Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health
Open accessAbstract
Background: The last decade has seen widespread retreat from user fees with the intention to reduce financial constraints to users in accessing health care and in particular improving access to reproductive, maternal and newborn health services. This has had important benefits in reducing financial barriers to access in a number of settings. If the policies work as intended, service utilization rates increase. However this increases workloads for health staff and at the same time, the loss of user fee revenues can imply that health workers lose bonuses or allowances, or that it becomes more difficult to ensure uninterrupted supplies of health care inputs. This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health. Methods: We undertook case studies in five countries (Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe). In each we reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors. Results: We question a number of common assumptions about the financing and human resource inter-relationships. The impact of fee removal on utilization levels is mostly not sustained or supported by all the evidence. Shortages of human resources for health at the national level are not universal; maldistribution within countries is the greater problem. Low salaries are not universal; most of the countries pay health workers well by national benchmarks. Conclusions: The interconnectedness between user fee policy and HRH situations proves difficult to assess. Many policies have been changing over the relevant period, some clearly and others possibly in response to problems identified associated with financing policy change. Other relevant variables have also changed. However, as is now well-recognised in the user fee literature, co-ordination of health financing and human resource policies is essential. This appears less well recognised in the human resources literature. This coordination involves considering user charges, resource availability at health facility level, health worker pay, terms and conditions, and recruitment in tandem. All these policies need to be effectively monitored in their processes as well as outcomes, but sufficient data are not collected for this purpose.
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Unofficial demands from pregnant women, for example soap and other disinfectants after delivery, are among unacceptable attitudes of skilled birth attendants.
“Some of which are: unofficial demands from pregnant women, for example soap and other disinfectants after delivery [7,15,16,19,20,22,23,31–36] and abusive behaviors [7,23,37].”
From A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis (2024) · cites this paper as [23]
The Discussion (page unavailable) reports that services intended to be free were not always experienced as free and that informal fees could replace formal ones. This supports the general concern about unofficial demands, but the paper does not identify demands for soap or disinfectants after delivery or describe them specifically as attitudes of skilled birth attendants. (LLM, conf=0.84)
Experimental — accuracy not yet measuredUnacceptable attitudes of skilled birth attendants are widely reported barriers to skilled delivery.
“Besides the problem of incompetence, unacceptable attitudes of SBAs are also widely reported barriers to skilled delivery.”
From A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis (2024) · cites this paper as [23]
The Discussion (page unavailable) says that whether health workers treat users with dignity and respect consistently ranks highly in studies of what matters to users, and links quality of care to service use. It does not specifically report that unacceptable attitudes of skilled birth attendants are widely documented barriers to skilled delivery. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAbusive behaviors are among unacceptable attitudes of skilled birth attendants.
“and abusive behaviors [7,23,37].”
From A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis (2024) · cites this paper as [23]
The Discussion (page unavailable) says that whether users are treated with dignity and respect is an important aspect of care largely controlled by health workers. It does not identify abusive behaviors specifically or say they are attitudes exhibited by skilled birth attendants. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Cites
Closing the gap in a generation: health equity through action on the social determinants of health
Marmot, M. G., Friel, S., Bell, R., Houweling, T. A. J., & Taylor, S. A. J. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61690-6 · Cited by 8,238 · see citing works
The burden of oral disease: challenges to improving oral health in the 21st century.
Petersen, P. E. (2005) · Europe PMC (PubMed Central) · Cited by 3,575 · see citing works
The World Health report 2006 1 : Working together for health 2
Guilbert, J.-J. (2006) · Education for Health · doi:10.1080/13576280600937911 · Cited by 2,657 · see citing works
United States Agency for International Development
Doheny, E. (2011) · Digital Commons @ Connecticut College (Connecticut College) · Cited by 1,243 · see citing works
The World Health Report 2005 - make every mother and child count
Lerberghe, W. V., Manuel, A., Matthews, Z., & Wolfheim, C. (2005) · ePrints Soton (University of Southampton) · Cited by 1,015 · see citing works
Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done?
Lawn, J. E., Lee, A. C., Kinney, M., Sibley, L., Carlo, W. A., Paul, V. K., Pattinson, R., & Darmstadt, G. L. (2009) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2009.07.016 · Cited by 561 · see citing works
Agyepong, I. A., & Adjei, S. (2007) · Health Policy and Planning · doi:10.1093/heapol/czn002 · Cited by 364 · see citing works
‘We are bitter but we are satisfied’: nurses as street-level bureaucrats in South Africa
Walker, L., & Gilson, L. (2004) · Social Science & Medicine · doi:10.1016/j.socscimed.2003.12.020 · Cited by 354 · see citing works
Universal health care and the removal of user fees
Yates, R. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60258-0 · Cited by 352 · see citing works
Xu, K., Evans, D. B., Kadama, P., Nabyonga, J., Ogwal, P. O., Nabukhonzo, P., & Aguilar, A. M. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.07.004 · Cited by 351 · see citing works
Sierra Leone Demographic and Health Survey 2008
Macro, I. (2009) · Cited by 285 · see citing works
A scoping review of the literature on the abolition of user fees in health care services in Africa
Ridde, V., & Morestin, F. (2010) · Health Policy and Planning · doi:10.1093/heapol/czq021 · Cited by 272 · see citing works
To Retain or Remove User Fees?
James, C. D., Hanson, K., McPake, B., Balabanova, D., Gwatkin, D. R., Hopwood, I., Kirunga, C., Knippenberg, R., Meessen, B., Morris, S. S., et al. (2006) · Applied Health Economics and Health Policy · doi:10.2165/00148365-200605030-00001 · Cited by 260 · see citing works
Self-citationSomething old or something new? Social health insurance in Ghana
Witter, S., & Garshong, B. (2009) · BMC International Health and Human Rights · doi:10.1186/1472-698x-9-20 · Cited by 247 · see citing works
Self-citationA model to prioritize access to elective surgery on the basis of clinical urgency and waiting time
Valente, R., Testi, A., Tànfani, E., Fato, M., Porro, I., Santo, M., Santori, G., Torre, G., & Ansaldo, G. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-1 · Cited by 245 · see citing works
Removing user fees for primary care in Africa: the need for careful action
Gilson, L., & McIntyre, D. (2005) · BMJ · doi:10.1136/bmj.331.7519.762 · Cited by 236 · see citing works
Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up?
Hofmeyr, G. J., Haws, R. A., Bergström, S., Lee, A. C., Okong, P., Darmstadt, G. L., Mullany, L. C., Oo, E. K. S., & Lawn, J. E. (2009) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2009.07.017 · Cited by 224 · see citing works
The Millennium Development Goals (MDGs): A Short History of the World’s Biggest PromisePreprint
Hulme, D. (2009) · SSRN Electronic Journal · doi:10.2139/ssrn.1544271 · Cited by 222 · see citing works
Zimbabwe : the political economy of transition, 1980-1986
Mandaza, I. (1986) · CODESRIA eBooks · Cited by 221 · see citing works
Health for Some? The Effects of User Fees in the Volta Region of Ghana
Nyonator, F. K., & Kutzin, J. (1999) · Health Policy and Planning · doi:10.1093/heapol/14.4.329 · Cited by 211 · see citing works
The Experience of Ghana in Implementing a User Fee Exemption Policy to Provide Free Delivery Care
Witter, S., Arhinful, D. K., Kusi, A., & Zakariah-Akoto, S. (2007) · Reproductive Health Matters · doi:10.1016/s0968-8080(07)30325-x · Cited by 204 · see citing works
Self-citationKruk, M. E., Mbaruku, G. M., Rockers, P. C., & Galea, S. (2008) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2008.02173.x · Cited by 204 · see citing works
Linking families and facilities for care at birth: What works to avert intrapartum-related deaths?
Lee, A. C., Lawn, J. E., Cousens, S. N., Kumar, V., Osrin, D., Bhutta, Z. A., Wall, S. N., Nandakumar, A. K., Syed, U. N., & Darmstadt, G. L. (2009) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2009.07.012 · Cited by 195 · see citing works
Reducing intrapartum-related deaths and disability: Can the health system deliver?
Lawn, J. E., Kinney, M. V., Lee, A. C., Chopra, M., Donnay, F. A., Paul, V. K., Bhutta, Z. A., Bateman, M., & Darmstadt, G. L. (2009) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2009.07.021 · Cited by 194 · see citing works
Meessen, B., Hercot, D., Noirhomme, M., Ridde, V., Tibouti, A., Tashobya, C. K., & Gilson, L. (2011) · Health Policy and Planning · doi:10.1093/heapol/czr062 · Cited by 190 · see citing works
User charges for health services in developing countries: A review of the economic literature
McPake, B. (1993) · Social Science & Medicine · doi:10.1016/0277-9536(93)90382-e · Cited by 174 · see citing works
Self-citationEquity in healthPreprint
Williams, A., & Cookson, R. (2000) · RePEc: Research Papers in Economics · Cited by 166 · see citing works
(1991) · Choice Reviews Online · doi:10.5860/choice.28-3502 · Cited by 145 · see citing works
Odekon, M. (2015) · The SAGE Encyclopedia of World Poverty · doi:10.4135/9781483345727.n582 · Cited by 140 · see citing works
The national free delivery and caesarean policy in Senegal: evaluating process and outcomes
Witter, S., Dieng, T., Mbengue, D., Moreira, I., & Brouwere, V. D. (2010) · Health Policy and Planning · doi:10.1093/heapol/czq013 · Cited by 137 · see citing works
Self-citationDiscontinuation of cost sharing in Uganda.
Burnham, G. M., Pariyo, G. W., Galiwango, E., & Wabwire‐Mangen, F. (2004) · Europe PMC (PubMed Central) · Cited by 134 · see citing works
Reducing user fees for primary health care in Kenya: Policy on paper or policy in practice?
Chuma, J. M., Musimbi, J., Okungu, V., Goodman, C. A., & Molyneux, S. C. (2009) · International Journal for Equity in Health · doi:10.1186/1475-9276-8-15 · Cited by 129 · see citing works
The national free delivery policy in Nepal: early evidence of its effects on health facilities
Witter, S., Khadka, S., Nath, H., & Tiwari, S. (2011) · Health Policy and Planning · doi:10.1093/heapol/czr066 · Cited by 129 · see citing works
Self-citationAli, M. K., & Narayan, K. M. V. (2009) · Global Health Action · doi:10.3402/gha.v2i0.2035 · Cited by 125 · see citing works
Abolition of user fees: the Uganda paradox
Nabyonga‐Orem, J., Mugisha, F., Kirunga, C., Macq, J., & Criel, B. (2011) · Health Policy and Planning · doi:10.1093/heapol/czr065 · Cited by 125 · see citing works
Health Policy in a Globalising World
Lee, K., Buse, K., & Fustukian, S. (2002) · Cambridge University Press eBooks · doi:10.1017/cbo9780511489037 · Cited by 120 · see citing works
Self-citationWitter, S., Adjei, S., Armar‐Klemesu, M., & Graham, W. J. (2009) · Global Health Action · doi:10.3402/gha.v2i0.1881 · Cited by 118 · see citing works
Self-citationThe national subsidy for deliveries and emergency obstetric care in Burkina Faso
Ridde, V., Richard, F., Bicaba, A., Queuille, L., & Conombo, G. (2011) · Health Policy and Planning · doi:10.1093/heapol/czr060 · Cited by 113 · see citing works
Penfold, S. C., Harrison, E., Bell, J. S., & Fitzmaurice, A. E. (2007) · PubMed Central · Cited by 110 · see citing works
Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect
Ssengooba, F., Rahman, S. A., Hongoro, C., Rutebemberwa, E., Mustafa, A., Kielmann, T., & McPake, B. (2007) · Human Resources for Health · doi:10.1186/1478-4491-5-3 · Cited by 104 · see citing works
Self-citationRidde, V., & Diarra, A. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-89 · Cited by 102 · see citing works
Do they work? Regulating for-profit providers in Zimbabwe
Hongoro, C. (2000) · Health Policy and Planning · doi:10.1093/heapol/15.4.368 · Cited by 98 · see citing works
Agyepong, I. A., & Nagai, R. A. (2011) · Health Policy · doi:10.1016/j.healthpol.2010.09.018 · Cited by 94 · see citing works
Skilled Health Professionals’ Migration and its Impact on Health Delivery in Zimbabwe
Chikanda, A. (2006) · Journal of Ethnic and Migration Studies · doi:10.1080/13691830600610064 · Cited by 91 · see citing works
Evaluating the economic outcomes of the policy of fee exemption for maternal delivery care in Ghana
Asante, F., Chikwama, C., Daniels, A., & Armar‐Klemesu, M. (2010) · Ghana Medical Journal · doi:10.4314/gmj.v41i3.55277 · Cited by 89 · see citing works
The equity impacts of community financing activities in three African countries
Gilson, L., Kalyalya, D. H., Küchler, F., Lake, S., Oranga, H., & Ouendo, M. (2000) · The International Journal of Health Planning and Management · doi:10.1002/hpm.599 · Cited by 81 · see citing works
Maintaining quality of health services after abolition of user fees: A Uganda case study
Nabyonga‐Orem, J., Karamagi, H. C., Atuyambe, L. M., Bagenda, F. N., Okuonzi, S. A., & Walker, O. (2008) · BMC Health Services Research · doi:10.1186/1472-6963-8-102 · Cited by 78 · see citing works
Witter, S., & Adjei, S. (2007) · The International Journal of Health Planning and Management · doi:10.1002/hpm.867 · Cited by 75 · see citing works
Self-citationUser-payment, decentralization and health service utilization in Zambia
Blas, E., & Limbambala, M. (2001) · Health Policy and Planning · doi:10.1093/heapol/16.suppl_2.19 · Cited by 75 · see citing works
The sudden removal of user fees: the perspective of a frontline manager in Burundi
Nimpagaritse, M., & Bertone, M. P. (2011) · Health Policy and Planning · doi:10.1093/heapol/czr061 · Cited by 72 · see citing works
Witter, S., Kusi, A., & Aikins, M. (2007) · Human Resources for Health · doi:10.1186/1478-4491-5-2 · Cited by 72 · see citing works
Self-citationUser fees, health staff incentives, and service utilization in Kabarole District, Uganda.
Kipp, W. E., Kamugisha, J., Jacobs, P., Burnham, G. M., & Rubaale, T. (2001) · Europe PMC (PubMed Central) · Cited by 72 · see citing works
Removing user fees: learning from international experience to support the process
McPake, B., Brikci, N., Cometto, G., Schmidt, A., & Araujo, E. (2011) · Health Policy and Planning · doi:10.1093/heapol/czr064 · Cited by 69 · see citing works
Self-citationHuman resources and access to maternal health care
ten Hoope-Bender, P., Liljestrand, J., & Macdonagh, S. (2006) · International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · doi:10.1016/j.ijgo.2006.04.003 · Cited by 57 · see citing works
Hospital based maternity care in Ghana - findings of a confidential enquiry into maternal deaths
Ansong‐Tornui, J., Armar‐Klemesu, M., Arhinful, D. K., Penfold, S. C., & Hussein, J. (2010) · Ghana Medical Journal · doi:10.4314/gmj.v41i3.55280 · Cited by 56 · see citing works
From targeted exemptions to user fee abolition in health care: Experience from rural Zambia
Masiye, F., Chitah, B. M., & McIntyre, D. (2010) · Social Science & Medicine · doi:10.1016/j.socscimed.2010.04.029 · Cited by 53 · see citing works
Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan
Steinhardt, L. C., Aman, I., Pakzad, I., Kumar, B., Singh, L. P., & Peters, D. H. (2011) · Health Policy and Planning · doi:10.1093/heapol/czr069 · Cited by 51 · see citing works
Gupta, N., & Poz, M. R. D. (2009) · Human Resources for Health · doi:10.1186/1478-4491-7-22 · Cited by 51 · see citing works
Health and Structural Adjustment in Rural and Urban Zimbabwe
Bijlmakers, L. A., Basset, M., & Sanders, D. M. (1996) · KTH Publication Database DiVA (KTH Royal Institute of Technology) · Cited by 48 · see citing works
Kivumbi, G. W. (2002) · Health Policy and Planning · doi:10.1093/heapol/17.suppl_1.64 · Cited by 48 · see citing works
Abolishing User Fees in Africa
Ridde, V., & Haddad, S. H. S. (2008) · PLoS Medicine · doi:10.1371/journal.pmed.1000008 · Cited by 45 · see citing works
Abdu, Z., Mohammed, Z. M. S., Bashier, I., & Eriksson, B. (2004) · The International Journal of Health Planning and Management · doi:10.1002/hpm.777 · Cited by 45 · see citing works
McIntyre, D., Gilson, L., & Mutyambizi (2005) · LSHTM Research Online (London School of Hygiene and Tropical Medicine) · Cited by 43 · see citing works
Improving the implementation of cost recovery for health: lessons from Zimbabwe
Hecht, R., Overholt, C., & Holmberg, H. R. (1993) · Health Policy · doi:10.1016/0168-8510(93)90017-j · Cited by 42 · see citing works
User fees and drugs: what did the health reforms in Zambia achieve?
van der Geest, S. (2000) · Health Policy and Planning · doi:10.1093/heapol/15.1.59 · Cited by 40 · see citing works
Simeo, F., Chanda‐Kapata, P., Chitah, B. M., & Masiye, F. (2008) · Cited by 38 · see citing works
Medical Leave: The Exodus Of Health Professionals From Zimbabwe
Chikanda, A. (2005) · University of Zimbabwe Institutional Repository (University of Zimbabwe) · Cited by 37 · see citing works
The status of maternal and newborn care services in Sierra Leone 8 years after ceasefire
Oyerinde, K., Harding, Y., Amara, P., Kanu, R., Shoo, R., & Daoh, K. (2011) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2011.05.006 · Cited by 36 · see citing works
An Unnecessary Evil? User fees for healthcare in low-income countries
Witter, S. (2005) · Queen Margaret University Publications Repository (Queen Margaret University) · doi:10.13140/rg.2.2.27605.70883 · Cited by 35 · see citing works
Self-citationRohde, J. E., Chatterjee, M., & Morley, D. C. (1993) · Cited by 35 · see citing works
Social Protection and Health: Experiences in Uganda
Yates, J., Cooper, R., & Holland, J. (2006) · Development Policy Review · doi:10.1111/j.1467-7679.2006.00328.x · Cited by 34 · see citing works
Mubyazi, G. M., Massaga, J. J., Kamugisha, M., Mubyazi, J.-N., Magogo, G. C., Mdira, K. Y., Gesase, S., & Sukwa, T. (2006) · Health Services Management Research · doi:10.1258/095148406775322061 · Cited by 30 · see citing works
Margaret Chan: committed to universal health coverage
Holmes, D. I. R. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61493-7 · Cited by 26 · see citing works
Removing user fees in the health sector in low-income countries: a multi-country review
Meessen, B., Hercot, D., Noirhomme, M., Ridde, V., Tibouti, A., Bicaba, A., Tashobya, C. K., & Gilson, L. (2009) · Cited by 22 · see citing works
Mapping user fees for health care in high-mortality countries – evidence from a recent survey
Witter, S. (2010) · Queen Margaret University Publications Repository (Queen Margaret University) · Cited by 21 · see citing works
Self-citationChildren and Women in Zimbabwe: A Situation Analysis, Update 1994
Tichagwa, W. N., & Dede-Esi (1994) · Cited by 20 · see citing works
The Dynamics of Policy Change: Lessons from Health Financing Reform in South Africa and Zambia
Gilson, L., Antezana, I., Bennett, S., Bowa, C. K., Brijlal, V., Doherty, J. E., Daura, M., Lake, S., Mabandhla, M., Masiye, F., et al. (2000) · Cited by 14 · see citing works
Sibley, L. M., & Glazier, R. H. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-s1-a12 · Cited by 13 · see citing works
The transformation of Zimbabwe's health care system: A review of the white paper on health
Manga, P. (1988) · Social Science & Medicine · doi:10.1016/0277-9536(88)90342-5 · Cited by 12 · see citing works
Herbst, C. H., Vledder, M., Campbell, K., Sjoblom, M. C., & Soucat, A. L. B. (2011) · World Bank Publications · Cited by 11 · see citing works
Key informant views of a free delivery and caesarean policy in Senegal.
Witter, S., & Diadhiou, M. (2008) · PubMed · Cited by 11 · see citing works
Self-citationMothers and infants to get free health care in Sierra Leone
Wakabi, W. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60371-6 · Cited by 11 · see citing works
Bijlmakers, L. A. (2003) · UvA-DARE (University of Amsterdam) · Cited by 11 · see citing works
Chirwa, Y., Witter, S., Munjoma, M., Mashange, W., Ensor, T., McPake, B., & Munyati, S. S. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-197 · Cited by 9 · see citing works
Self-citationThe globalisation of health sector reform policies: is ‘lesson drawing’ part of the process?
McPake, B. (2001) · Cambridge University Press eBooks · doi:10.1017/cbo9780511489037.009 · Cited by 7 · see citing works
Self-citationIncreasing access to ‘free’ health services: are health workers not a missing link?
Campbell, J., Oulton, J. A., McPake, B., & Buchan, J. (2010) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2010.02446.x · Cited by 7 · see citing works
Self-citationThe Human Resources for Health Crisis in Zambia
Herbst, C. H., Vledder, M., Campbell, K., Sjoblom, M. C., & Soucat, A. L. B. (2011) · World Bank working paper · doi:10.1596/978-0-8213-8761-0 · Cited by 7 · see citing works
Children and women in Zimbabwe : a situation analysis update, July 1985-July 1990
Loewenson, R. H., & Zimbabwe (1990) · Cited by 5 · see citing works
Flagged first, then by citations
2 of the 90 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Ministry of Health and Sanitation Health Sector Performance Review, Scaling up Maternal and Child Health Services in Sierra Leone 2010 Freetown: Government of Sierra Leone
Cited by
Sorted by citations
MACKINTOSH, M. M., Channon, A. A., Karan, A., Selvaraj, S., Cavagnero, E., & Zhao, H. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00342-1 · Cited by 282 · see citing works
Marahatta, S. B., Yadav, R. K., Giri, D., Lama, S., Rijal, K. R., Mishra, S. R., Shrestha, A. C., Bhattarai, P. R., Mahato, R. K., & Adhikari, B. (2020) · PLoS ONE · doi:10.1371/journal.pone.0227293 · Cited by 141 · see citing works
Panday, S., Bissell, P., van Teijlingen, E., & Simkhada, P. P. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2567-7 · Cited by 134 · see citing works
Enweronu-Laryea, C. C., Dickson, K., Moxon, S. G., Simen-Kapeu, A., Nyange, C., Niermeyer, S., Bégin, F., Sobel, H. L., Lee, A. C., von Xylander, S. R., et al. (2015) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-15-s2-s4 · Cited by 120 · see citing works
Incentives to change: effects of performance-based financing on health workers in Zambia
Shen, G. C., Nguyen, H. T. H., Das, A., Sachingongu, N., Chansa, C., Qamruddin, J. N., & Friedman, J. A. (2017) · Human Resources for Health · doi:10.1186/s12960-017-0179-2 · Cited by 84 · see citing works
The free health care initiative: how has it affected health workers in Sierra Leone?
Witter, S., Wurie, H. R., & Bertone, M. P. (2015) · Health Policy and Planning · doi:10.1093/heapol/czv006 · Cited by 81 · see citing works
Self-citationBertone, M. P., Samai, M. H., Edem-Hotah, J., & Witter, S. (2014) · Conflict and Health · doi:10.1186/1752-1505-8-11 · Cited by 81 · see citing works
Self-citationThe gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts
Witter, S., Namakula, J., Wurie, H. R., Chirwa, Y., So, S., Vong, S., Ros, B., Buzuzi, S., & Theobald, S. (2017) · Health Policy and Planning · doi:10.1093/heapol/czx102 · Cited by 70 · see citing works
Self-citationThe quality of free antenatal and delivery services in Northern Sierra Leone
Koroma, M. M., Kamara, S. S., Bangura, E. A., Kamara, M. A., Lokossou, V., & Keita, N. (2017) · Health Research Policy and Systems · doi:10.1186/s12961-017-0218-4 · Cited by 59 · see citing works
Percival, V., Richards, E., Wurie, H. R., Namakula, J., Ssali, S., & Theobald, S. (2018) · Globalization and Health · doi:10.1186/s12992-018-0401-6 · Cited by 60 · see citing works
Human resource shortage in India’s health sector: a scoping review of the current landscape
Mehta, V., Ajmera, P., Kalra, S., Miraj, M., Gallani, R., Shaik, R. A., Serhan, H. A. A., & Sah, R. (2024) · BMC Public Health · doi:10.1186/s12889-024-18850-x · Cited by 50 · see citing works
Ibrahim, N., Pozo-Martin, F., & Gilbert, C. E. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-0831-2 · Cited by 46 · see citing works
How effective and fair is user fee removal? Evidence from Zambia using a pooled synthetic control
Lépine, A., Lagarde, M., & Nestour, A. L. (2017) · Health Economics · doi:10.1002/hec.3589 · Cited by 44 · see citing works
Pradhan, E., Canning, D., Shah, I., Puri, M. C., Pearson, E., Thapa, K., Bajracharya, L., Maharjan, M., Maharjan, D. C., Bajracharya, L., et al. (2019) · Reproductive Health · doi:10.1186/s12978-019-0738-1 · Cited by 44 · see citing works
Asamoah, B. O., Agardh, A., Pettersson, K. O., & Östergren, P. (2014) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-14-295 · Cited by 42 · see citing works
James, N. F., Lawson, K. D., & Acharya, Y. (2020) · Global Health Research and Policy · doi:10.1186/s41256-020-00158-z · Cited by 40 · see citing works
Nalluri, V., & Chen, L. (2023) · Technological Forecasting and Social Change · doi:10.1016/j.techfore.2023.123049 · Cited by 39 · see citing works
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Roozbeh, N., Nahidi, F., & Hajiyan, S. (2016) · Saudi Medical Journal · doi:10.15537/smj.2016.12.15505 · Cited by 32 · see citing works
Parmar, D., & Banerjee, A. (2019) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112582 · Cited by 32 · see citing works
Anafi, P., Mprah, W. K., Jackson, A. M., Jacobson, J., Torres, C. M., Crow, B. M., & O’Rourke, K. M. (2018) · International Quarterly of Community Health Education · doi:10.1177/0272684x18763378 · Cited by 31 · see citing works
Jansen, C., Codjia, L., Dieleman, M. A., Lamine, Y., & Cometto, G. (2014) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s46418 · Cited by 30 · see citing works
Margaret Chan: committed to universal health coverage
Holmes, D. I. R. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61493-7 · Cited by 26 · see citing works
Bertone, M. P., Martins, J. S., Pereira, S. M., Martineau, T., & Alonso‐Garbayo, A. (2018) · Human Resources for Health · doi:10.1186/s12960-018-0325-5 · Cited by 26 · see citing works
Self-citationEdoka, I., Ensor, T., McPake, B., Amara, R., Tseng, F., & Edem-Hotah, J. (2016) · Health Economics Review · doi:10.1186/s13561-016-0096-4 · Cited by 25 · see citing works
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Durham, J., Pavignani, E., Beesley, M. E., & Hill, P. (2015) · Human Resources for Health · doi:10.1186/s12960-015-0005-7 · Cited by 25 · see citing works
Zida, A., Lavis, J. N., Sewankambo, N. K., Kouyaté, B. A., & Moat, K. A. (2017) · Health Research Policy and Systems · doi:10.1186/s12961-017-0228-2 · Cited by 22 · see citing works
Merten, S., Ntalasha, H., & Musheke, M. (2016) · PLoS ONE · doi:10.1371/journal.pone.0155510 · Cited by 21 · see citing works
Dossou, J., Brouwere, V. D., Belle, S. V., & Marchal, B. (2019) · Health Policy and Planning · doi:10.1093/heapol/czz146 · Cited by 20 · see citing works
Délamou, A., Dubourg, D., Béavogui, A. H., Delvaux, T., Kolié, J. S., Barry, T. H., Camara, B. S., Edginton, M. E., Hinderaker, S. G., & Brouwere, V. D. (2015) · PLoS ONE · doi:10.1371/journal.pone.0129162 · Cited by 19 · see citing works
Maini, R., den Bergh, R. V., van Griensven, J., Tayler‐Smith, K., Ousley, J., Carter, D., Mhatre, S., Ho, L. S., & Zachariah, R. (2014) · BMC Health Services Research · doi:10.1186/s12913-014-0504-6 · Cited by 19 · see citing works
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Newell, R., Spillman, I., & Newell, M. (2017) · Journal of Public Health in Africa · doi:10.4081/jphia.2017.592 · Cited by 17 · see citing works
Kuwawenaruwa, A., Mtei, G., Baraka, J., & Tani, K. (2016) · Journal of Health Population and Nutrition · doi:10.1186/s41043-016-0075-8 · Cited by 14 · see citing works
Progress towards Every Newborn Action Plan (ENAP) implementation in Iran: obstacles and bottlenecks
Mirbaha-Hashemi, F., Tayefi, B., Rampisheh, Z., Tehrani‐Banihashemi, A., Ramezani, M., Khalili, N., Pournik, O., Asl, R. T., Habibelahi, A., Heidarzadeh, M., et al. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03800-x · Cited by 14 · see citing works
Structural barriers to maternity care in Cameroon: a qualitative study
Harsono, A., Bond, C., Enah, C., Ngong, M., Kyeng, R., Wallace, E., Turan, J. M., Szychowski, J. M., Carlo, W., Ambe, L., et al. (2024) · Reproductive Health · doi:10.1186/s12978-024-01834-w · Cited by 10 · see citing works
Chirwa, Y., Mashange, W., Chandiwana, P., Buzuzi, S., Munyati, S. S., Chandiwana, B., & Witter, S. (2014) · Cited by 10 · see citing works
Self-citationThe development of HRH policy in Sierra Leone, 2002-2012 - a document review
Bertone, M. P., Edem-Hotah, J., Samai, M. H., & Witter, S. (2013) · Cited by 9 · see citing works
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Koon, A. D., Smith, L., Ndetei, D. M., Mutiso, V., & Mendenhall, E. (2016) · Critical Public Health · doi:10.1080/09581596.2016.1208362 · Cited by 9 · see citing works
Han, B., & Guan, H. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-02995-8 · Cited by 7 · see citing works
Jones, S., Ameh, C., Gopalakrishnan, S., Sam, B., Bull, F., Labicane, R. R., Dabo, F., & van den Broek, N. R. (2015) · Midwifery · doi:10.1016/j.midw.2015.09.011 · Cited by 7 · see citing works
Sundaresan, A., Uddin, R., & Sorensen, C. J. (2023) · Seminars in Perinatology · doi:10.1016/j.semperi.2023.151845 · Cited by 5 · see citing works
Abredu, J., Dwumfour, C. K., Alipitio, B., Alordey, M., Dzomeku, V. M., & Witter, S. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0002902 · Cited by 4 · see citing works
Self-citationEdoka, I., & McPake, B. (2014) · WHO South-East Asia Journal of Public Health · doi:10.4103/2224-3151.206743 · Cited by 4 · see citing works
Self-citationAjayi, A. I., & Akpan, W. E. (2019) · Springer eBooks · doi:10.1007/978-3-319-94869-0_12 · Cited by 4 · see citing works
Witter, S., Ilboudo, P. G., Cunden, N., Boukhalfa, C., Makoutode, P. C., & Daou, Z. (2016) · Health Policy and Planning · doi:10.1093/heapol/czw116 · Cited by 3 · see citing works
Self-citationFontanet, C. P., Kaiser, J. L., Fong, R. M., Ngoma, T., Lori, J. R., Biemba, G., Munro‐Kramer, M. L., Sakala, I., McGlasson, K. L., Vian, T., et al. (2021) · International Journal of Health Policy and Management · doi:10.34172/ijhpm.2021.61 · Cited by 3 · see citing works
Kasina, M. (2016) · University of Nairobi Research Archive (University of Nairobi) · Cited by 3 · see citing works
Serchim, C. K., Opoku, D., Bonney, R. A., Safo, K. S., Amegble, S. K., Kodi, N. N. K., & Mensah, K. A. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12861-z · Cited by 2 · see citing works
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Olum, S., Adyanga, A. F., & Ocan, J. (2024) · International Journal of Advanced Research · doi:10.37284/ijar.7.1.1656 · Cited by 2 · see citing works
Kaçar, H. K., Köse, E. D., & Okuyucu, K. (2025) · Journal of Health Sciences and Medicine · doi:10.32322/jhsm.1588026 · Cited by 2 · see citing works
Panday, S. (2016) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York) · Cited by 2 · see citing works
Patient Satisfaction with Laboratory Services: Current Trends and Strategies for Quality Improvement
Kunzharikova, D., Kaliyeva, A. E., Baspakova, A. M., Kurmangaliyeva, S. S., & Alkaubayeva, A. (2025) · Journal of Environmental Treatment Techniques · doi:10.18502/jett.v13i1.18699 · Cited by 1 · see citing works
Ebinim, H., Olatunji, O., Samuel, O., Oluwatola, T., Hoemeke, L., Chenge, C., Otu, E., Orbunde, T., Omanukwue, M., & Sampson, S. (2025) · Discover Health Systems · doi:10.1007/s44250-025-00239-1 · Cited by 1 · see citing works
Mcharo, O., Kapesa, A., Materu, J., Luwayi, J. R., Nahay, F., Basinda, N., Chibwe, E., & Okello, E. S. (2025) · Reproductive Health · doi:10.1186/s12978-025-02087-x · Cited by 3 · see citing works
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Sharma, S., Sharma, A., Verma, A., Sharma, A. M., & Patel, R. (2025) · BENTHAM SCIENCE PUBLISHERS eBooks · doi:10.2174/9798898811594125010010 · Cited by 2 · see citing works
MScN (MNH), B., Asule, B. M., & Mukaka, V. (2017) · International Journal of Advanced Research · doi:10.21474/ijar01/5507 · Cited by 1 · see citing works
Republic of Sierra Leone Priorities for Sustainable Growth and Poverty Reduction
World Bank Group (2018) · World Bank, Washington, DC eBooks · doi:10.1596/29701 · Cited by 1 · see citing works
Asamoah, B. O. (2014) · Lund University Publications (Lund University)
The Impact of Free Healthcare on Hospital Deliveries in Sierra Leone
Samura, S. S. (2016) · ScholarWorks (Walden University)
Moyo, I., Mavhandu‐Mudzusi, A. H., & Human, S. P. (2017) · Africa Journal of Nursing and Midwifery · doi:10.25159/2520-5293/1233
Lim, C. K., Tan, K. L., & Haufiku, M. S. (2018) · International Journal of Interactive Mobile Technologies (iJIM) · doi:10.3991/ijim.v12i7.9635
Campbell, A., Tennant, V., & Henry, F. J. (2019) · Universal Journal of Public Health · doi:10.13189/ujph.2019.070401
Paschoalotto, M. A. C., Passador, J. L., Passador, C. S., & de Oliveira, P. H. (2020) · Revista de Políticas Públicas · doi:10.18764/2178-2865.v24n2p619-633
IUDs: Maternity Nurses’ Practices of Infection Control Measures
Rashed, A. B., Amer, N. A., & Ali, Z. A. (2020) · Saudi Journal of Nursing and Health Care · doi:10.36348/sjnhc.2020.v03i11.008
Mala, P. O. (2017) · Palgrave Macmillan US eBooks · doi:10.1057/978-1-349-95297-7_9
Multivariate Logistic Regression Models in the Progression of Vision Threatening Disease
Vasudevan, S. (2023) · International Journal of Medical Sciences and Nursing Research · doi:10.55349/ijmsnr.2023331619
Barreras de acceso para la atención prenatal: experiencia en la Red de Salud Chiclayo, 2024
Palma-García, C. M., Crespo, H. F. G., Izaguirre-Sotomayor, M. H., Arias, R. A. R., & Palma-García, L. (2025) · Revista Internacional de Salud Materno Fetal · doi:10.47784/rismf.2025.10.4.439
Mirbaha-Hashemi, F., Tayefi, B., Rampisheh, Z., Tehrani‐Banihashemi, A., Ramezani, M., Khalili, N., Pournik, O., Asl, R. T., Habibelahi, A., Heidarzadeh, M., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14608919
Mirbaha-Hashemi, F., Tayefi, B., Rampisheh, Z., Tehrani‐Banihashemi, A., Ramezani, M., Khalili, N., Pournik, O., Asl, R. T., Habibelahi, A., Heidarzadeh, M., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14608913
Mirbaha-Hashemi, F., Tayefi, B., Rampisheh, Z., Tehrani‐Banihashemi, A., Ramezani, M., Khalili, N., Pournik, O., Asl, R. T., Habibelahi, A., Heidarzadeh, M., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14608907
Mirbaha-Hashemi, F., Tayefi, B., Rampisheh, Z., Tehrani‐Banihashemi, A., Ramezani, M., Khalili, N., Pournik, O., Asl, R. T., Habibelahi, A., Heidarzadeh, M., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14608910
Mirbaha-Hashemi, F., Tayefi, B., Rampisheh, Z., Tehrani‐Banihashemi, A., Ramezani, M., Khalili, N., Pournik, O., Asl, R. T., Habibelahi, A., Heidarzadeh, M., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14608922
Mirbaha-Hashemi, F., Tayefi, B., Rampisheh, Z., Tehrani‐Banihashemi, A., Ramezani, M., Khalili, N., Pournik, O., Asl, R. T., Habibelahi, A., Heidarzadeh, M., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14608904
Mirbaha-Hashemi, F., Tayefi, B., Rampisheh, Z., Tehrani‐Banihashemi, A., Ramezani, M., Khalili, N., Pournik, O., Asl, R. T., Habibelahi, A., Heidarzadeh, M., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14608916
Mengistu, A. K., & Mengistie, M. B. (2026) · Archives of Public Health · doi:10.1186/s13690-026-01909-z
Alinejad, N., Rafati, L., Hayati, R., Ansarizadeh, M., Yousefi, M., Mohammadi, H., & Torkashvand, J. (2026) · Environmental Health Engineering and Management · doi:10.34172/ehem.1715
Ali, T. S., Pradhan, N. A., Zaidi, S. A., Ali, A., Jamal, W. Z., & Ariff, S. (2026) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-026-09459-6
NKIE-UKIED, G.-F. K., PENOY, A. I., KILOLO, J. K., & NKABANZA, A. N. (2026) · REVUE DES SCIENCES DE LA SANTE · doi:10.71004/rss.026.v5.i2.139
- Authors
- McPake, B., Witter, S., Ensor, T., Fustukian, S., Newlands, D., Martineau, T., & Chirwa, Y.
- Affiliations
- Queen Margaret University (GB)
- University of Leeds (GB)
- University of Aberdeen (GB)
- Liverpool School of Tropical Medicine (GB)
- Biomedical Research and Training Institute (ZW)
- Corresponding author
- Chirwa, Yotamu
- Venue
- Human Resources for Health
- Published
- 2013-09-22
- Volume
- 11
- Issue
- 1
- Pages
- 46-46
- ISSN
- 1478-4491 (ISSN-L)
- PMC
- PMC3849922
- OpenAlex
- W2119365967
- Cited by
- 79
- References
- 90
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 9 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 10 · 2016: 10 · 2015: 6 · 2014: 7 · 2013: 1 · 2012: 1
- FWCI
- 13.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Human Resources for Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Queen Margaret University Publications Repository (Queen Margaret University) (submittedVersion)
- Greater South Information System
- Funders
- Department for International Development
- Topics
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- user fees, health worker workload, health worker remuneration, health financing policy, health care utilization, health workforce recruitment, low- and middle-income countries
- MeSH terms
- Workforce, Fees and Charges, Ghana, Health Policy, Health Services Accessibility, Humans, Maternal Health Services, Nepal, Personnel Staffing and Scheduling, Sierra Leone, Zambia, Zimbabwe, Workload, Reproductive Health Services, Healthcare Financing
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