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User fees abolition policy in Niger: Comparing the under five years exemption implementation in two districts

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  • Ridde, Valéry
  • Diarra, Aïssa
  • Moha, Mahaman

Abstract

Objective Analysis of the implementation process for a national user fees abolition policy aimed at children under age five organized in Niger since October 2006.Methods This was a study of contrasted cases. Two districts were selected, Keita and Abalak; Keita is supported by an international NGO. In 2009, we carried out socio-anthropological surveys in all the health facilities of both districts and qualitative interviews with 211 individuals.Results Keita district launched the policy before Abalak did, and its implementation was more effective. The populations and the health workers of both districts were relatively well aware of the user fees abolition. Both districts experienced significant delays in the reimbursement of treatments provided free of charge in the health centres (9 months in Keita, 24 months in Abalak). The presence of the NGO compensated for the State's shortcomings, particularly with respect to maintaining the drug supply, which became difficult because of payment delays. In Abalak, district officials reinstated user fees.Conclusions The technical relevance of user fees abolition is undermined by the State's lack of preparation for its funding and organizational management.

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  • Ridde, Valéry & Diarra, Aïssa & Moha, Mahaman, 2011. "User fees abolition policy in Niger: Comparing the under five years exemption implementation in two districts," Health Policy, Elsevier, vol. 99(3), pages 219-225, March.
    • Handle: RePEc:eee:hepoli:v:99:y:2011:i:3:p:219-225
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    References listed on IDEAS

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    1. Marcel Fafchamps & Bart Minten, 2007. "Public Service Provision, User Fees and Political Turmoil," Journal of African Economies, Centre for the Study of African Economies, vol. 16(3), pages 485-518, June.
    2. Walker, Liz & Gilson, Lucy, 2004. "'We are bitter but we are satisfied': nurses as street-level bureaucrats in South Africa," Social Science & Medicine, Elsevier, vol. 59(6), pages 1251-1261, September.
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    1. Eugenia Amporfu, 2013. "Effect of regulated user fee on quality of healthcare for the poor and the non-poor," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 60(4), pages 357-373, December.
    2. D’Ostie-Racine, Léna & Dagenais, Christian & Ridde, Valéry, 2013. "An evaluability assessment of a West Africa based Non-Governmental Organization's (NGO) progressive evaluation strategy," Evaluation and Program Planning, Elsevier, vol. 36(1), pages 71-79.

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