ReviewHealth policy and planning2017
Building a middle-range theory of free public healthcare seeking in sub-Saharan Africa: a realist review.
Review in Health policy and planning, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review.International journal for equity in health · 2019Pooled it
- Trial
- What influences the impact of health financing reforms? Using qualitative comparative analysis to identify patterns in health financing systems and their effects on financial protection.SSM - health systems · 2025Review
- Exploring evidence of healthcare-seeking pathways for maternal complications in Sub-Saharan Africa: a scoping review.BMC pregnancy and childbirth · 2025Article
- Approaches That Simplify Implementation of Complex Interventions in Healthcare System Change: "Scoping Review".Journal of multidisciplinary healthcare · 2025Review
- Tackling unmanaged oropharyngeal dysphagia in primary care: a behavioural science realist review of interventions.BMJ open · 2024Review
- Article
- Reconceptualizing Integrated Knowledge Translation goals: a case study on basic and clinical science investigating the causes and consequences of food allergy.Implementation science communications · 2023Article
- Using the multiple streams model to elicit an initial programme theory: from policy dialogues to a roadmap for scaling up integrated care.BMJ global health · 2023Article
- Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability.JMIR formative research · 2023Article
- Conducting focus groups in realist evaluation.Evaluation (London, England : 1995) · 2022Article
- Effect of the free healthcare policy on socioeconomic inequalities in care seeking for fever in children under five years in Burkina Faso: a population-based surveys analysis.International journal for equity in health · 2022Article
- User fees removal and community-based management of undernutrition in Burkina Faso: what effects on children's nutritional status?Public health nutrition · 2021Article
- Exploring the impact of a community participatory intervention on women's capability: a qualitative study in Gulu Northern Uganda.BMC women's health · 2021Article
- Applying the Realist Evaluation Approach to the Complex Process of Policy Implementation-The Case of the User Fee Exemption Policy for Cesarean Section in Benin.Frontiers in public health · 2021Article
- Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso.International journal of environmental research and public health · 2020Article
- Impact of a free care policy on the utilisation of health services during an Ebola outbreak in the Democratic Republic of Congo: an interrupted time-series analysis.BMJ global health · 2020Article
- Analysis of the implementation of a community-based intervention to control dengue fever in Burkina Faso.Implementation science : IS · 2020Article
- Opening the 'implementation black-box' of the user fee exemption policy for caesarean section in Benin: a realist evaluation.Health policy and planning · 2020Article
- Using implementation science theories and frameworks in global health.BMJ global health · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
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 relevance to the theory. From that analysis, we formulated a MRT on seeking free public healthcare in SSA. It highlights three key mechanisms in users' choice to seek free public healthcare: trust, risk awareness and acceptability. Contextual elements that influence both users' ability and choice to seek free care include: availability of and control over resources at the individual level; characteristics of users' and providers' communities at the local level; and health system organization, governance and policies at the structural level.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.