Immpact, Foresterhill, Aberdeen, UK.
Health Policy Plan. 2010 Sep;25(5):384-92. doi: 10.1093/heapol/czq013. Epub 2010 Apr 1.
This article presents the results of an evaluation of the free delivery and caesarean policy (FDCP) in Senegal. The policy was introduced into five poor regions in 2005 and in 2006 was extended at regional hospital level to all regions apart from the capital (Dakar). The evaluation was carried out in 2006-7. There were four research components, all focused on selected facilities and districts within the five FDCP regions: a financial analysis of expenditure on the policy and wider health financing in the five regions and nationally; 54 key informant interviews from national down to facility level; 10 focus group discussions and 8 in-depth interviews; and analysis based on clinical record extraction of 761 major obstetric interventions. The evaluation found significant implementation difficulties, especially related to the allocation of funds and kits and the adequacy of their contents. Despite that, significant increases in utilization in normal deliveries (from 40% to 44% of expected deliveries in FDCP areas over 2004-5) and in caesarean rates (rising from 4.2% to 5.6% in FDCP areas) were recorded. National data suggested that these trends were not found in non-FDCP regions. Using the evaluation data, the cost per additional caesarean under the policy was US$467 and the cost per additional supervised normal delivery was US$21. The article concludes that, in order to achieve its full potential, the FDCP requires improved systems for planning and allocating resources, and new channels to reimburse lower level facilities. It is also important that all complicated deliveries (not just caesareans) are included in the package. In the case of Senegal, a complementary strategy of investment in facilities, transportation and staffing is required to bring greater geographical access and upgrade services. These findings are likely to be relevant to other countries currently experimenting with similar approaches to reducing financial barriers to skilled attendance at delivery.
本文介绍了塞内加尔免费分娩和剖宫产政策（FDCP）的评估结果。该政策于 2005 年在五个贫困地区实施，并于 2006 年在区域医院层面扩展到除首都（达喀尔）以外的所有地区。评估于 2006-2007 年进行。有四个研究组成部分，都集中在五个 FDCP 地区的选定设施和地区：对五个地区和全国范围内该政策和更广泛的卫生筹资的支出进行财务分析；从国家到设施层面的 54 次关键知情人访谈；10 次焦点小组讨论和 8 次深入访谈；以及基于对 761 例主要产科干预措施的临床记录提取的分析。评估发现实施存在重大困难，特别是与资金和套件的分配以及其内容的充分性有关。尽管如此，正常分娩的利用率仍显著增加（FDCP 地区的预期分娩量从 2004-2005 年的 40%增加到 44%），剖宫产率也有所上升（FDCP 地区从 4.2%上升到 5.6%）。全国数据表明，这些趋势在非 FDCP 地区并未出现。利用评估数据，该政策下每增加一例剖宫产的成本为 467 美元，每增加一例有监督的正常分娩的成本为 21 美元。文章总结认为，为了充分发挥政策潜力，FDCP 需要改进资源规划和分配系统，并开辟新的渠道来补偿较低级别的设施。同样重要的是，将所有复杂的分娩（不仅仅是剖宫产）纳入一揽子计划。就塞内加尔而言，需要投资于设施、交通和人员配备的补充战略，以扩大地理覆盖范围并升级服务。这些发现可能与其他目前正在尝试通过减少获得熟练分娩服务的财务障碍来实现类似目标的国家相关。
