.000 Fcfa. ‘You get to a facility and you are entitled to some medications, they say we don’t have and they write it for you, what do you do? Some variation in interpretation and implementation was noted for the pregnant women. The study was based on a review of existing literature – grey and published – and on a key informant interviews (n = 13) carried out in March-June 2012. The guidelines had to be prepared quickly as it was announced by the President for a fixed date. 2007, 22 (2): 133-143. The introduction of the new policy for pregnant women was seen as primarily a political initiative, with limited stakeholder consultation. Nous avons été guidés dans chacune de nos actions et décisions par une démarche participative et concertée. ‘Basically, it was designed to reduce maternal mortality by improving access to women who do not use maternal health services because of financial reasons’ (respondent 3). ‘At all levels in the district, by them trying to work together, they improved their working so that it facilitated care for the women’ (respondent 6). Omniprésente au travail, l’information professionnelle fait partie de ces objets familiers qu’il est difficile d’appréhender scientifiquement. Le préfet de Kita, Mamadou Diakité, nâa pas réussi à les raisonner. There are various costs which are not covered by the policy, including transport and minor personal items which are required for a delivery, according to KI. Quel message avez-vous à l’endroit des chargeurs de Kayes ? The study findings are consistent with previous studies in Ghana relating to exemption policies, particularly in relation to problems of delays in reimbursement, and lack of incentives to award full exemptions at the service provider level[1, 25, 27]. Le mandat finissant aura été également marqué par l’instauration et le renforcement de partenariats dynamiques, soldés pour certains par différentes misions et échanges qui illustrent notre souci d’accompagner et d’encadrer les acteurs régionaux de notre secteur. Ridde V, Robert E, Meessen B: A literature review of the disruptive effects of user fee exemption policies on health systems. Pour le président du conseil local des jeunes de Kita, les transporteurs ont promis de revoir leurs tarifs, mais rien nâa été fait. The few articles and documents of relevance were analysed thematically, using the six main research questions. Sokhna Diarra has 2 jobs listed on their profile. Il est également chargé d’entreprendre et de coordonner les études, les actions de formation d’information et de conseil pouvant contribuer à la promotion et au développement des activités des chargeurs. Part of Tout comme la délégation venue de Bamako. Affaire des terres de la concession rurale dâune superficie de 400 hectares du village de Nâteguedo-Niaré : Quâest-ce qui fait courir réellement ces prédateurs fonciers venant du village de Sirakoro-Niaré ? SW led on the literature review, analysis of interviews and drafting. It will not cover for instance your transport cost to the hospital and back. See the complete profile on LinkedIn and discover Dickson's connections and jobs at similar companies. No analysis of financial impact has yet been conducted. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Modibo has 1 job listed on their profile. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators . View Oumar Diarra's profile on LinkedIn, the world's largest professional community. volume 12, Article number: 16 (2013) Overall, key informants are positive about the policy, focussing largely on the complementary measures which are needed on the demand- and supply-side, and also the need for longer term funding and effective monitoring of the policy. the policy of placing midwives in each community – however, these are also facing implementation challenges. Celle-ci ne veut plus revivre l'humiliation subie face à la Hongrie 10-1!C'est face à un mur bleu que les Diables vont se retrouver. Given that the stakeholder group was limited, no identifiers are given for the citations below, to respect the anonymity of informants. A search was also done through Google Scholar for published articles on maternal exemptions in Ghana. 2008, Accra: MoH, NHIS: National Health Insurance Scheme website. Provided by the Springer Nature SharedIt content-sharing initiative. Question de droit : Mandat dâamener, mandat dâarrêt, mandat de dépôt, des hommes de droit expliquent, Contribution, Bonne Gouvernance : Petit dictionnaire pour nous aider à comprendre, Doctrines, Rite : Le souci quotidien de la purification, Le journaliste français Olivier Dubois, otage au Mali depuis 7 mois, Insécurité alimentaire à Tombouctou: Les autorités locales rassurent la population, Patrouille sécuritaire dâun contingent à Aguelhok: Un mort et 8 blessés enregistrés, Arrivée de militaires néerlandais au Mali pour une mission aérienne de six mois, Kidal: Un casque bleu tué suite à un accident à Aguelhok, Barkhane â Takuba : Les Force armées Maliennes en opération à Ansongo et en entraînement à Ménaka, Transition politique : Les recettes périmées de Tiébilé Dramé, Sanction contre le Mali: La France et ses partenaires de lâUnion européenne soutiendront la CEDEAO, Sanctions de la CEDEAO : Sans surprise pour le PARENA, Bittar dans un rôle de défiance, Mali : le gouvernement réagit aux sanctions de la Cédéao, Ãlaboration de lâavant-projet de la loi électorale au Mali : Des partis politiques boycottent, Assises nationales de la refondation : LâADEMA-PASJ vire à 360°, Communiqué du conseil des ministres du mercredi 3 novembre 2021, COMMUNIQUE DU CONSEIL DES MINISTRES DU MERCREDI 27 OCTOBRE 2021, Boubacar Niang, président du Conseil Malien des Chargeurs de Kayes : «La satisfaction de lâusager est au cÅur de nos préoccupations», Ecoutez la radio sur vos mobiles et tablettes. The facilities in our country are sited more skewed towards the urban that have money and so those who were benefitting from the free care were those who did not really need to benefit’ (respondent 6). Most respondents showed very little awareness of the lessons learned from the earlier phase of maternal delivery exemptions, which were still technically in force when the new NHIS-based policy came in, although the application had collapsed due to lack of funding[14]. In reality, this division is said to be more concerned with managing doctors and nurses, so the midwives and this policy are to some extent falling between two stools. Ils restituent, toutefois, avec une relative fidélité, les actions réalisées par notre équipe, y compris les missions effectuées et les partenariats noués. Ensuring that the health system has the necessary supplies and facilities to provide the services, There should be good general monitoring, but also focussed on equity, In order to sustain and extend the policy, longer term funding sources need to be identified, Family planning services should be added to the package, as this is cost effective and saves lives. The Ministry of Women and Children are meant to represent the interests of women and children in relation to other ministries, feeding back information on priority areas and problems on the ground. The limitations of these methods have to be acknowledged. Ghana has made significant progress in health outcomes: infant mortality has reduced (from 77 in 1988 to 50 in 2008), while child mortality has reduced to 80 deaths per 1,000 births[2]. 2009,2., Ghana Statistical Service, Ghana Health Service, ICF Macro: Ghana Demographic and Health Survey 2008: Key Findings. Idem pour la mission à laquelle nous avons pris part en Mauritanie, dans le cadre de la rencontre billaterale pour la promotion du corridor Nouakchott-Bamako, en vue d’un partenariat economique durable. Communication of the policy was limited to bureaucratic transmission of guidelines, as it was the case in many countries in the region[10, 20], and some media coverage, which is thought to have reached most people, at least for the pregnant women policy. 1ère édition de « FUTURE ENERGIE EN AFRIQUE » à DUBAÏ : Le Mali plaide à l’endroit des opérateurs et investisseurs du secteur de l’Energie et des hydrocarbures, Communiqué du Gouvernement suite au communiqué final de la 3ème session extraordinaire de la conférence des Chefs d'Etat et de gouvernement de la CEDEAO, Tiébilé Dramé, du Parena, veut un «Premier ministre rassembleur, moins clivant» pour le Mali, Mme TRAORE DEDEOU TOURE, Directrice du CAP de BAGUINEDA « On gère les papiers, pas l’argent », Mme Sidibé Rokia Diakité, maire de la commune rurale de Wassoulou- Balé : «La présence des dragues dans nos cours d’eau nous donne de sérieux soucis », Gestion des rumeurs contre les vaccins et la vaccination contre la COVID-19 : L'éclairage de Souleymane Traoré, Marimantia Diarra : «Il faut éviter la politique de la chaise vide», Opérations militaires : Une vingtaine de terroristes neutralisés, Communiqué Final de la Conférence des Chefs d’État et de Gouvernement de la CEDEAO tenue ce 7 Novembre 2021, Communiqué du Conseil des Ministres du Mercredi 03 Novembre 2021: CM N°2021-35/SGG. Health Policy. Thematic framework for results from exploratory interviews. Aboagye P: Key messages from the EmONC needs assessment. They were informed about the study and the purpose of the study, and that their participation was entirely voluntary. statement and The recognition that most women do not deliver with a skilled attendant was a major concern and the common perception was that removing financial barriers would facilitate access to health care service use by pregnant women. For the under-18 s policy, all of the process questions which this study aimed to answer remain unanswered. However, in 2008 the fixed transfer to district schemes per exempted member of any type was 14 Ghanaian cedis (GhC). Some of these generated additional barriers for women. 2012, 12: (174). Quid, Monsieur le Président, de votre délégation régionale ? From the point of view of policy effectiveness, the greatest concern is the presence of informal charging, which appears to be both a response to the delays in funding (legitimate charging, one might call it, to fill gaps)[25] and rent seeking by staff. So there were some mutual suspicions on both sides and sometimes people also felt that the insurance people are not paying them their due, which is sometimes also true because they’ll take away some the money for not writing something on it so they’ll deduct something’ (respondent 6). 2009, Ref Type: Slide. Guidelines had been issued but beyond collecting numbers of women registered, no additional monitoring and evaluation have yet been put in place to monitor its implementation. À l’instar de toutes les délégations régionales du Conseil malien des chargeurs, celle de Kayes fait figure de démembrement de la structure nationale et répond d’une volonté de déconcentrer les services publics pour les rapprocher des usagers. While the first phase has been relatively thoroughly evaluated[1], there is less understanding about the recent NHIS reforms in terms of access to reproductive and child health services, which includes the decision in 2008 to extend free coverage to all under-18 s, regardless of parental membership. Facilities and staff were reported to have faced increasing workloads as a result of the policy, especially in urban areas. SW, BG and VR designed the research. While the study set out to understand the development and implementation of the free care policy for the under-18 s, this component had to be dropped due to low awareness by respondents. For the maternal exemptions, there is a clear understanding of the objectives of the policy, though few refer back to the experiences of predecessor policies (the delivery exemption policy and the exemption of under-fives, both still theoretically in place when these new initiatives came in). Implementation of the policy has reportedly varied due to different interpretation of the policy by various implementers. Skilled deliveries have remained fairly constant, at around 45% in 2006–9 (though with annual fluctuations). View Diarra Sekou's profile on LinkedIn, the world's largest professional community. The main difference from the earlier Delivery Exemption Policy is that this absence of sustained funding has been masked by the general revenues of the NHIS, which have subsidised the policy. See the complete profile on LinkedIn and discover Diarra's connections and jobs at similar companies. Although the scope of the original study covered both maternal and under-18 exemptions, the awareness of respondents of the details and operation of the policy for under-18 s were so limited that this component had to be removed in the analysis. Building a future for women and children: the 2012 report. Comme on le dit, tout est bien qui finit bien. These are of relevance not only to Ghana, but beyond, as countries search for effective mechanisms to extend universal health coverage. See the complete profile on LinkedIn and discover Sokhna Diarra's connections and jobs at similar companies. Spéculation foncière à Sirakoro Dounfing : Les habitants appellent les autorités au secours ! But there have been differences in local interpretation of the package of care: ‘Some of them by the mere word of abortion, then they won’t pay but if the doctor wrote miscarriage then they will pay’ (respondent 3), ‘The weaknesses are the misalignment between protocols where health insurance determine what they will pay irrespective of what the service is suppose to provide; we keep going back and f orth’ (respondent 3). Although the policy is monitored through routine NHIS systems, no plan was elaborated from the start to monitor or evaluate this policy specifically, although one is now planned, with UNICEF support, in 2012. Int J Equity Health 12, 16 (2013). Maternal mortality remains high, though it has declined in the past two decades from 740 per 100,000 live births in 1990 to 451 in 2008. During the same year, free membership was made available to all children (under-18). There was a lack of understanding amongst these key informants of how the policy was being funded. Cet ouvrage s’adresse à un public d’enseignants, de chercheurs et d’étudiants, de journalistes et de responsables d’ONG. Ils y trouveront matière à penser l’avenir d’un monde en plein bouleversement. The results are presented below following the framework presented in Figure 1, which adopts the logical sequence of policy development, implementation and effects. Witter S, Arhinful D, Kusi A, Zakariah-Akoto S: The experience of Ghana in implementing a user fee exemption policy to provide free delivery care. International Journal for Equity in Health As deaths are focussed amongst poorer women and more remote women, efforts must be made to reach these groups. Trouvé à l'intérieur – Page 389... urbains doit intégrer les éléments suivants : le coût du transport : fixé par personne et par distance ( le tarif ... Douala qu'à Yaoundé indiquent que les coûts de transport varient entre 40 et 80 % de la marge brute ( F.A. Diarra ... Health Policy Plan. See the complete profile on LinkedIn and discover Modibo's connections and jobs at similar companies. Trouvé à l'intérieur – Page 2068353a , pièce d'état civil rature 276c ) , transport 1588a , prix littéraire 838b , 1725a ( Paris 838b , aviation - avion ) , animal congé 1634b , étranger 1595b , étudiant 1637c , 346a , publiée 353a , tarif 839a , province 1725a ... Some referred to the earlier studies done by Immpact, but it was not clear whether these had influenced the new policy design. Health Policy. Il est en outre investi d’un rôle consultatif, qui consiste à donner son avis à la demande des pouvoirs publics ou à faire des suggestions en s’auto-saisissant de toute question relevant des domaines du transport et du transit des marchandises. Reprod Health Matters. Witter S, Adjei S: Start-stop funding, its causes and consequences: a case study of the delivery exemptions policy in Ghana. The wider concerns about raising quality of care, and ensuring that all supply-side and demand-side elements are in place to make the policy effective will take a longer term and bigger commitment. To find out if guidelines were put in place for the dissemination, implementation, monitoring and evaluation of the policy and how these were implemented. Koni Maria has 1 job listed on their profile. Après lâéchec des négociations, ils ont bloqué la route nationale 24 (RN24) aux bus des compagnies de transports pendant deux jours. The lack of champions of the policy, from national down to local level, was raised by some informants. We all acknowledge the views of all key informants. This article is published under license to BioMed Central Ltd. Countries such as Cote d’Ivoire, Mali and Senegal which are considering how to integrate exemptions into their national health insurance systems should reflect on the challenges which this may bring. This may be a missed opportunity, as many of the themes of the interviews reflect problems identified before. Certain facilities were more reluctant than others to implement the policy e.g. Witter S, Adjei S, Armar-Klemesu M, Graham W: Providing free maternal health care: ten lessons from an evaluation of the national delivery exemption policy in Ghana. Je leur donne l’assurance que cette confiance placée en ma modeste personne ne sera pas galvaudée inch’Allah. How cost-effective is the policy as a whole? A safe motherhood task force was also set up in September 2008. Policy makers acknowledged that there are other barriers (financial and non-financial) to the use of health care services beside payment at the point of care. Abdoulaye Tolo et Alioun Diarra de la compagnie Africa Star, Tiessolo Konaré de AK-Transp, Fodé Traoré de Diarra-Transport et Diawara Siriman de Mandé-Transp se sont réjouis des éclairages donnés par le représentant de la CMTR. 2011, 26 (1): 1-11. It has to be recognised, however, that the policy adds to the financial risks faced by the NHIS, as currently managed. Ghana has been selected as a case study for this research as it has actively engaged in a number of policy reforms in recent years to increase the financial accessibility of maternal and child health care. Other access barriers include distance to facilities, socio-cultural barriers, and supply-side barriers, such as the lack of availability of critical equipments and drugs at the point of need, lack of availability of skilled staff and poor attitude of providers. That raised concerns amongst some stakeholders about what would happen when the one-off grant ended. How has utilisation responded for the various services (antenatal care, supervised deliveries, caesareans, postnatal care)? View Sokhna Diarra Ndao's profile on LinkedIn, the world's largest professional community. Le Rapport sur la sant dans le monde 2006 expose l'analyse que font les spcialistes de la crise du personnel de sant dans le monde et propose des mesures de grande envergure pour y remdier dans les dix ans qui viennent en agissant ds ... The constraints found in Ghana are also echoed in other countries in the region[12, 28]. Heal Econ Rev. For the public, the media, Members of Parliament and District Chief Executives took up and passed on the message of the President. Veuillez ne pas poster plusieurs fois le même commentaire, car notre système de détection de spams risque de bloquer immédiatement vos messages. ‘Under ICD or either safe motherhood, there is no champion midwife in either ICD or safe motherhood… maybe they need Director Midwifery Services so somebody who is the champion of midwifery services based in ICD’ (respondent 8).
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