Presentation done at the AfHEA conference in March 2011, Saly Senegal.

1. The Policy Process of Removing user fees in health services in low-income countries: a framework for a multi country review How to remove user fees David Hercot, Bruno Meessen, Valery Ridde & Lucy Gilson

3. Methodology for the review

4. The Five Elements of The Framework

6. Rationale for the Review

7. Methodology for the review

8. Five Elements of the Policy Process Unintendedpositiveimpact Intended impact Unintendednegativeimpact process context content actors

9. Good Practice Hypothesis a well-documented and assessed practice that provide evidence of success/impact and which are valuable for replication, scaling up and further study Methodology for the Review

10. Five Elements of the Policy Process Unintendedpositiveimpact Intended impact Unintendednegativeimpact process context content actors

11. Process: The Rational Planning cycle

12. 1. Thorough Situation Analysis Process: Preliminary situation analysis

13. 2. Clear Policy Objectives 3. Vision, ownership and leadership Process: Priority Setting

15. 4. Use of International and National Scientific evidence 5. Considering different policy options 6. Thorough assessment of the option 7. Early identification of accompanying measures 8. Preferences of key stakeholders met Involve Stakeholders when designing Process: Option Appraisal

17. PHC funds,

18. special additional funds for drugs. Revision of incurred costs Did Senegal consider the expected increase in utilisation?

19. 9. Testing the reform 10. Planning implementations steps 11. Commitment on budgetary burden 12. Clear and robust rules for transferring resources Process: Programming

20. In both countries, No assessment of first stage before phase 2

21. Process: The Rational Planning cycle

22. 13. Technical leadership 14. Coordination unit 15. Capacity building 16. Communication strategies 17. Actors abide by the new rules Process: Implementation

23. An existing task force took the responsibility to follow up implementation issues The coordination unit did not produce procedure manual nor policy paper in 6 months

24. 18. Monitoring and Evaluation Indicators: utilization rate, the disbursement rate, drugs stock out, Longer term evaluation patient satisfaction, financial protection, quality of care, Process:Monitoring and Evaluation

25. Five Elements of the Policy Process Unintendedpositiveimpact Intended impact Unintendednegativeimpact process context content actors

26. Context

27. Context

28. Actors

29. Government – users Free Care Government – Facilities Access to resource and their use Content : Analyzing contracts

30. Content over time

31. Five Elements of the Policy Process Unintendedpositiveimpact Intended impact Unintendednegativeimpact process context content actors

32. Impact

33. Discussion

34. http://www.itm.eu/unicef Thank you