Ghana
|
Service delivery
|
· Increase in utilization [21,31,32,35]
|
Health workforce
|
· Increase in workload, loss of income [31]
|
|
· Insufficient medical personnel; increase in workload [32]
|
Health information
|
· No information
|
Medical products, vaccines and technologies
|
· No information on the number of acts and the amount of reimbursements [31]
|
Financing
|
· Funding unpredictable, insufficient and discontinuous; problems with reimbursement in cases of referrals [31]
|
|
· Funding unpredictable, insufficient and discontinuous; informal payments; health centres going into deeper debt [35]
|
Leadership and governance
|
· Lack of information and complexity of funding procedures; poor supervision; problems in assigning responsibilities [31]
|
|
· Lack of information and communication (funding); competition with other interventions; poor supervision; ‘no blame’ game [35]
|
Kenya
|
Service delivery
|
· Increase in demand for service [36,37]
|
Health workforce
|
· Increase in workload [33]
|
Health information
|
· No information
|
Medical products
|
· Problems of availability and insufficiency of drugs and kits [33]
|
Financing
|
· Informal payments [22]
|
|
· Informal payments; loss of income for health centres [33]
|
|
· Insufficient funding; informal payments [36]
|
Leadership
|
· Poor understanding of the policy; problems in assigning responsibilities [33]
|
Madagascar
|
Service delivery
|
· Increase in utilization [19]
|
Health workforce
|
· No information
|
Health information
|
· No information
|
Medical products
|
· Problems of availability of drugs [19]
|
Financing
|
· No information
|
Leadership
|
· No information
|
South Africa
|
Service delivery
|
· Increase in utilization [29,38-40]
|
Health workforce
|
· Increase in workload; lack of time for consultations; feeling of being exploited; frustration, etc. [29]
|
|
· Increase in patient/provider ratio [38]
|
Health information
|
· No information
|
Medical products
|
· Problems of availability of drugs [29]
|
Financing
|
· No information
|
Leadership
|
· Feeling of a lack of recognition among workers; poor planning and communication [29]
|
Senegal
|
Service delivery
|
· Increase in utilization [23]
|
Health workforce
|
· Increase in workload [23]
|
Health information
|
· No information
|
Medical products
|
· Delays and under-distribution of consumables [23]
|
Financing
|
· Informal payments; delays in reimbursements; loss of revenue for the health centres [23]
|
Leadership
|
· Poor understanding of the policy [23]
|
Tanzania
|
Service delivery
|
· No information
|
Health workforce
|
· No information
|
Health information
|
· No information
|
Medical products
|
· No information
|
Financing
|
· Informal payments [41]
|
Leadership
|
· No information
|
Uganda
|
Service delivery
|
· Increase in utilization [20,24-26,28,34]
|
|
· Increase in utilization; decline in service quality [27]
|
Health workforce
|
· Lower morale of providers [27,29]
|
|
· Increase in the average number of consultations per provider; negative attitude of providers [22]
|
Health information
|
· No information
|
Medical products
|
· Problems of availability of drugs [24,26,27,29,34]
|
Financing
|
· Insufficient funding [25,34]
|
|
· Difficulties in meeting recurrent expenses; informal payments [27]
|
Leadership |
· Interference with other types of interventions [27] |