From: A literature review of the disruptive effects of user fee exemption policies on health systems
Health system functions | Pressures on the health system |
---|---|
Service provision | Increase in service utilization and in the demand for services |
Health personnel | Increase in workload, increase in the patient/provider ratio, insufficient medical staff |
Loss of income | |
Lack of time for consultations | |
Feeling of being exploited, frustrated, overworked | |
Negative attitude of providers | |
Deterioration in staff morale | |
Health information | Lack of information on the number and type of services carried out in the health centres and on the amount of reimbursements. |
Drugs and vaccines | Problems of availability of drugs |
Insufficient drugs and kits to meet local needs | |
Delays and under-distribution of consumables | |
Funding | Funding unpredictable, insufficient and discontinuous |
Loss of income for health centres and increased debt | |
Problems with reimbursements for cases of referrals | |
Reverting back to charging for services and drugs | |
Insufficient funding | |
Service providers having difficulty paying recurrent expenses | |
Delays in reimbursements | |
Governance and leadership | Poor planning and communication; poor understanding of the policies |
Inadequate supervision | |
“No blame” game and problems in obtaining accounting reports and in assigning responsibilities for acts | |
Complexity of funding procedures | |
Interference with other health policies and programs |