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What causes inequity in access to publicly funded health services that are supposedly free at the point of use? A case of user fee exemptions for older people in Senegal

Mladovsky, Philipa and Bâ, Maymouna (2016) What causes inequity in access to publicly funded health services that are supposedly free at the point of use? A case of user fee exemptions for older people in Senegal. Working Paper Series (No.16-177). London School of Economics and Political Science, Department of International Development, London, UK.

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Abstract

Plan Sésame (PS) was launched in 2006 to provide free access to health services to Senegalese citizens aged 60 and over. As in many countries, this user fee exemption is marred by inequitable implementation. This study seeks to identify underlying causal mechanisms to explain how and why some people were relatively less likely to have access to publicly funded health care. Explanations identified in focus group and interview data are organised into four themes: (i) PS as a poorly implemented and accessed “right” to health care; (ii) PS as a “privilege” reserved for elites; (iii) PS as a “favour” or moral obligation to friends or family members of health workers; and (iv) PS as a “curse” caused by adverse incorporation. These results are analysed through critical realist and social constructivist epistemological lenses, in order to reflect on different interpretations of causality. Within the critical realist interpretation, the results point to a process of social exclusion. However, this interpretation, with its emphasis on objective reality, is contradicted by some local, subjective experiences of inequality and corruption. An alternative social constructionist interpretation of the results is therefore explored; it is argued this may be needed to prevent relatively powerful actors’ versions of the truth from prevailing.

Item Type: Monograph (Working Paper)
Official URL: http://www.lse.ac.uk/internationalDevelopment/home...
Additional Information: © 2016 The Authors
Divisions: International Development
LSE Health
Subjects: H Social Sciences > HJ Public Finance
H Social Sciences > HN Social history and conditions. Social problems. Social reform
Sets: Departments > International Development
Research centres and groups > LSE Health
Date Deposited: 23 May 2016 14:48
Last Modified: 18 Sep 2020 23:06
Projects: 261440
Funders: European Commission's Seventh Framework Programme FP7/ 2007
URI: http://eprints.lse.ac.uk/id/eprint/66578

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