Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #109470

Yann Derriennic, Abt Associates, 4800 Montgomery Lane, Suite 600, Bethesda, MD 20814, Katherine Wolf, MPH, Emory University, Partners for Health Reform plus Project, 4800 Montgomery Lane, Suite 600, Bethesda, MD 20814, Maureen Daura, Health Services and System Project, Los Angeles Blvd, Long Acres, Lusaka, Zambia, Mwangala Namushi Kalila, Kafue District Social Welfare Office, Kafue Town, Kafue, Zambia, Ruth Hankede, Kafue District Health Management Team, Kafue Town, Kafue, Zambia, and C. Natasha Hsi, MPH, Partners for Health Reform plus Project (PHRplus), Abt Associates, 4800 Montgomery Lane, Suite 600, Bethesda, MD 22203, 301 718 3151, natasha_hsi@abtassoc.com.

Cost sharing in the form of user fees in Zambia's public health care system was first implemented in the 1990s. Responding to concerns about financial barriers for the most vulnerable groups, the Community Health Waiver Scheme (CHEWS) Pilot provided coupons for vulnerable households in Kafue District to access government health services at no cost to the user. The coupons were distributed through the government's innovative Public Welfare Assistance Scheme (PWAS) based on community welfare assistance committees (CWAC). The CHEWS assessment compiles data collected through the waiver monitoring system, and household and facility surveys. This data was compared to a baseline collected prior to the start of the pilot. The data collected includes: patient demographics, type of services utilized, health seeking behavior, knowledge of CHEWS and PWAS, and health facility utilisation. The result showed no significant change in health seeking behavior among the target group. Knowledge of CHEWS and PWAS was low and utilisation by the vulnerable did not increase. It is proposed that these results were due to the lack of an IEC campaign to promote the program and lack of funding for support visits to the CWAC – resulting in lack of knowledge and inefficient targeting of the waivers. This leads to the conclusion that health financing reforms need the same level of effort in IEC and supervision as disease specific interventions to be effective when targeting hard to reach groups. The CHEWS assessment will be used to inform the national-level policy dialogue on possible expansion of the waiver scheme.

Learning Objectives:

• Learn about waiver implementation in a cost sharing setting
• Identify challenges in targeting vulnerable populations

Keywords: International Health, Vulnerable Populations

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation