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

Health Policy and Planning
Emilie RobertValéry Ridde

Abstract

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. We conducted a realist review of health user fee exemption policies (UFEPs) in sub-Saharan Africa (SSA). This article presents how we developed both the intervention theory (IT) of UFEPs and a MRT of free public healthcare seeking in SSA, building on Sen's capability approach. Over the course of this iterative process, we explored theoretical writings on healthcare access, services use, and healthcare seeking behaviour. We also analysed empirical studies on UFEPs and healthcare access in free care contexts. According to the IT, free care at the point of delivery is a resource allowing users to make choices about their use of public healthcare services, choices previously not generally available to them. Users' ability to choose to seek free care is influenced by structural, local, and individual conversion factors. We tested this IT on 69 empirical studies selected on the basis of their scientific rigor and...Continue Reading

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Citations

May 8, 2020·BMJ Global Health·Valéry RiddeEmilie Robert
Aug 30, 2019·International Journal for Equity in Health·Suzanne G M van HeesErnst J A M Spaan
Dec 24, 2018·Maternal and Child Health Journal·David ZombréKate Zinszer
Sep 12, 2020·International Journal of Environmental Research and Public Health·Yvonne BeaugéValéry Ridde
Dec 5, 2020·Global Public Health·Laurence Touré, Valéry Ridde

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