Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for Human Resources for Health (HRH)

Abstract

In the last decade a growing consensus has emerged that user fees are regressive and undermine equitable access to essential health services, and in particular, may negatively affect pregnant women and children under five. A policy shift removing or reducing fees has occurred with consequences for the health system, including the need for replacement revenue and to ensure quality in response to increased utilization. Both of these raise specific concerns for human resources for health (HRH) and suggest that careful planning of the supply side response to the demand stimulated by removal of fees has to take place. This research responds to this concern. Its objective is to determine the associations and interrelationships between workforce characteristics (stock, distribution, competencies and motivational state) and equitable access to Reproductive, Maternal and Neonatal Health (RMNH) services resulting from the removal of, or exemption from user fees. The study was conducted in five countries: Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe, and consisted of literature review of international and local published and grey literature, desk based analysis of secondary data from the five countries and field work in two countries, including primary data collection in Zimbabwe. This document comprises a 6-page policy brief, the main report, the literature review, the 5 case studies and references