Witter Sophie, Brikci Nouria, Harris Tim, Williams Richard, Keen Sarah, Mujica Ana, Jones Alex, Murray-Zmijewski Alex, Bale Barbara, Leigh Bailah, Renner Ade
International Health Financing and Health Systems, Queen Margaret University, Edinburgh, UK.
Oxford Policy Management, Oxford, UK.
Int J Health Plann Manage. 2018 Apr;33(2):434-448. doi: 10.1002/hpm.2484. Epub 2018 Jan 12.
This article presents the findings of a theory-based evaluation of the Sierra Leone Free Health Care Initiative (FHCI), using mixed methods. Analytical approaches included time-series analysis of national survey data to examine mortality and morbidity trends, as well as modelling of impact using the Lives Saved Tool and expenditure trend analysis. We find that the FHCI responded to a clear need in Sierra Leone, was well designed to bring about needed changes in the health system to deliver services to the target beneficiaries, and did indeed bring funds and momentum to produce important systemic reforms. However, its ambition was also a risk, and weaknesses in implementation have been evident in a number of core areas, such as drugs supply. We conclude that the FHCI was one important factor contributing to improvements in coverage and equity of coverage of essential services for mothers and children. Modelled cost-effectiveness is high-in the region of US$ 420 to US$ 444 per life year saved. The findings suggest that even-or perhaps especially-in a weak health system, a reform-like fee removal, if tackled in a systematic way, can bring about important health system gains that benefit vulnerable groups in particular.
本文介绍了一项运用混合方法对塞拉利昂免费医疗倡议（FHCI）进行的基于理论的评估结果。分析方法包括对全国调查数据进行时间序列分析，以研究死亡率和发病率趋势，以及使用“挽救生命工具”进行影响建模和支出趋势分析。我们发现，免费医疗倡议回应了塞拉利昂的明确需求，设计合理，旨在推动卫生系统发生必要变革，为目标受益人提供服务，并且确实带来了资金和动力，促成了重要的系统性改革。然而，其雄心也是一种风险，在药品供应等一些核心领域，实施过程中的弱点显而易见。我们得出结论，免费医疗倡议是促进孕产妇和儿童基本服务覆盖范围及覆盖公平性改善的一个重要因素。模拟的成本效益很高——每挽救一个生命年约为420至444美元。研究结果表明，即使——或者也许尤其是——在薄弱的卫生系统中，像取消费用这样的改革，如果以系统的方式进行，也能带来重要的卫生系统收益，尤其使弱势群体受益。
