Table 3 Pressures mentioned in the literature by country, health system functions, and authors (1988 to 2009)
From: A literature review of the disruptive effects of user fee exemption policies on health systems
Health system functions | Pressures mentioned in the literature |
|---|---|
Ghana | |
Service delivery | |
Health workforce | · Increase in workload, loss of income [31] |
· Insufficient medical personnel; increase in workload [32] | |
Health information | · No information |
Medical products, vaccines and technologies | · No information on the number of acts and the amount of reimbursements [31] |
Financing | · Funding unpredictable, insufficient and discontinuous; problems with reimbursement in cases of referrals [31] |
· Funding unpredictable, insufficient and discontinuous; informal payments; health centres going into deeper debt [35] | |
Leadership and governance | · Lack of information and complexity of funding procedures; poor supervision; problems in assigning responsibilities [31] |
· Lack of information and communication (funding); competition with other interventions; poor supervision; ‘no blame’ game [35] | |
Kenya | |
Service delivery | |
Health workforce | · Increase in workload [33] |
Health information | · No information |
Medical products | · Problems of availability and insufficiency of drugs and kits [33] |
Financing | · Informal payments [22] |
· Informal payments; loss of income for health centres [33] | |
· Insufficient funding; informal payments [36] | |
Leadership | · Poor understanding of the policy; problems in assigning responsibilities [33] |
Madagascar | |
Service delivery | · Increase in utilization [19] |
Health workforce | · No information |
Health information | · No information |
Medical products | · Problems of availability of drugs [19] |
Financing | · No information |
Leadership | · No information |
South Africa | |
Service delivery | |
Health workforce | · Increase in workload; lack of time for consultations; feeling of being exploited; frustration, etc. [29] |
· Increase in patient/provider ratio [38] | |
Health information | · No information |
Medical products | · Problems of availability of drugs [29] |
Financing | · No information |
Leadership | · Feeling of a lack of recognition among workers; poor planning and communication [29] |
Senegal | |
Service delivery | · Increase in utilization [23] |
Health workforce | · Increase in workload [23] |
Health information | · No information |
Medical products | · Delays and under-distribution of consumables [23] |
Financing | · Informal payments; delays in reimbursements; loss of revenue for the health centres [23] |
Leadership | · Poor understanding of the policy [23] |
Tanzania | |
Service delivery | · No information |
Health workforce | · No information |
Health information | · No information |
Medical products | · No information |
Financing | · Informal payments [41] |
Leadership | · No information |
Uganda | |
Service delivery | |
· Increase in utilization; decline in service quality [27] | |
Health workforce | |
· Increase in the average number of consultations per provider; negative attitude of providers [22] | |
Health information | · No information |
Medical products | |
Financing | |
· Difficulties in meeting recurrent expenses; informal payments [27] | |
Leadership | · Interference with other types of interventions [27] |