To measure adherence to the national user fee policy, tracer conditions were selected to represent a mix of cases commonly treated at Kenyan primary health facilities, and the government's priority public health interventions across different age groups, genders and illness types.
The proportion of facilities adhering to the user fee policy for each tracer condition and overall adherence (i.e. adherence to all tracer conditions) were computed.
When laboratory fees were excluded from stated user fees, we still found that no facilities reported adhering to the policy across all tracers, with similar patterns of adherence across age and illness groups.
No facilities adhered fully to the user fee policy across all eight tracers, with adherence ranging from 62.2% for an adult with tuberculosis to 4.2% for an adult with malaria.
Adherence to user fee policy was assessed for eight tracer conditions based on health worker reports, and patients were asked about actual amounts paid.
By examining a specific health problem or process, tracer conditions allowed us to focus on the impact of the policies on these particular conditions.
In analysing the policy soup we will use universal access to EmOC as a tracer for the right to health approach.
Adherence was measured from facility in-charge responses regarding fees normally charged at the facility for patients presenting with the tracer conditions, both including and excluding laboratory fees given their ambiguous status within the 10/20 policy.
When adherence was assessed across all eight tracer conditions combined, including laboratory fees, none of the facilities adhered fully to the official user fee policy.
In order to explore factors associated with adherence, three tracer conditions were selected that were applicable to all facilities, but found to have varying adherence to user fee policy: child with malaria, adult with TB, and ANC client.
