Work Packages

These are particularly important elements in this proposal, as the intervention is a health financing one, which involves the shifting of costs (in theory) from patients to governments (and donors). Its impact will be heavily linked to the effectiveness of the financing channels. In addition, the analysis of the equity effects of the policy will be critical to understanding its success or failure.

This WP will therefore develop the overall causal framework for the analysis and will help to synthesise the end findings on cost-effectiveness of interventions, in particular by collecting cost data, which will be combined with results from other WPs to derive cost effectiveness (understood here in the broadest sense, to include wider health system impacts as well as narrow ones).

The health policy component will analyse the way in which policy is driven, and also assist in evaluating the internal innovation of the community of practice component.

The second thematic WP is the local health systems (WP3) one. This takes a two-way analysis, considering both what enables successful implementation of the policies at the district level, but also what the effects of the policy are on the health system itself. This will be key to understanding the dynamics of reform (not just the effects, but the processes which contribute to them and which will need to be taken into consideration in generalising from evaluation results).

The final thematic WP looks at quality of care and health outcomes (WP4). Neither are easy to measure in the maternal health field, which is why tools will be adapted and piloted which have potential to track quality of care and changes to outcomes without major (and expensive) maternal mortality surveys.

Four focal countries will be involved in research in all three of these thematic areas (though the exact combination of tools varies according to the local needs and the timing of reform - some have had some degree of documentation already; others very little or none). Three are in francophone West Africa - Benin, Burkina Faso and Mali - and one in the Maghreb (Morocco). They are participating in this proposal because they have all introduced policies to remove fees for deliveries and caesareans in the past few years, and have all expressed a strong commitment to evaluating their reforms. None of them has as yet had a full evaluation of their policies. They will work in close collaboration with researchers based in the thematic WPs to develop the tools, conduct the research, disseminate findings, and adapt the tools for other contexts.

The final WP is the dissemination one. This has two parts. The first is a 'community of practice', which will set up a regional network of policy-makers, researchers and health partners, to learn lessons from one another during this period of reform (most countries in the region having introduced some version of this targeted cost reduction policy in recent years). The CoP itself is an innovation which we will be evaluating. In addition, more conventional dissemination at the international level will also be supported by this WP, working with all other partners.

The objectives for this WP are:

1. To establish a research framework for evaluating complex interventions and providing coherence across WPs.
   
2. To develop innovative methodologies for health policy analysis, focussing on what drives policy change and how policy is transferred, both from international to national level (and back), but also across national contexts.
   
3. To develop a framework for evaluating the community of practice component.
   
4. To develop innovative methodologies for health finance research, focussing on practical tools for assessing how reforms change incentives at facility and health worker level, which is a core determinant of how a policy is translated into practice and hence how it affects care patterns and health gains (or lack of them).
   
5. To contribute to tools which can 'measure' implementation of a health financing policy.
   
6. To measure changes to service costs and household expenditure and health seeking behaviour that are linked to the fee exemption policies.
   
7. To deploy these tools in the context of the focal countries of the region to contribute to a robust but also sensitive evaluation of the fee exemption reforms (including their long-term effect and sustainability).

The findings from the FEMHealth project have now been finalised.

• See the r eports and policy briefs produced by the consortium.

General objective:

To evaluate the impact of fee exemption policies for EmOC on local health systems (LHS) and to analyse the conditions and mechanisms of success or failure of the policy implementation.

Specific objectives:

1. to conduct a rapid identification of study sites based on existing MOH data to identify “poorly” and “well” performing districts in regards to fee removal policy
   
2. to develop an innovative tool to assess the impact of national policies on local health systems and to apply this tool to assess the impact of the fee exemption for EmOC policy in selected districts
   
3. to conduct realist evaluation case studies in these selected districts and carry out comparative analysis to understand why the policy has been taken up - or not - and the conditions of success.

The findings from the FEMHealth project have now been finalised.

• See the r eports and policy briefs produced by the consortium.

The objectives for this WP are:

1. To establish a research framework for evaluating complex interventions and providing coherence across WPs
   
2. To develop innovative methodologies for health policy analysis, focussing on what drives policy change and how policy is transferred, both from international to national level (and back), but also across national contexts
   
3. To develop a framework for evaluating the community of practice component.
   
4. To develop innovative methodologies for health finance research, focussing on practical tools for assessing how reforms change incentives at facility and health worker level, which is a core determinant of how a policy is translated into practice and hence how it affects care patterns and health gains (or lack of them)
   
5. To contribute to tools which can 'measure' implementation of a health financing policy
   
6. To measure changes to service costs and household expenditure and health seeking behaviour that are linked to the fee exemption policies
   
7. To deploy these tools in the context of the focal countries of the region to contribute to a robust but also sensitive evaluation of the fee exemption reforms (including their long-term effect and sustainability).

The findings from the FEMHealth project have now been finalised.

• See the r eports and policy briefs produced by the consortium.

This work package implements an innovative model to generate, accumulate and share knowledge at regional level in the domain of selective free health care. Knowledge is understood in a broad sense: both scientific evidence and practical expertise on how to do things.

In November 2011 a CoP workshop was held in Bamako, Mali Meeting summary

Following on from the meeting in Mali a policy brief on maternal health fee exemptions was produced

• English
• French

Download A conceptual framework for assessing performance of Communities of Practice in Health Policy by Bruno Meessen and Maria Paola Bertone (2012).

FEMHealth contribution to Second Global Symposium on Health Systems Research 2nd November 2012 Beijing a panel of four presentations, chaired by Sophie Witter:

(1) the Community of Practice concept and early experiences (Allison Kelley);

(2) a framework for monitoring and evaluating CoPs (Maria Bertone);

(3) monitoring data on members and their activities (Bruno Meessen) and

(4) early findings on the value-added for members (Isabelle Lange) CoPANEL_Beijing2012.pdf

We are pleased to share with you the annual report for the Financial Access Health Services CoP for 2102, which provides an overview of activities, but also perceived successes and challenges (English version ; French version ).

The model of knowledge management is a regional community of practice: the “financial access community of practice” (FA CoP).

The FA CoP brings together experts working on the various policies and mechanisms being put in place across Africa. The CoP is a forum for gathering and sharing knowledge among its members, and for coordinating initiatives being carried out by different agencies.

Three “clusters” of the CoPFA:

• health insurance mechanisms including national, social, private, and community-based health insurance schemes.
  
• means-testing based mechanisms, including waivers, health equity funds, vouchers and conditional cash transfers, with an emphasis on identifying and covering the poor.
  
• categorical targeting mechanisms based on specific priority health care services (malaria prevention and treatment, maternal and child health services, HIV/AIDS services) and/or specific categories of the population (children under five years of age, pregnant women, the elderly).

The FA CoP, whose activities are organised in French and English, works through a variety of strategies.

• face-to-face meetings (regional workshops, training sessions),
• web-based exchanges (discussion forum, webchats, resource centre for studies, documents, and tools)
• professional development opportunities and networking
• studies/analysis/documentation on priority topic areas
• development and support to country-level CoPs on financial access

What can the FA CoP offer your country?

• a pool of expert-practitioners familiar with operational, scientific and policy challenges related to improving financial access to health services
• a network for cross-learning with other countries facing similar challenges
• access to global knowledge on improving financial access
• opportunities for technicians to attend events or training sessions

What can the FA CoP offer you?

• access to an international network in a very dynamic field of knowledge
• opportunities for learning, exchanging and debating
• constant information on new theoretical, operational or empirical developments related to improving financial access
• opportunities for professional growth, through better visibility, capacity building, and access to new job openings

If you have any questions about the CoP, please email us at cdp.afss@gmail.com

General objective:

• To develop methodologies and evaluate the impact of selective free health care policies on local health systems, health outcomes and quality of care

Specific objectives:

• to participate in the development of the innovative tools on health systems, health outcomes and quality of care by participating to workshops and testing tools at national level
• to take a leading role in the development and implementation of tools to measure the impact of the policy on household expenditure (working with WP2)
• to generate new knowledge on the impact of a policy of subsidising delivery and EmOC on maternal and neonatal health by collecting data using innovative multidisciplinary evaluation tools
• to liaise with policy makers at national level and regional level through CoP activities, in order to refine new knowledge
• to communicate national findings at national and international level in order to improve the implementation of current and future policies on the removal of user fees, in conjunction with IRSS.

See presentations from the Dissemination Event in Burkina Faso .

• See the presentations from the Dissemination Event in Benin .

General objective:

To develop methodologies and evaluate the impact of selective free health care policies on local health systems, health outcomes and quality of care

Specific objectives:

• to participate in the development of the innovative tools on health systems, health outcomes and quality of care by participating in workshops and testing tools at national level
  
• to generate new knowledge on the impact of the policy of free caesarean section on maternal and neonatal health by collecting data using innovative multidisciplinary evaluation tools
  
• to liaise with policy makers at national level and regional level through CoP activities, in order to refine new knowledge
  
• to communicate national findings at national and international level in order to improve the implementation of current and future policies on the removal of user fees

General objective:

To develop methodologies and evaluate the impact of selective free health care policies on local health systems, health outcomes and quality of care

Specific objectives:

• to participate in the development of the innovative tools on health systems, health outcomes and quality of care by participating in workshops and testing tools at national level
  
• to generate new knowledge on the impact of the policy of free caesarean section on maternal and neonatal health by collecting data using innovative multidisciplinary evaluation tools
  
• to liaise with policy makers at national level and regional level through CoP activities, in order to refine new knowledge
  
• to communicate national findings at national and international level in order to improve the implementation of current and future policies on the removal of user fees

See presentations from the Dissemination Event in Morocco .