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APHA Scientific Session and Event Listing

Recorded presentation

Suneeta Sharma, PhD, MHA, Sarah Smith, MPH, Marissa Pine, and Bill Winfrey, PhD. Futures Group International, Constella Group, 1 Thomas Circle, NW, Suite 200, Washington, DC 20005, 2027759680, ssharma@futuresgroup.com

Constrained public sector budgets and an increase in demand for services have led many countries to implement user fees. In response to concerns that these fees reduce access among the poor, governments have implemented waiver and exemption mechanisms. However, these mechanisms do not address informal fees and other costs incurred by clients. There is a general lack of information on the effectiveness of these mechanisms on access to RH services. This study explored the impact of these formal and informal fees on the poor in Uttranchal, India. The study links supply and demand sides by analyzing policies, provider perspectives, and consumer expenditure patterns to create a complete picture of formal and informal fees. The data analyzed includes government policies, facility records, household survey, focus group discussions, facility surveys, and key informant interviews.

The study found that (1) Clients, even in the presence of exemption systems, are paying for RH services, a large proportion of which are informal payments; (2) many poor clients are not able to access subsidized services because of a general lack of awareness of fee structure and exemption mechanisms by both the clients themselves and providers; (3) policies that dictate the utilization of revenue by facilities limit their ability to improve quality of services and/or subsidize services for the poor.

We will present the main findings of this study and policy recommendations to reduce information payments and improve access to RH services among the poor.

Learning Objectives:

• •Identify financial barriers faced by women
• seeking reproductive health services.
• •Articulate the strengths and weaknesses of
• exemption and waiver mechanisms for
• reproductive health services.
• •Discuss the potential policy recommendations
• that would improve financial access to
• reproductive health services among the poor

Keywords: Financing, India

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation