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Thus, stakeholders will need to find strategies to improve successful implementation of exemption models.
In 2008, Save The Children UK (STC-UK) published a guide to help with the planning and implementation of exemption policies.
At hospital level, such as with Svay Rieng Provincial Hospital, there is a growing awareness for community-based structures such as Feedback Committees and Village Development Committees to participate in the implementation of exemption schemes.
In particular, a concern that pregnant women and children under five years are negatively affected by such financial barriers has prompted many low- and middle-income countries to reconsider levying user charges by ensuring either more thorough implementation of exemption or waiver mechanisms, significant reduction in fee levels, or their abolition altogether [ 5, 6].
In particular, a concern that pregnant women and children under five are negatively affected by such financial barriers has prompted many low and middle income countries to reconsider levying user charges by ensuring either more thorough implementation of exemption or waiver mechanisms, significant reduction in fee levels or their abolition altogether [ 2, 3].
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On the other hand, both Touré and Diarra and Ousseini bear witness to the countless problems encountered on a daily basis by both health workers and users in the implementation of exemptions.
For example, the implementation of fee exemption policies in particular have led to a decrease in OOP payments for maternal health services [8 12].
Decreased quality in delivery care services may be the result of increased workload or declining staff morale, particularly when the implementation of the exemption policy is not accompanied by a commensurate increase in human, material and financial resources [ 16].
This would be breaking a tacit rule of the game, that can be even be observed sometimes in the press: while Malian journalists ignore the difficulties associated with the implementation of fee exemption at the point of service delivery, their editors refer to it in private discussions [ 12].
These knowledge aggregation exercises undertaken in each country and supported by a team of external researchers, in which policy stakeholders employed both tacit and scientific knowledge, confirmed the importance that must be given to preparation and implementation of these exemption measures.
Children below 18 years, the aged (70+), pregnant women, SSNIT pensioners and indigents are entitled to NHI membership while being exempted from premium payments, though the implementation of these exemptions appears to have been poor.
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