THE EFFECT OF USER FEE FOR PREVENTIVE CARE ON HEALTH SEEKING BEHAVIOUR IN JAMAICA

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THE EFFECT OF USER FEE FOR PREVENTIVE CARE ON
HEALTH SEEKING BEHAVIOUR IN JAMAICA Wilma
Bailey Stanley Lalta Georgiana Gordon-Strachan Ald
rie Henry-Lee Jasper Barnett Elizabeth
Ward IDRC-PAHO WORKSHOP RESEARCH TO POLICY
IN PUBLIC HEALTH Rio de Janeiro, Brazil, August
21-25, 2006
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Background and Context

• Increases in user fees for health care
• The extension of fees to preventive care
• The effect of these on utilization of family
  planning, antenatal and immunization services
• Diabetes and hypertension included because they
  are leading causes of ill health among the
  elderly in Jamaica

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Methodology

• A mixed methodology comprising
• A cohort study involving a questionnaire survey
  among a sample of 500 households in three
  geographical areas
• Focus group discussions
• Mystery clients in health centres
• Expert interviews
• Review of previous studies and secondary data

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Research to Policy acheivements and challenges

• Outcome Mapping
• Its ability to stimulate effective
  communication.
• The selection of those who were able to influence
  change as boundary partners
• The Project Advisory Committee A model for
  future activities
• The use of workshops, letters and presentations
  to keep partners informed
• Workshops most useful in facilitating feedback
• Membership top heavy as providers/frontline
  workers unable to participate

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Overcoming mistrust of

• the research agenda
• The Permanent Secretary of the MOH is rattled
• She had to be wooed
• She advised on membership of our Advisory
  Committee
• the research process
• A scientific selection of survey sites can select
  the extreme end of the scale - the worst. This
  can put the country in a very bad light.
• Coping with a defensive posture, a reaction to
  the problems of access revealed.

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Changes

• Success can be claimed if findings
  stimulate/precipitate change in policy or in the
  attitude of our boundary partners

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Changes (policy)

• Questionnaire survey and group discussions reveal
  poor awareness of social protection

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Changes (programmes)

• Inclusion of two directors of welfare programmes
  as boundary partners
• Very stimulating interaction
• Changes in registration
• Streamlining beneficiary system
• Increased enrollment in welfare programmes

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Changes (attitude)

• Workshops stimulate flow of ideas among boundary
  partners
• New ideas to improve system of exemption
• Adoption will affect income of health centres and
  Regional Health Authorities
• Cautious attitude to proposal to exempt the
  chronic elderly

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Impact of Project

• Project repeatedly mentioned at discussions at
  MOH
• Recognition of the role of independent
  researchers
• Reports generated now form a part of essential
  database
• These were a part of the projects design

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Working together

• Policy makers in sufficiently senior positions
  within the MOH to move the process forward
• They smoothed the path
• Their input into the actual research was hampered
  by their responsibilities
• The job of coordinating the study was more taxing
  than envisaged
• The loss of the Health Economist - we missed his
  expertise

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Conclusions

• Special efforts must be made to expose providers
  to research findings
• The expertise of policy makers is important to
  the research process
• Policy makers must be able to commit their time
  and this must be borne in mind in selection
  especially for projects extending over relatively
  long periods
• The assessment of results as the investigation
  proceeds and immediately communicating problems
  to partners can bring about change during the
  life of projects