OpenUCT :: Browsing by Author "Thomas, Stephen"

Browsing by Author "Thomas, Stephen"

Now showing 1 - 12 of 12

Open Access
Analysing unofficial user fees in government and non-government hospitals in Uganda
(2003) Sonko, Rita Najjemba; Thomas, Stephen
Unofficial fees are a common feature in Ugandan health facilities and exist in different forms. This study explores the forms of unofﬁcial fees existing in Ugandan hospitals and compares ﬁndings from government and non-governmental hospitals in both rural and urban areas. It also investigates the reasons for or causes of such fees as well as the relationship between unofficial fees and other factors such as quality of care within the hospitals. The overall aim of the study is to analyze the magnitude and impact of unofﬁcial fees on patients' expenditure and thereby make recommendations for improvement in efﬁciency and equity with regards to out-of-pocket funding. Both qualitative and quantitative interview methods are used to obtain data from service providers and patients in each hospital and a comparison of ﬁndings obtained using the two methods is made. The main ﬁndings from the study are that unofﬁcial fees are rampant in government hospitals and can be classiﬁed into four categories; fees for commodities such as drugs; fees for access to services; fees for services such as laboratory, radiology and surgery and gratuity payments. The latter category is the commonest form reported in non- government hospitals while all the others are rare. Estimates of unofﬁcial fees amount to a signiﬁcant percentage of patients' expenditure, especially in the cases where surgery and radiology are required especially for rural-based patients. It's also found that most of the patients attending government hospitals pay at least one form of unofficial fees. Unofficial fees were found to be closely associated with poor quality of care in that the latter enhanced an informal economy, which resulted in the fees being charged/paid. The study shows that efﬁciency and equity (access to quality care and ability to pay) are negatively affected by the practice of collecting unofficial fees. Recommendations for policy makers to address the problem are made as well as suggestions for the best-suited methodology for analysing unofficial fees in the Ugandan context.
Open Access
An analysis of the user-free policy for health care in Kenya : is the effort worth it?
(1999) Mwangi, PK; Thomas, Stephen
This study analyses the user fee policy for health care in Kenya that was introduced to try and recoup some of the costs incurred in providing care as well as rationalise the use of resources. The study aims to generate policy-related findings that are crucial to MOH policy makers in their attempt to provide quality and affordable care. In particular, factors associated with proper function or malfunction of the user fee policy are discussed. The study focussed on four hospitals located in Central province of Kenya. This province was purposefully chosen for its convenience and its high potential for cost recovery. Equity in health care consumption, efficiency, sustainability and perceived quality of care are reviewed. Both primary and secondary data were used. Quantitative and qualitative data were solicited by way of administering questionnaires. Respondents were divided into two categories: providers (staff) and consumers (patients) of health care. The latter were subdivided into inpatients and outpatients. Each of these categories had a specific questionnaire. Further, an attempt is made to estimate net revenue generated in the year 1997/98 by the facilities under study. Costs associated with fee collection were estimated on monthly basis and then projected for the whole year. There are important findings from the study; though patients are charged higher fees at hospitals than at primary levels in order to bolster the referral system, many patients are bypassing the nearby primary care facilities. This study recommends that bypassing patients should be charged higher fees than referred ones.
Open Access
Decentralised resource allocation and its impact on equitable health care financing
(2008) Mbatsha, Sandi Andrew; Thomas, Stephen
The main objectives of this thesis are to: (i) Map the financing of non-hospital primary health care within local government areas in South Africa; analyse the equity of financing health care in relation to need (iii) and document the process followed at provincial and local government level in decision making around budgeting for non-hospital Public Health Care services.
Open Access
Evaluation of the 1988 user-fee policy in Lesotho
(2001) Selikane, Mapaseka; Thomas, Stephen
This report provides a comprehensive evaluation of the factors underlying the evolution, design and implementation of the 1988 fee policy in Lesotho. The chief aim of the study was to conduct a critical appraisal of this policy, focusing on the key factors that might have constrained or facilitated the process. The performance of the policy was assessed in terms of financial sustainability in the health sector as well as promotion of equitable access for economically marginalized groups.
Open Access
Fiscal federalism an equity in the financing of primary health care: The case of South Africa
(2009) Okorafor, Okore Apia; McIntyre, Di; Thomas, Stephen
This thesis investigates the implications of fiscal federalism on the equitable distribution of primary health care resources in South Africa. The study evaluates the processes and criteria for intergovernmental and sector budgeting, the influence of key stakeholders, community involvement in PHC budgeting, and policy objectives of the health sector to assess how they impact on the realisation of an equitable distribution of PHC resources. A combination of qualitative and quantitative analyses was employed in the study. Quantitative analysis of health expenditure and health need data was used to assess whether the distribution of PHC resources has become more or less equitable. Health districts were the units of analysis. Deprivation indices were generated using principal components analysis for each district from demographic and socio-economic variables. The deprivation index was used as a proxy for relative need at the level of districts, and was compared with non-hospital PHC per capita expenditure using regression analysis. This analysis was carried out for per capita PHC from 2001 to 2007. Data on the process for intergovernmental fiscal arrangements and budgeting for health was collected through review of government publications and interviews with government officials. These were analysed thematically. Literature on the subject predicts that if lower levels of government have considerable autonomy in determining primary health care allocations, there is a greater scope for inequities in the distribution of primary health care resources. However, the results of the study are contrary to expectations. Although, the introduction of fiscal federalism in South Africa created an additional constraint to achieving a more equitable distribution of PHC resources, recent trends in primary health care allocations are more equitable than in previous years. A growing public sector budget, consistent increases in health sector allocations, and overwhelming political support for equity in South Africa have been the key reasons for the shifts towards a more equitable distribution of primary health care resources. These findings form the main contribution to the literature on the subject.
Open Access
Managing actors in South African health financing reform : testing a conceptual framework
(2003) Thomas, Stephen; Gilson, Lucy; McIntyre, Di
Health ﬁnancing reforms, especially those aimed at improving equity, are prone to opposition. Those driving health reforms frequently ﬁnd themselves pitted against vested interests. The thesis explores how best a reform driver might manage other actors in the reform process to achieve key goals. This involves creating and testing a conceptual framework. A review of the international health care reform literature identiﬁes key gaps in knowledge. Additional bodies of theory, mainly from economics, are selected for review on the basis of their potential insight into relationships between reform drivers and actors. Their ﬁndings are compared and contrasted and taken forward into a conceptual framework. This is then tested against four case studies of health ﬁnancing reform in South Africa: geographic resource allocation, health insurance and the removal of user fees, largely between 1994 and 1999, and the reform of the Conditional Grant for Tertiary hospitals, from 2000 to 2002. Two different approaches are used for testing the conceptual framework. First, key themes about managing actors are drawn from actor interviews in three case studies of health ﬁnancing reform. With the second, more deductive, approach reform drivers in-- an additional case study were questioned on every element of the conceptual framework to see whether it provided an adequate description and understanding of how reform processes occurred. These two very different approaches acted as a check against each other but produced similar ﬁndings. The thesis suggests that an awareness of actor characteristics (such as resources, constraints, reputation and interests) can help a reform driver better manage reform development to achieve desired change. Reform drivers should build up teams of actors that can at the very least bring power, technical skills and specialist knowledge to the reform effort. Team building will also require careful consideration of the different forms of motivation appropriate to each actor. Ideally reform drivers should avoid opposing actors. Yet the prevailing context may indicate this is not possible. In such case reform drivers should limit information exchange, present and discuss reforms at a conceptual level, undermine technically any counter-reform design and choose carefully in which arena to ﬁght.
Open Access
Measuring health worker motivation in a teaching hospital in South Africa from December 01 to December 02
(2002) Mmasi, John Eugene; Thomas, Stephen
The objective of this study is to measure health worker motivation in a South African context. Sout Africa is a middle income developing country. Health workers consume up to 60% of public health budgets in South Africa, and yet unlike many developing countries, it is possible that resource re-allocation may lead to some drastic changes in health workers' motivation.
Open Access
Northern Cape Provincial health accounts, the capacity issues and assessment of the feasibility to institutionalise
(2002) Baba, Luvuyo Lumkile; Thomas, Stephen
Provincial Health Accounts describe the sources, uses, and channels for all funds utilized in the health sector and are a basic requirement for optimal management of the allocation and mobilization of health sector resources. This study emphasises the concept of National Health Accounts at provincial level in order to get a full picture of the financial organization of the health care system in the selected province, Northern Cape, and assesses its achievement of efficiency and equity objectives.
Open Access
A stakeholder analysis of the UCT hospital
(2003) Thomas, Patrick; Thomas, Stephen
The UCT Hospital is a private, fully independent hospital within the buildings of the Groote Schuur Hospital. It has been operational for well over two years. Planning and development began a further four years before this. During the last two years the hospital has changed its name, shareholders and management structures. Since the start of the planning the various stakeholders will too have changed their respective structure and business foci. These changes have added to poor knowledge of all the stakeholders' aims and desires for the hospital. The aims and objectives of this study are to establish what the various stakeholders wish to gain from their relationship with the UCT Hospital. Furthermore, this study investigates the degree of public-private interaction with Groote Schuur Hospital and proposes various possibilities for their future existence and co-operation. A stakeholder analysis indicated that the primary stakeholders wish to expand and grow the hospital. Opponent stakeholders are not satisfied with the structure of and their relations with the UCT Hospital. Key problems in the relationship with Groote Schuur Hospital include tense relations, poor regulation of resource-sharing, and that the two hospitals are vying for comparable markets. These problems are inhibiting growth for both institutions. Communication, improved regulations and specialised market sectors are key needs to help resolve the problems between the two institutions. Various possibilities for future co-existence revolve around the degree of public- private interaction between the two institutions. The most viable option seems to be for the two hospitals to work closely together to form a public-private partnership, where the Groote Schuur Hospital Private Ward is outsourced to the UCT Hospital. This will involve UCT Hospital relinquishing some autonomy and freedom, but result in them having less competition and a greater market base. GSH will have to abandon their own private ward, but can increase risk-sharing, gain in efficiency and effectiveness in the private ward, and get involved in a co-management structure.
Open Access
A study to evaluate support for the health sector devolution policy in Zambia : an actor analytic perspective
(2005) Kagulula, Solomon S; Thomas, Stephen; Okorafor, Okore
This study is an evaluation of Support for the Health Sector Devolution Policy in Zambia. The study adopts a stakeholder analytical approach and its central objective is to study characteristics of key stakeholders, analyse how these influence support for implementing the devolution policy in the Zambian Health Sector and recommend strategies for taking forward the decentralisation process.
Open Access
Understanding the impact of user fees on gender in Tanzania
(2003) Rwechungura, Assumpta D; Thomas, Stephen; Budlender, Debbie
In 1993 the government of Tanzania introduced user fees in health care services. The poor, children under five, Maternal and Child Health/Family Planning and maternity services are among the groups exempted from fees. However, it is observed that the fee exemption system in public health facilites is not functioning. According to the media and gender activists, the introduction of user fees in primary health care services was reported to have impacted negatively on vulnerable groups, particularly poor women. This study aims at exploring how user fees for health care impacted on poor Tanzanian women. In order to have a clear understanding of the issues, the study establishes the impact of user fees on poor women as perceived by poor women in urban and rural areas, and by key stakeholders involved in user fee policy development. Further, the study looks at efforts made by diferent stakeholders to take into account a gender perspective in the design and implementation of the policy. Finally, the study examines whether the policy process took into consideration the potential negative effects on poor women after its implementation.
Open Access
Willingness to pay for social health insurance in Zambia a two-stage regression approach
(2002) Kaambwa, Billingsley Chimuka; Thomas, Stephen
Among the key objectives of health financing reforms in Zambia has been the need to generate additional financial resources and foster partnerships between users and providers. The choice of the financing mechanism(s) therefore becomes critical in ensuring that objectives in the health sector are met. SHI is one financing method that can help meet the objectives of the health sector. This feasibility study set out to answer the question of whether or not the Zambian formal sector was prepared to endorse and pay for SHI in the country.

Browsing by Author "Thomas, Stephen"

Results Per Page

Sort Options