Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada.
Health Policy. 2011 Mar;99(3):219-25. doi: 10.1016/j.healthpol.2010.09.017.
Analysis of the implementation process for a national user fees abolition policy aimed at children under age five organized in Niger since October 2006.
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.
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.
The technical relevance of user fees abolition is undermined by the State's lack of preparation for its funding and organizational management.
分析自 2006 年 10 月以来，尼日尔为 5 岁以下儿童组织实施的全国取消用户付费政策的执行过程。
这是一项对比案例研究。选择了两个地区，即基塔和阿巴拉克；基塔得到了一个国际非政府组织的支持。2009 年，我们在两个地区的所有卫生机构进行了社会人类学调查，并对 211 人进行了定性访谈。
基塔区比阿巴拉克区更早推出该政策，其执行效果也更好。两个地区的居民和卫生工作者对取消用户付费都有一定的了解。两个地区都在为卫生中心免费提供的治疗费用的报销方面遇到了显著的延迟（基塔区为 9 个月，阿巴拉克区为 24 个月）。非政府组织的存在弥补了国家的不足，特别是在维持药品供应方面，由于付款延迟，药品供应变得困难。在阿巴拉克区，地区官员恢复了用户付费。
由于国家在资金和组织管理方面缺乏准备，取消用户付费的技术相关性受到了影响。
