However, the multiplicity of exemption measures since 2009, particularly in West Africa, suggests that the stance of GHAs has in turn prompted other LMICs such as Côte d'Ivoire, Togo and Sierra Leone to implement exemption policies.
In circumstances like these, it is no longer a matter of hoping for or stimulating the political will of those at the top to implement exemption policies, but of undertaking a complete overhaul of the health system and health bureaucracy.
The results of the proposed research may be useful to African decision-makers who would be willing to implement exemption policies in their countries and to government and international agencies that wish to support them.
The existing system for implementing the exemption policy under the CHF is weak.
However, given the major problems that country encountered in implementing the exemption policy after 2009 (Diarra & Ousséini, this issue), this success must be reconsidered in light of the fact that most of the health centres subsequently declared bankruptcy [ 50].
In fact, implementing targeted exemptions in Africa is a challenge [ 16].
Many countries have introduced fee reduction or elimination policies, including implementing new exemptions for particular patient groups or health conditions (for example in Kenya, Niger, Mali, Ghana, Nigeria, Burkina Faso, Tanzania and Zambia), or removing fees across the board as in Uganda and South Africa (Gilson 1997; McPake et al. 2011; Meessen et al. 2011a, 2011b; Ridde and Morestin 2011).
From this point on, a host of incentives have been implemented including exemption from using transit lanes, reduced company car tax, and exemption from car ferry fares.
The prime minister, Tony Abbott, agreed the Coalition would implement this exemption.
We worked with the sector, particularly NCVO and the Charity Tax Group, to ensure that not only did government implement the exemption, but that they implemented it in a way that it as useful as possible for charities.
