Article Sidebar
Main Article Content
Abstract
Introduction. L’implémentation de la politique des kits obstétricaux (KOU) démotiverait certains personnels de santé dans les formations sanitaires dès lors que les recettes sont affectées et qu’il y a un manque à gagner. Méthodes. Une enquête a été conduite auprès du personnel impliqué dans la mise en œuvre des KOU dans les districts de santé de Maroua afin d’apprécier leur satisfaction vis-à-vis de cette stratégie. Résultats. Presque tous les personnels interviewés (93,2%) reconnaissaient l’utilité des KOU. Certains (70,2%) affirmaient qu’ils renforçaient la confiance des populations vis-à-vis des prestataires de soins; cependant, 39,7% se plaignaient de la surcharge en travail et 61,4% de la baisse des revenues. Plus de la moitié de ces personnels (53,0%) réclamait une augmetation de leur rénumération « motivation », 68,6% suggéraient que soient allouées des primes de performance basées sur le nombre d’accouchements réalisés. Une minorité (23,0%) proposait l’abandon des kits au profit de l’ancien système de paiement des soins obstétricaux. Conclusion. La mise en place d’un mécanisme d’intéressement des intervenants dans l’opérationnalisation de la politique des KOU est une nécessité. Il est crucial de renforcer la redevabilité du personnel vis-à-vis des utilisatrices et du système de santé afin de fiabiliser et de pérenniser le processus d’implémentation des KOU ; condition pouvant conduire à une réduction appréciable de la mortalité maternelle et néonatale.
ABSTRACT
Introduction. The implementation of Emergency Obstetrical Kits (E.O.K.) policy will lead to lack of motivation of some health personnel in health services, given that the revenue is affected with the loss of gain. Methods. A study has been carried out with some health personnel involved in the implementation of the E.O.K. policy in Maroua health districts. This was to evaluate their satisfaction with respect to this strategy. Results. Almost all the personnel interviewed (93.2%) recognized the utility of the E.O.K. Some (70.2%) approved its role in strengthening the confidence of the population towards the health care providers; however, 39.7% complained of work overload and 61.4% of the drop in revenue. More than half (53.0%) claimed an increase in their revenue “motivation”, 68.6% suggested an allocation of subsidies based on the number of deliveries realized. A minority (23.0%) proposed withdrawal on the E.O.K. policy in favour of the former system of payment for obstetric care. Conclusion. The putting in place on a profit-sharing system among stakeholder involved in the implementation of the E.O.K. system is a necessity. It is crucial to reinforce the accountability of the personnel with respect to the users and the health system in order to increase the reliability and sustainability of the E.O.K. implementation process; a condition which could lead to a considerable decrease in neonatal and maternal mortality rate.
Keywords
Article Details
References
- World Health Organization, UNICEF. Trends in maternal mortality: 1990-2015: estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. 2015;
- OMS. Mortalité maternelle [Internet]. WHO. 2014 [cité 29 juill 2016]. Disponible sur: http://www.who.int/mediacentre/factsheets/fs348/fr/
- De Brouwere V, De Brouwere V, Tonglet R, Van Lerberghe W. Strategies for reducing maternal mortality in developing countries: what can we learn from the history of the industrialized West? Trop Med Int Health. 1 oct 1998;3(10):771‑82.
- Mh B-C. [Maternal mortality in developing countries: statistical data and improvement in obstetrical care]. Med Trop Rev Corps Sante Colon. 2003 2002;63(4‑5):358‑65.
- Perkins M, Brazier E, Themmen E, Bassane B, Diallo D, Mutunga A, et al. Out-of-pocket costs for facility-based maternity care in three African countries. Health Policy Plan. juill 2009;24(4):289‑300.
- Witter S, Armar-Klemesu M, Dieng T. National fee exemption schemes for deliveries: comparing the recent experiences of Ghana and Senegal. Stud Health Serv Organ Policy Ser. 2008;24:167‑98.
- Ouma MN, Chemwolo BT, Pastakia S, Christoffersen-Deb A, Washington S. Pilot study of single-use obstetric emergency medical kits to reduce maternal mortality. Int J Gynecol Obstet. 1 oct 2012;119(1):49‑52.
- Ridde V, Richard F, Bicaba A, Queuille L, Conombo G. The national subsidy for deliveries and emergency obstetric care in Burkina Faso. Health Policy Plan. nov 2011;26 Suppl 2:ii30-40.
- Bradley S, McAuliffe E. Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system. Hum Resour Health. 2009;7:14.
- De Brouwere V, Delvaux T, Leke R. Achievements and lessons learnt from facility-based maternal death reviews in Cameroon. BJOG Int J Obstet Gynaecol. 1 sept 2014;121:71‑4.
- Institut National de la Statistique (INS). Tendances, profil et déterminants de la pauvreté au Cameroun entre 2001- 2014 [Internet]. 2014 [cité 27 août 2016]. Disponible sur: http://www.statistics-cameroon.org/news.php?id=334
- De Brouwere V. Reducing financial barriers to obstetric care in low-income countries. 2000;
- Gohou V, Ronsmans C, Kacou L, Yao K, Bohoussou KM, Houphouet B, et al. Responsiveness to life-threatening obstetric emergencies in two hospitals in Abidjan, Côte d’Ivoire. Trop Med Int Health. 1 mars 2004;9(3):406‑15.
- Meessen B, Hercot D, Noirhomme M, Ridde V, Tibouti A, Tashobya CK, et al. Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries. Health Policy Plan. 11 janv 2011;26(suppl 2):ii16-ii29.
- Ridde V, Richard F, Bicaba A, Queuille L, Conombo G. The national subsidy for deliveries and emergency obstetric care in Burkina Faso. Health Policy Plan. 11 janv 2011;26(suppl 2):ii30-ii40.
- Hatt LE, Makinen M, Madhavan S, Conlon CM. Effects of User Fee Exemptions on the Provision and Use of Maternal Health Services: A Review of Literature. J Health Popul Nutr. déc 2013;31(4 Suppl 2):S67‑80.
- Tashobya CK, Ssengooba F, Cruz VO, Yates R, Murindwa G, McPake B. Health systems reforms in Uganda: processes and outputs. London school of hygiene and tropical medicine. Health systems development programme (HSD); 2006.
- Prytherch H, Kakoko DCV, Leshabari MT, Sauerborn R, Marx M. Maternal and newborn healthcare providers in rural Tanzania: in-depth interviews exploring influences on motivation, performance and job satisfaction. Rural Remote Health. 2012;12:2072.
- Samb OM, Belaid L, Ridde V. Burkina Faso : la gratuité des soins aux dépens de la relation entre les femmes et les soignants ? Humanit Enjeux Prat Débats. 1 juin 2013;(35):34‑43.
- Pearson L, Gandhi M, Admasu K, Keyes EB. User fees and maternity services in Ethiopia. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. déc 2011;115(3):310‑5.
- Ridde V, Diarra A. A process evaluation of user fees abolition for pregnant women and children under five years in two districts in Niger (West Africa). BMC Health Serv Res. 2009;9:89.
- Agyepong IA, Nagai RA. « We charge them; otherwise we cannot run the hospital » front line workers, clients and health financing policy implementation gaps in Ghana. Health Policy. 1 mars 2011;99(3):226‑33.
- Ben Ameur A, Ridde V, Bado AR, Ingabire M-G, Queuille L. User fee exemptions and excessive household spending for normal delivery in Burkina Faso: the need for careful implementation. BMC Health Serv Res. 2012;12:412.
- Dieleman M, Gerretsen B, van der Wilt GJ. Human resource management interventions to improve health workers’ performance in low and middle income countries: a realist review. Health Res Policy Syst. 2009;7:7.
References
World Health Organization, UNICEF. Trends in maternal mortality: 1990-2015: estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. 2015;
OMS. Mortalité maternelle [Internet]. WHO. 2014 [cité 29 juill 2016]. Disponible sur: http://www.who.int/mediacentre/factsheets/fs348/fr/
De Brouwere V, De Brouwere V, Tonglet R, Van Lerberghe W. Strategies for reducing maternal mortality in developing countries: what can we learn from the history of the industrialized West? Trop Med Int Health. 1 oct 1998;3(10):771‑82.
Mh B-C. [Maternal mortality in developing countries: statistical data and improvement in obstetrical care]. Med Trop Rev Corps Sante Colon. 2003 2002;63(4‑5):358‑65.
Perkins M, Brazier E, Themmen E, Bassane B, Diallo D, Mutunga A, et al. Out-of-pocket costs for facility-based maternity care in three African countries. Health Policy Plan. juill 2009;24(4):289‑300.
Witter S, Armar-Klemesu M, Dieng T. National fee exemption schemes for deliveries: comparing the recent experiences of Ghana and Senegal. Stud Health Serv Organ Policy Ser. 2008;24:167‑98.
Ouma MN, Chemwolo BT, Pastakia S, Christoffersen-Deb A, Washington S. Pilot study of single-use obstetric emergency medical kits to reduce maternal mortality. Int J Gynecol Obstet. 1 oct 2012;119(1):49‑52.
Ridde V, Richard F, Bicaba A, Queuille L, Conombo G. The national subsidy for deliveries and emergency obstetric care in Burkina Faso. Health Policy Plan. nov 2011;26 Suppl 2:ii30-40.
Bradley S, McAuliffe E. Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system. Hum Resour Health. 2009;7:14.
De Brouwere V, Delvaux T, Leke R. Achievements and lessons learnt from facility-based maternal death reviews in Cameroon. BJOG Int J Obstet Gynaecol. 1 sept 2014;121:71‑4.
Institut National de la Statistique (INS). Tendances, profil et déterminants de la pauvreté au Cameroun entre 2001- 2014 [Internet]. 2014 [cité 27 août 2016]. Disponible sur: http://www.statistics-cameroon.org/news.php?id=334
De Brouwere V. Reducing financial barriers to obstetric care in low-income countries. 2000;
Gohou V, Ronsmans C, Kacou L, Yao K, Bohoussou KM, Houphouet B, et al. Responsiveness to life-threatening obstetric emergencies in two hospitals in Abidjan, Côte d’Ivoire. Trop Med Int Health. 1 mars 2004;9(3):406‑15.
Meessen B, Hercot D, Noirhomme M, Ridde V, Tibouti A, Tashobya CK, et al. Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries. Health Policy Plan. 11 janv 2011;26(suppl 2):ii16-ii29.
Ridde V, Richard F, Bicaba A, Queuille L, Conombo G. The national subsidy for deliveries and emergency obstetric care in Burkina Faso. Health Policy Plan. 11 janv 2011;26(suppl 2):ii30-ii40.
Hatt LE, Makinen M, Madhavan S, Conlon CM. Effects of User Fee Exemptions on the Provision and Use of Maternal Health Services: A Review of Literature. J Health Popul Nutr. déc 2013;31(4 Suppl 2):S67‑80.
Tashobya CK, Ssengooba F, Cruz VO, Yates R, Murindwa G, McPake B. Health systems reforms in Uganda: processes and outputs. London school of hygiene and tropical medicine. Health systems development programme (HSD); 2006.
Prytherch H, Kakoko DCV, Leshabari MT, Sauerborn R, Marx M. Maternal and newborn healthcare providers in rural Tanzania: in-depth interviews exploring influences on motivation, performance and job satisfaction. Rural Remote Health. 2012;12:2072.
Samb OM, Belaid L, Ridde V. Burkina Faso : la gratuité des soins aux dépens de la relation entre les femmes et les soignants ? Humanit Enjeux Prat Débats. 1 juin 2013;(35):34‑43.
Pearson L, Gandhi M, Admasu K, Keyes EB. User fees and maternity services in Ethiopia. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. déc 2011;115(3):310‑5.
Ridde V, Diarra A. A process evaluation of user fees abolition for pregnant women and children under five years in two districts in Niger (West Africa). BMC Health Serv Res. 2009;9:89.
Agyepong IA, Nagai RA. « We charge them; otherwise we cannot run the hospital » front line workers, clients and health financing policy implementation gaps in Ghana. Health Policy. 1 mars 2011;99(3):226‑33.
Ben Ameur A, Ridde V, Bado AR, Ingabire M-G, Queuille L. User fee exemptions and excessive household spending for normal delivery in Burkina Faso: the need for careful implementation. BMC Health Serv Res. 2012;12:412.
Dieleman M, Gerretsen B, van der Wilt GJ. Human resource management interventions to improve health workers’ performance in low and middle income countries: a realist review. Health Res Policy Syst. 2009;7:7.