Building a middle-range theory of free public healthcare seeking in sub-Saharan Africa: a realist review

by Emilie Robert, Oumar Mallé Samb, Bruno Marchal et al.
Health Policy Plan (2017) 32 (7): 1002-1014 – Published: 16 May 2017

13 pp. 386 kB

Realist reviews are a new form of knowledge synthesis aimed at providing middle-range theories (MRTs) that specify how interventions work, for which populations, and under what circumstances. This approach opens the ‘black box’ of an intervention by showing how it triggers mechanisms in specific contexts to produce outcomes. The authors conducted a realist review of health user fee exemption policies (UFEPs) in sub-Saharan Africa (SSA). UFEPs place an additional resource in people’s wallets: free healthcare at the point of delivery. This resource gives them the opportunity to use public health services whenever they feel the need, without being dissuaded by cost. Three mechanisms explain why beneficiaries would choose to seek free public healthcare: trust, risk awareness, and acceptability.7

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