Background A free obstetric care policy (FOCP) has been implemented in Morocco in 2008 in order to further decrease maternal mortality.
Methods Through in-depth interviews we explored the perceptions of health professionals in public Moroccan hospitals with regard to fee exemption policies. We tried to understand what drives health professionals to ignore, modify or apply a health policy as formulated.
Results Respondents express significant influences of such policies on their work environment (higher workload and scarcity of resources) and on the patient/provider relationship, both of which may cause a negative effect on health workers’ motivation. A mix of motivational determinants incites health workers in their turn to influence policy implementation.
Conclusion Understanding the motivational determinants of health workers may optimize policy implementation at the point of service delivery.
Tinasti K. Morocco's policy choices to achieve Universal health coverage. Pan Afr Med J. 2015;21:53. doi:10.11604/pamj.2015.21.53.6727
Abouchadi S, Belghiti Alaoui A, Meski FZ, De Brouwere V. Implementing a maternal mortality surveillance system in Morocco - challenges and opportunities. Trop Med Int Health. 2013;18(3):357-365. doi:10.1111/tmi.12053
Boukhalfa C, Abouchadi S, Cunden N, Witter S. The free delivery and caesarean policy in Morocco: how much do households still pay? Trop Med Int Health. 2016;21(2):245-252. doi:10.1111/tmi.12638
Witter S, Boukhalfa C, Cresswell JA, et al. Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco. Int J Equity Health. 2016;15(1):123. doi:10.1186/s12939-016-0412-y
Belaid L, Ridde V. An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso. BMC Pregnancy Childbirth. 2012;12:143. doi:10.1186/1471-2393-12-143
Ridde V, Queuille L, Kafando Y, Robert E. Transversal analysis of public policies on user fees exemptions in six West African countries. BMC Health Serv Res. 2012;12:409. doi:10.1186/1472-6963-12-409
Nimpagaritse M, Bertone MP. The sudden removal of user fees: the perspective of a frontline manager in Burundi. Health Policy Plan. 2011;26 Suppl 2:ii63-71. doi:10.1093/heapol/czr061
Meessen B, Hercot D, Noirhomme M, et al. Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries. Health Policy Plan. 2011;26 Suppl 2:ii16-29. doi:10.1093/heapol/czr062
Van der Veken K, Richard F, Marchal B, et al. POEM – Policy Effect Mapping. A framework to assess the effects of a targeted policy on the local health system. Antwerp: ITM; 2014.
Goufodji S. Rapport de synthèse: l’évaluation de la politique de gratuité de la césarienne dans cinq zones sanitaires, Bénin, FEMHealth. Cotonou: CERRHUD; 2014.
Ganaba R, Yaogo M, Ilboudo P, et al. Coût et impact de la politique de subvention des accouchements et des SONU au Burkina Faso. Ouagadougou: AFRICSanté; 2014.
Lipsky M. Street-Level Bureaucracy, 30th Ann. Ed.: Dilemmas of the Individual in Public Service. Russell Sage Foundation; 2010.
Hornby AS. Oxford Advanced Learners Dictionary of Current English. London: Oxford University Press; 2010.
Boukhalfa C, Essolbi A, Assarag B, Filali H, Abouchadi S, Meski FZ. Evaluation de l’impact de la politique de gratuité de l’accouchement et de la césarienne au niveau de six provinces au Maroc. Nouveaux outils, nouvelles connaissances. Rabat: ENSP; 2014.
Braun V, Clarke V. What can "thematic analysis" offer health and wellbeing researchers? Int J Qual Stud Health Well-being. 2014;9:26152. doi:10.3402/qhw.v9.26152
Franco LM, Bennett S, Kanfer R, Stubblebine P. Determinants and consequences of health worker motivation in hospitals in Jordan and Georgia. Soc Sci Med. 2004;58(2):343-355.
Lehmann U, Gilson L. Actor interfaces and practices of power in a community health worker programme: a South African study of unintended policy outcomes. Health Policy Plan. 2013;28(4):358-366. doi:10.1093/heapol/czs066
van Olmen J, Criel B, Van Damme W, et al. Analysing health systems dynamics. A framework. Antwerp: ITG Press; 2011.
Walker L, Gilson L. 'We are bitter but we are satisfied': nurses as street-level bureaucrats in South Africa. Soc Sci Med. 2004;59(6):1251-1261. doi:10.1016/j.socscimed.2003.12.020
Essolbi A, Ababou M, Hachri H, et al. Cartographie des effets de la politique de gratuité de l'accouchement et de la césarienne au Maroc. Rabat: ENSP; 2014.
Onwuegbuzie AJ, Leech NL. Validity and Qualitative Research: An Oxymoron? Qual Quant. 2007;41(2):233-249. doi:10.1007/s11135-006-9000-3
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357. doi:10.1093/intqhc/mzm042
Sahel A, DeBrouwere V, Dujardin B, Kegels G, Belkaab N, Alaoui Belghiti A. Implementing a nationwide quality improvement approach in health services. Leadersh Health Serv (Bradf Engl). 2015;28(1):24-34. doi:10.1108/lhs-04-2014-0042
Agyepong IA, Nagai RA. "We charge them; otherwise we cannot run the hospital" front line workers, clients and health financing policy implementation gaps in Ghana. Health Policy. 2011;99(3):226-233. doi:10.1016/j.healthpol.2010.09.018
Aniteye P, Mayhew SH. Shaping legal abortion provision in Ghana: using policy theory to understand provider-related obstacles to policy implementation. Health Res Policy Syst. 2013;11:23. doi:10.1186/1478-4505-11-23
Carasso BS, Lagarde M, Cheelo C, Chansa C, Palmer N. Health worker perspectives on user fee removal in Zambia. Hum Resour Health. 2012;10:40. doi:10.1186/1478-4491-10-40
Erasmus E. The use of street-level bureaucracy theory in health policy analysis in low- and middle-income countries: a meta-ethnographic synthesis. Health Policy Plan. 2014;29 Suppl 3:iii70-78. doi:10.1093/heapol/czu112
Mbindyo P, Gilson L, Blaauw D, English M. Contextual influences on health worker motivation in district hospitals in Kenya. Implement Sci. 2009;4:43. doi:10.1186/1748-5908-4-43
Witter S, Wurie H, Bertone MP. The free health care initiative: how has it affected health workers in Sierra Leone? Health Policy Plan. 2016;31(1):1-9. doi:10.1093/heapol/czv006
Franco LM, Bennett S, Kanfer R. Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002;54(8):1255-1266.
Eggermont M. The Impact of European Human Rights on Childbirth. In: Haeck Y, Brems E, eds. Human Rights and Civil Liberties in the 21st Century. Dordrecht: Springer; 2014:213-222. Ius Gentium: Comparative Perspectives on Law and Justice, vol 30.
Maslow AH, Frager R. Motivation and Personality. 3rd ed. New York: Harper and Row; 1987.
Adams JS. Toward an Understanding of Inequity. J Abnorm Psychol. 1963;67:422-436.
Mathauer I, Imhoff I. Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Hum Resour Health. 2006;4:24. doi:10.1186/1478-4491-4-24
Van der Veken, K., Dkhimi, F., Marchal, B., & Decat, P. (2018). “They Are After Quantity, Not Quality”: Health Providers’ Perceptions of Fee Exemption Policies in Morocco. International Journal of Health Policy and Management, 7(12), 1110-1119. doi: 10.15171/ijhpm.2018.76
MLA
Karen Van der Veken; Fahdi Dkhimi; Bruno Marchal; Peter Decat. "“They Are After Quantity, Not Quality”: Health Providers’ Perceptions of Fee Exemption Policies in Morocco", International Journal of Health Policy and Management, 7, 12, 2018, 1110-1119. doi: 10.15171/ijhpm.2018.76
HARVARD
Van der Veken, K., Dkhimi, F., Marchal, B., Decat, P. (2018). '“They Are After Quantity, Not Quality”: Health Providers’ Perceptions of Fee Exemption Policies in Morocco', International Journal of Health Policy and Management, 7(12), pp. 1110-1119. doi: 10.15171/ijhpm.2018.76
VANCOUVER
Van der Veken, K., Dkhimi, F., Marchal, B., Decat, P. “They Are After Quantity, Not Quality”: Health Providers’ Perceptions of Fee Exemption Policies in Morocco. International Journal of Health Policy and Management, 2018; 7(12): 1110-1119. doi: 10.15171/ijhpm.2018.76