The pilot experiences were not taken into account in the government's implementation of the fee exemption policy [ 34].
The difficulties experienced by the State due to the lack of financial and technical resources prior to implementation of the fee exemption policy have aggravated the health system's structural malfunctions.
Another national policy issue cited by workers as unjust both from a distributive and procedural injustice perspective was the implementation of the fee free delivery policy, which involved universal exemptions from payment of user fees for delivery services (Ansong-Tornui et al. 2007).
During the last 20 years since the home-visit nursing system was started, there have been many positive revisions for home-visit nursing services with both medical and long-term care insurance by each insurance policy revision with the implementation of the fee-for-services policy [ 1- 4].
In order to better mobilize support for implementation of this global health governance reform package, we would initially limit implementation of the fee-based structure to recruitment of HCWs who reside or who are trained in one of the 57 countries identified by WHO as having a critical HCW shortage.
General questions were asked to gather background information on the following: the facility, implementation of the user fee policy (for facilities that removed fees), trend in utilisation rates, revenue from user fees, drug management, and overall perception of the impact of the policy change.
By using a qualitative approach, our aim is to give substance to the quantitative data [ 13] in order to better understand the successes and failures of the implementation of the user fee exemption for children under five.
After six years of implementation of the user fee exemption for children under five, Niger remains one of the countries with the worst health indicators in the world for this age group.
However, the implementation of the user fee policy not only failed to achieve these objectives, it also resulted in decreased health care utilisation consequently increasing morbidity and mortality [ 7, 8].
It also delays the implementation of these fees by one year, until 2011, and makes changes to facilitate administration by the IRS.
Above and beyond this basic structural problem, however, recent changes in higher education – principally the implementation of the new fees regime in 2012 and the associated student protests – have put the question of university access firmly back in the political spotlight.
