FEMHealth announces the publication of a range of outputs related to their FEMHealth project. These are available in English and in French. FEMHealth is a research project on the role of fee exemption policies in reducing the financial barriers for delivery or emergency obstetric care. FEMHealth has been working in Burkina Faso, Benin, Mali and Morocco.

With the push toward universal health coverage many governments and international donors are exploring the removal of user fees – particularly for priority services like maternal health. To explore the impact of these policies in practice FEMHealth has conducted studies using realist evaluation.

What’s new?

The findings are useful to policy makers grappling with the real world problem of increasing the uptake of services and researchers wishing to explore the process of policy implementation. Headline findings include:

On the whole policies to remove financial barriers were more effective at protecting families financially than changing health behaviour.

If the primary goal of these policies is to increase service utilisation we haven’t seen a dramatic shift. But that doesn’t mean that the policies aren’t worthwhile.

There is a variation in terms of the implementation of fee exemption policies in different sites. Whatever the policy design, the way that managers operationalise them is important – there are lessons for all health policy makers in this.

It is often argued that the removal of fees will lead to a deterioration in quality of care and the collapse of services. This is not the case in the countries we studied.

There is an urgent need to build the needs of the new born into the package of services offered for free.

The quality of obstetric care provided in facilities is key to the fight against maternal and perinatal mortality. There is limited point in getting women into facilities unless they receive adequate care. Even when women got a good service in technical terms they didn’t necessarily feel well treated. This points to the need to improve the provider-patient relationship.

Aims

The overall aims of the project are (1) to develop new methodological approaches for the evaluation of complex interventions in low income countries, (2) to improve the health of mothers and their newborns by performing comprehensive evaluations of the impact, cost and effectiveness of the removal of user fees for delivery care on maternal and neonatal health outcomes and service quality, and (3) to improve the communication of this evidence to policy-makers and other stakeholders.

The research will be conducted by a consortium of eight partner institutions.