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
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.
McPake, B.; Witter, S.; Ensor, T.; Fustukian, S.; Newlands, D.; Martineau, T. Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for Human Resources for Health (HRH). Queen Margaret University, East Lothian, UK (2011) 196 pp.
Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for Human Resources for Health (HRH)