Evaluation of the Implementation of Free Health Care for Women of Childbearing Age and Children Aged 0 to 5 in the Dosso Region – Brief

Since 2006, Niger has been implementing the measure of free health care. This includes providing free health services for certain categories of the population, particularly children under five (5) years of age and women, including: Family planning, prenatal consultation, caesarean section/ectopic pregnancy/uterine rupture, and gynecological cancer. For children under five (5) years of age, free health care covers all preventive and curative care. HCME in collaboration with the Ministry of Public Health, Population and Social Action commissioned a rapid evaluation of the measure of the free health care package in the Dosso region with the financial support of TWENDE MBELE and UNICEF to assess the implementation of this intervention. This evaluation revealed certain shortcomings in the implementation of this measure of the free care package, namely:
• the delay and/or non-reimbursement of a critical mass of invoices from health facilities; • lack of human resources and medicines;
• a massive influx of patients to health centers;
• a reduction in the quality of services;
• a lack of sustainable sources to guarantee sustainable funding for the policy of free health care;
• the existence of major problems with the reliability and sustainability of the care exemption system on the one hand, and the quality of care provided on the other;
• the impossibility of tracking the traceability of reimbursements received by health facilities and of determining the exact proportion of free care in the operation of health services.

However, the policy of free health care in Niger has significantly improved the access of vulnerable populations to health care and services. It has improved the attendance of the population at health facilities and is associated, among other things, with the reduction of maternal mortality rates and of children aged 0 to 5.

Taking into account the recommendations presented above will allow a better implementation of the reform with regard to the new institutional framework for steering coordinated by INAM.