title: Removal of user fees for caesareans and under-fives in northern Sudan: a review of policy implementation and effectiveness.
abstract: In 2008, the Government of Sudan launched a policy of free curative care for under-fives and caesareans. This paper presents the findings of a review of this policy, on the basis of research conducted in five focal states of northern Sudan in 2010. Policy implementation was assessed using four research tools: key informant interviews, exit interviews, a facility survey, and analysis of facility finances and the cost of the package of care. The findings point to important weaknesses in implementation, such as unclear specification of the exact target group and package of care and inadequate funding. Despite this, service utilisation appears to have responded, at least in the short term. The findings also highlight the urgent need for improved access to basic health care and financial protection against health care costs in northern Sudan (for those with and without national health insurance membership). This review contributes to the growing literature on the selective removal of user fees for priority services. It indicates the range of challenges to effective implementation (strategic, financial and organisational). Some of these are particular to Sudan, but many are shared, and indicate important lessons for improving access to and quality of care for women and children in Africa.
authors.affiliation: Immpact, University of Aberdeen, Aberdeen, UK. s.witter@abdn.ac.uk
authors.forename: Sophie
authors.initials: S
authors.lastname: Witter
authors.forename: Khalda
authors.initials: K
authors.lastname: Khalid Mousa
authors.forename: Manar E
authors.initials: ME
authors.lastname: Abdel-Rahman
authors.forename: Rania
authors.initials: R
authors.lastname: Hussein Al-Amin
authors.forename: Mohammed
authors.initials: M
authors.lastname: Saed
mesh_terms: D002585:Cesarean Section / Q000191:economics* / Q000706:statistics & numerical data; D002662:Child Health Services / Q000191:economics / Q000458:organization & administration*; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D005251:Fees, Medical / Q000706:statistics & numerical data; D005260:Female; D005380:Financing, Government; D005102:Health Expenditures / Q000706:statistics & numerical data; D006291:Health Policy / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000191:economics / Q000458:organization & administration; D011247:Pregnancy; D015397:Program Evaluation; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration; D013397:Sudan