Publications des membres du Ceped

2017

Article de revue


  • Robert Emilie, Lemoine Aurélia et Ridde Valéry (2017) « Que cache le consensus des acteurs de la santé mondiale au sujet de la couverture sanitaire universelle? Une analyse fondée sur l’approche par les droits », Canadian Journal of Development Studies / Revue canadienne d'études du développement, 38 (2) (avril 3), p. 199-215. DOI : 10.1080/02255189.2017.1301250. https://www.tandfonline.com/doi/full/10.1080/02255189.2017.1301250.

  • Robert Emilie, Samb Oumar Mallé, Marchal Bruno et Ridde Valéry (2017) « Building a middle-range theory of free public healthcare seeking in sub-Saharan Africa: a realist review », Health Policy and Planning, 32 (7) (mai 16), p. 1002-1014. DOI : 10.1093/heapol/czx035.
    Résumé : 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.
    Mots-clés : Access to healthcare, health policy and systems research, health user fees, middle-range theory, realist review, sub-Saharan Africa.
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  • Robin Nelly (2017) « Territoires "minés" et tensions ethnographiques, des zones de conflit au monde judiciaire », E-Migrinter, 15 (mars). DOI : 10.4000/e-migrinter.848. https://halshs.archives-ouvertes.fr/halshs-01757538.
    Résumé : Un itinéraire de recherches dans le domaine des migrations internationales, du Maghreb à l'Afrique subsaharienne, marqué par dix-sept années d'expatriation au Sénégal, constitue indéniablement une expérience humaine particulière, au plus près des sociétés, et parfois des institutions, du Sud.
    Mots-clés : CONFLIT POLITIQUE, EPISTEMOLOGIE, HISTOIRE DE VIE, ITINERAIRE DE RECHERCHE, MIGRATION INTERNATIONALE, RECHERCHE SCIENTIFIQUE, STRATEGIE DE RECHERCHE, TERRAIN DE RECHERCHE.
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  • Robin Nelly et Saïs Lakdhar (2017) « La fabrique des réseaux de traite au Sénégal : échelles migratoires et situations prostitutionnelles », éd. par K. Téhéna, Outre-Terre, Revue européenne de géopolitique, 53 (4), p. 67-82. DOI : 10.3917/oute1.053.0067. http://www.cairn.info/revue-outre-terre-2017-4-page-67.htm.
    Mots-clés : MIGRATION, PARCOURS MIGRATOIRE, PROSTITUTION, RESEAU DE TRAITE, SOCIOLOGIE URBAINE, TOURISME SEXUEL, TRAITE.
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  • Ruzagira Eugene, Baisley Kathy, Kamali Anatoli, Biraro Samuel, Grosskurth Heiner et Working Group on Linkage to HIV Care (2017) « Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa: a systematic review », Tropical medicine & international health: TM & IH, 22 (7) (juillet), p. 807-821. DOI : 10.1111/tmi.12888.
    Résumé : BACKGROUND: Home-based HIV counselling and testing (HBHCT) has the potential to increase HIV testing uptake in sub-Saharan Africa (SSA), but data on linkage to HIV care after HBHCT are scarce. We conducted a systematic review of linkage to care after HBHCT in SSA. METHODS: Five databases were searched for studies published between 1st January 2000 and 19th August 2016 that reported on linkage to care among adults newly identified with HIV infection through HBHCT. Eligible studies were reviewed, assessed for risk of bias and findings summarised using the PRISMA guidelines. RESULTS: A total of 14 studies from six countries met the eligibility criteria; nine used specific strategies (point-of-care CD4 count testing, follow-up counselling, provision of transport funds to clinic and counsellor facilitation of HIV clinic visit) in addition to routine referral to facilitate linkage to care. Time intervals for ascertaining linkage ranged from 1 week to 12 months post-HBHCT. Linkage ranged from 8.2% [95% confidence interval (CI), 6.8-9.8%] to 99.1% (95% CI, 96.9-99.9%). Linkage was generally lower (<33%) if HBHCT was followed by referral only, and higher (>80%) if additional strategies were used. Only one study assessed linkage by means of a randomised trial. Five studies had data on cotrimoxazole (CTX) prophylaxis and 12 on ART eligibility and initiation. CTX uptake among those eligible ranged from 0% to 100%. The proportion of persons eligible for ART ranged from 16.5% (95% CI, 12.1-21.8) to 77.8% (95% CI, 40.0-97.2). ART initiation among those eligible ranged from 14.3% (95% CI, 0.36-57.9%) to 94.9% (95% CI, 91.3-97.4%). Additional linkage strategies, whilst seeming to increase linkage, were not associated with higher uptake of CTX and/or ART. Most of the studies were susceptible to risk of outcome ascertainment bias. A pooled analysis was not performed because of heterogeneity across studies with regard to design, setting and the key variable definitions. CONCLUSION: Only few studies from SSA investigated linkage to care among adults newly diagnosed with HIV through HBHCT. Linkage was often low after routine referral but higher if additional interventions were used to facilitate it. The effectiveness of linkage strategies should be confirmed through randomised controlled trials.
    Mots-clés : aconsejamiento y prueba del VIH en el hogar, conseil et dépistage du VIH à domicile, HIV/AIDS, home-based HIV counselling and testing, liaison avec les soins, linkage to care, Ouganda, Uganda, VIH/SIDA, vinculación a la atención sanitaria.
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  • Saisho Moeha et Sandron Frédéric (2017) « Baleines et Route des baleines : patrimonialisation et territoire dans le sud-ouest de l’océan Indien », Autrepart, 84, p. 51–73. DOI : 10.3917/autr.084.0051.

  • Scetti Fabio (2017) « Variation dialectale du portugais parlé au sein de la communauté de Montréal », Géolinguistique, 17, p. 151-175. DOI : 10.4000/geolinguistique.407.
    Résumé : La migration portugaise a donné à la ville de Montréal l’un des plus florissants quartiers portugais du Canada : la comunidade. Le portugais est la langue véhiculaire dans la comunidade et le drapeau de l’identité du quartier. Bien que le portugais soit promu comme langue de pouvoir au niveau international, l’analyse des pratiques orales montre sa variation dialectale. Le but de cette contribution est donc de mettre en lumière les traits phonétiques et structurels des variétés régionales portugaises du nord du Portugal, de Madère et des Açores dans ce contexte particulier. Les résultats montrent que les pratiques linguistiques à l’école mettent en valeur la norme standard. Mais l’analyse des pratiques orales souligne que l’évolution des normes se dirige vers ces variétés régionales et vers la norme du portugais brésilien.
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  • Seppey Mathieu, Ridde Valéry, Touré Laurence et Coulibaly Abdourahmane (2017) « Donor-funded project's sustainability assessment: a qualitative case study of a results-based financing pilot in Koulikoro region, Mali », Globalization and Health, 13 (1) (décembre). DOI : 10.1186/s12992-017-0307-8. https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-017-0307-8.


  • Shimakawa Yusuke, Pourette Dolorès, Bainilago Louis, Enel Catherine, Sombié Roger, Rado Ramanampamonjy, Lemoine Maud et Giles-Vernick Tamara (2017) « Improving communication about viral hepatitis in Africa », The Lancet Infectious Diseases, 17 (7), p. 688-689. DOI : 10.1016/S1473-3099(17)30339-0. http://linkinghub.elsevier.com/retrieve/pii/S1473309917303390.
    Mots-clés : AFRIQUE SUBSAHARIENNE, CENTRAFRIQUE, COMMUNICATION, connaissances, COTE D'IVOIRE, GAMBIE, Hépatite, MADAGASCAR, Professionnels de santé.
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  • Souley Ibrahim Hamani, Sween-Cadieux Esther, Moha Mahaman, Calvès Anne E. et Ridde Valéry (2017) « Renforcer la politique de gratuité des soins au Niger: bilan d’un atelier délibératif national novateur », Revue francophone de recherche sur le transfert et l’utilisation des connaissances, 2 (2) (décembre 31). https://retro.erudit.org/ojs/service/revue-tuc/article/view/15.
    Résumé : Depuis 2006, le Niger, sous pression de la Banque Mondiale, a mis en place une politique de gratuité des soins pour les femmes enceintes et les enfants de moins de cinq ans. Cependant, sa mise en œuvre s’est avérée difficile et parfois dysfonctionnelle. En mars 2012, un atelier national délibératif de trois jours, sollicité par l’union Européenne (ECHO) a donc été organisé pour échanger sur les acquis, limites et perspectives de renforcement de cette politique. L’atelier a regroupé 160 acteurs dont des chercheurs, humanitaires, décideurs politiques et techniques, élus locaux, représentants communautaires et intervenants sur le terrain. Plusieurs résultats de recherche (court métrage, notes de recherche et exposés) ont alimenté les échanges afin que les recommandations proposées soient appuyées par des données scientifiques. Étant donné l’ampleur de cet atelier, cette étude vise à décrire l’organisation et le déroulement de l’événement et à en évaluer les effets. Les données proviennent d’entretiens (n=173avant l’atelier, n=45 pendant ou un an après l’atelier et n=22 deux ans après l’atelier) avec une multitude de participants à différents moments du processus ainsi que de l’observation de l’atelier. Les résultats montrent que cet atelier a mené à quelques changements à court, moyen et long terme. Grâce à l’enthousiasme suscité par l’atelier, un comité de suivi s’est réuni à quelques reprises. Cependant, le comité a cessé de se réunir et cela a nui à l’application des recommandions issues de l’atelier délibératif. L’étude permet de relever les principaux défis qui ont entravé la mise en œuvre de ces recommandations dans le contexte nigérien.
    Mots-clés : Afrique de l’Ouest, gratuité des soins, Niger, Politique publique, processus délibératif, transfert de connaissances, utilisation des connaissances, ⛔ No DOI found.
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  • Taeron Corinne, Mbiribindi Romain, Derche Nicolas et Desgrées du Loû Annabel (2017) « Empowerment in sexual health for Sub-Saharan migrants in Paris: results from a community-based study », European Journal of Public Health, 27 (suppl_3) (novembre 1). DOI : 10.1093/eurpub/ckx189.268. http://academic.oup.com/eurpub/article/doi/10.1093/eurpub/ckx189.268/4557036.
    Résumé : Background In Europe, immigrants represent 34% of new HIV diagnoses (ECDC 2014). Several studies recently showed that between a third and half of HIV-positive immigrants in Europe acquired HIV post migration, in relation with social hardship experiences (Fakoya et al. 2015; Desgrées du Loû et al. 2016). Hence there is a strong need for efficient interventions to reduce Sub-Saharan immigrants’ social and sanitary vulnerability. The aim of our study is to design and evaluate the feasibility of a community-based intervention for Sub-Saharan immigrants’ empowerment in sexual health in Paris greater area. Methods Two community-based organizations (Arcat and Afrique Avenir) and three research teams conduct the pilot research together. The research is led in 2017-2018 and consists in participant observation in the two organizations, common workshops about existing interventions, and peers’ implication. Interviews are also led with key informers of the community. Results Preliminary results show that a community-based multicomponent intervention is feasible and could reduce Sub-Saharan immigrants’ vulnerability. Different interventions are designed for different “risk profiles”: i) vulnerability grid and rapid referral for recently arrived, vulnerable persons – women in particular and ii) gender-sensitive, specifically-tailored prevention sessions for men who have a low perception of their risk. Conclusions A package of interventions designed to reduce social and sanitary vulnerability in order to reduce sexual health is feasible among Sub-Saharan immigrants’ in Paris greater area. Key elements are implication of community-based organizations and peers. Further evaluation is needed to really measure the impact of this intervention.
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  • Temporal Franck (2017) « Les jeunes ultramarins : quelle(s) réalité(s) ? », Cahiers de l’action, 49 (2) (décembre 7), p. 7-17. DOI : 10.3917/cact.049.0007. https://www.cairn.info/revue-cahiers-de-l-action-2017-2-p-7.htm.
    Résumé : La Guadeloupe, la Guyane, la Martinique, La Réunion et l’île de Mayotte forment, ensemble, les départements et régions d’outre-mer (DROM). Ces territoires, éloignés les uns des autres et de la France métropolitaine, ne forment pas un ensemble homogène, mais partagent un statut commun et des caractéristiques qui les distinguent des autres régions françaises. L’objet de cet article est d’analyser les principales caractéristiques démographiques et socio-économiques de ces territoires en se centrant sur la population des jeunes adultes. À partir d’une synthèse des données les plus récentes, l’objectif est de fournir un bref panorama des principales tendances démographiques et migratoires dans ces régions, puis de s’intéresser aux difficultés socio-économiques que rencontrent les jeunes vivant dans les DROM. La présentation de ces éléments de contexte a pour objectif de mettre en lumière d’une part les distinctions existantes entre les DROM et d’autre part, entre les jeunes ultramarins afin de mieux comprendre leurs mobilités.
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  • Turcotte-Tremblay Anne-Marie, Gali-Gali Idriss Ali, De Allegri Manuela et Ridde Valery (2017) « The unintended consequences of community verifications for performance-based financing in Burkina Faso », Social Science & Medicine, 191 (octobre), p. 226-236. DOI : 10.1016/j.socscimed.2017.09.007.
    Résumé : Performance-based financing (PBF) is being widely implemented to improve healthcare services in Africa. An essential component of PBF involves conducting community verifications, wherein investigators from local associations attempt to trace samples of patients. Community surveys are administered to patients to verify whether healthcare workers reported fictitious services to increase their revenue. At the same time, client satisfaction surveys are administered to assess whether patients are satisfied with the services received. Although some global health actors are concerned that PBF can trigger unintended consequences, this topic remains neglected. The objective of this study was to document the unintended consequences of community verification. Guided by the diffusion of innovations theory, we conducted a multiple case study. The cases were the catchment areas of seven healthcare facilities in Burkina Faso. Data were collected between January 2016 and May 2016 using non-participant observation, 92 semi structured interviews, and informal discussions. Participants included a wide range of stakeholders, such as community verifiers, investigators, patients, and healthcare providers. Data were coded using QDA Miner, and thematic analysis was conducted. Healthcare workers did not significantly disturb or try to influence community verifiers during patient selection for community verifications. Unintended consequences included stakeholders' dissatisfaction regarding compensation modalities, work overload for community verifiers, and falsification of verification data by investigators. Community verifications led to loss of patient confidentiality as well as fears and apprehensions, although some patients were pleased to share their views regarding healthcare services. Community verifications also triggered marital issues, resulting in conflicts with, or interference from, husbands. The numerous challenges associated with locating patients in their communities led stakeholders to question the validity and utility of the results. These unintended consequences could jeopardize the overall effectiveness of community verifications. Attention should be paid to these unintended consequences to inform effective implementation and refine future interventions. (C) 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC
    Mots-clés : Burkina Faso, burundi, health-policy, Implementation, interventions, middle-income countries, Multiple case study, Performance-based financing, schemes, Unintended consequences, Verification.
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  • Vermot Cécile (2017) « Introduction : la migration comme expérience émotionnelle », Migrations Societe, 168 (2), p. 15-22. (Les émotions des migrants. Une approche sociologique). DOI : 10.3917/migra.168.0015. https://www.cairn.info/revue-migrations-societe-2017-2-page-15.htm.
    Résumé : Étudier les migrations à travers le prisme de la sociologie des émotions ouvre de nouvelles perspectives pour comprendre l’expérience migratoire, puisque l’analyse des émotions permet d’avoir accès à l’intime du sujet, à sa subjectivité [3] [3] Les émotions se trouvent au centre de la subjectivité des…, et donc de saisir ce que signifie pour lui la situation dans laquelle il se trouve, ce qu’il a vécu mais aussi ses objectifs et ses aspirations selon son appartenance sociale. 2Ce dossier thématique [4] [4] La coordonnatrice du présent dossier tient à remercier les…, qui trouve son origine dans une journée d’étude que nous avons organisée au sein du Centre population et développement (Ceped) à l’Université Paris Descartes le 12 juin 2015, permet de présenter un regard croisé Nord-Sud sur les émotions des migrants en proposant des contributions de chercheurs latino-américains et européens.
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  • Vermot Cécile (2017) « Peurs et aspiration à l’émigration à Miami et à Barcelone des Argentins de la classe moyenne (1999-2003) », Amérique Latine Histoire et Mémoire. Les Cahiers ALHIM. Les Cahiers ALHIM, 34 (décembre 6). DOI : 10.4000/alhim.5815. http://journals.openedition.org/alhim/5815.
    Résumé : L’objectif de cet article est d’analyser le rôle qu’a eu la peur dans l’aspiration à l’émigration des « perdants » de la « fête ménémiste ». À quelles représentations est-elle liée dans la mise en récit de leur mobilité ? Quelle a été son rôle dans leur aspiration à l’émigration ? Son expression est-elle liée à l’acte migratoire ? Au statut de migrant ? 52 entretiens semi-directifs avec des migrants argentins qui ont quitté leur pays entre 1999 et 2003 ont été réalisés en espagnol. Trente entretiens ont été réalisés à Miami et 22 entretiens à Barcelone. Les résultats montrent que la peur est mobilisée de trois manières différentes dans le discours des migrants. Elle est liée à un sentiment d’insécurité vis-à-vis de la délinquance en Argentine, à un sentiment de vulnérabilité et d’impuissance vis-à-vis de l’incertitude économique et politique et enfin, au risque de la migration. Prendre en compte la peur du point de vue de la sociologie des émotions permet de contribuer à l’intelligibilité du processus migratoire de ces Argentins de la classe moyenne. Ces peurs sont en effet liées à des représentations propres à cette partie de la classe moyenne dans une perspective de genre et durant cette période socio-historique.
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  • Vermot Cécile (2017) « Migration et émotions genrées: Les Argentins à Miami et à Barcelone », Migrations Société, 168 (2), p. 67-83. DOI : 10.3917/migra.168.0051. http://www.cairn.info/revue-migrations-societe-2017-2-page-67.htm.


  • Vernet Marie-Astrid, Reynard Stéphanie, Fizet Alexandra, Schaeffer Justine, Pannetier Delphine, Guedj Jeremie, Rives Max, Georges Nadia, Garcia-Bonnet Nathalie, Sylla Aboubacar I., Grovogui Péma, Kerherve Jean-Yves, Savio Christophe, Savio-Coste Sylvie, de Séverac Marie-Laure, Zloczewski Philippe, Linares Sandrine, Harouna Souley, Abdoul Bing M’Lebing, Petitjean Frederic, Samake Nenefing, Shepherd Susan, Kinda Moumouni, Koundouno Fara Roger, Joxe Ludovic, Mateo Mathieu, Lecine Patrick, Page Audrey, Tchamdja Tang Maleki, Schoenhals Matthieu, Barbe Solenne, Simon Bernard, Tran-Minh Tuan, Longuet Christophe, L’Hériteau François et Baize Sylvain (2017) « Clinical, virological, and biological parameters associated with outcomes of Ebola virus infection in Macenta, Guinea », JCI Insight, 2 (6) (mars 23). DOI : 10.1172/jci.insight.88864. https://insight.jci.org/articles/view/88864.
    Résumé : BACKGROUND. The pathogenesis of Ebola virus (EBOV) disease (EVD) is poorly characterized. The establishment of well-equipped diagnostic laboratories close to Ebola treatment centers (ETCs) has made it possible to obtain relevant virological and biological data during the course of EVD and to assess their association with the clinical course and different outcomes of the disease. METHODS. We were responsible for diagnosing EBOV infection in patients admitted to two ETCs in forested areas of Guinea. The pattern of clinical signs was recorded, and an etiological diagnosis was established by RT-PCR for EBOV infection or a rapid test for malaria and typhoid fever. Biochemical analyses were also performed. RESULTS. We handled samples from 168 patients between November 29, 2014, and January 31, 2015; 97 patients were found to be infected with EBOV, with Plasmodium falciparum coinfection in 18%. Overall mortality for EVD cases was 58%, rising to 86% if P. falciparum was also present. Viral load was higher in fatal cases of EVD than in survivors, and fatal cases were associated with higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT), C-reactive protein (CRP), and IL-6 levels. Furthermore, regardless of outcome, EVD was characterized by higher creatine kinase (CPK), amylase, and creatinine levels than in febrile patients without EVD, with higher blood urea nitrogen (BUN) levels in fatal cases of EVD only. CONCLUSION. These findings suggest that a high viral load at admission is a marker of poor EVD prognosis. In addition, high AST, ALT, CRP, and IL-6 levels are associated with a fatal outcome of EVD. Damage to the liver and other tissues, with massive rhabdomyolysis and, probably, acute pancreatitis, is associated with EVD and correlated with disease severity. Finally, biochemical analyses provide substantial added value at ETCs, making it possible to improve supportive rehydration and symptomatic care for patients. FUNDING. The French Ministry of Foreign Affairs, the Agence Française de Développement, and Institut Pasteur.
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  • Vignier Nicolas, Dray-Spira Rosemary, Lert France, Pannetier Julie, Ravalihasy Andrainolo, Gosselin Anne, Lydié Nathalie, Bouchaud Olivier, Desgrées du Loû Annabel et Grp Anrs-Parcours (2017) « Accès aux soins des personnes originaires d'Afrique subsaharienne vivant avec une hépatite B chronique = Health care access of Sub-Saharan African migrants living with chronic hepatitis B », Santé Publique, 3 (29), p. 361-370. DOI : 10.3917/spub.173.0361. https://www-cairn-info.frodon.univ-paris5.fr/revue-sante-publique-2017-3-page-361.htm.
    Résumé : Objective: The objective of this study was to analyse health care access of Sub-Saharan African migrants living with chronic hepatitis B (CHB) in France. Methods: The ANRS-Parcours survey was a life-event survey conducted in 2012-2013 among Sub-Saharan African migrants recruited by health care facilities managing CHB in the Paris region. Data were collected by face-to-face interview using a biographical grid and a standardized questionnaire. Results: 96.4% of the 619 participants basic health insurance coverage with CMU universal health insurance coverage in 18.6% of cases and AME state medical assistance in 23.4% of cases. One-third of basic health insurance beneficiaries did not have any complementary health insurance and 75.7% had long-term disease status. The median time to acquisition of health insurance cover after arrival in France was one year. 22.0% of participants reported delaying health care for financial reasons since their arrival in France and 9.7% reported being refused health care usually due to refusal of CMU or AME. Health care access was effective within one year of the diagnosis. Delayed health care access was more common among people without health insurance coverage in the year of diagnosis. Patients lost to follow-up for more than 12 months were rare. Conclusion: Sub-Saharan African migrants living with chronic hepatitis B rapidly access health insurance coverage and health care. However, barriers to health care access persist for some people, essentially due to absent or incomplete health insurance cover and refusal of care for AME or CMU beneficiaries.
    Mots-clés : AFRIQUE SUBSAHARIENNE, France, Health Care Quality, Access, and Evaluation, Health insurance coverage, Hepatitis B, migrants, sub-Saharan Africa.
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  • Woode Maame Esi, Bousmah Marwân-al-Qays et Boucekkine Raouf (2017) « Parental morbidity, child work, and health insurance in Rwanda », Journal of Demographic Economics, 83 (1) (mars), p. 111-127. DOI : 10.1017/dem.2016.28. https://www.cambridge.org/core/journals/journal-of-demographic-economics/article/parental-morbidity-child-work-and-health-insurance-in-rwanda/157F832F4692F12BD12762FDC9B4618D.
    Résumé : Measuring direct and indirect effects of extending health insurance coverage in developing countries is a key issue for health system development and for attaining universal health coverage. This paper investigates the role played by health insurance in the relationship between parental morbidity and child work decisions. We use a propensity score matching technique combined with hurdle models, using data from Rwanda. The results show that parental health shocks have a substantial influence on child work when households do not have health insurance. Depending on the gender of the sick parent, there is a substitution effect not only between the parent and the child on the labor market, but also between the time the child spends on different work activities. Altogether, results reveal that health insurance protects children against child work in the presence of parental health shocks.
    Mots-clés : Child work, Health insurance, Health shocks, Hurdle model, I13, I15, J22, O12, Propensity scores, Rwanda.
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  • Zombré David, De Allegri Manuela et Ridde Valéry (2017) « Immediate and sustained effects of user fee exemption on healthcare utilization among children under five in Burkina Faso: A controlled interrupted time-series analysis », Social Science & Medicine, 179 (avril), p. 27-35. DOI : 10.1016/j.socscimed.2017.02.027. https://linkinghub.elsevier.com/retrieve/pii/S0277953617301235.
    Résumé : Background Little is known about the long-term effects of user fee exemption policies on health care use in developing countries. We examined the association between user fee exemption and health care use among children under five in Burkina Faso. We also examined how factors related to characteristics of health facilities and their environment moderate this association. Method We used a multilevel controlled interrupted time-series design to examine the strength of effect and long term effects of user fee exemption policy on the rate of health service utilization in children under five between January 2004 and December 2014. Results The initiation of the intervention more than doubled the utilization rate with an immediate 132.596% increase in intervention facilities (IRR: 2.326; 95% CI: 1.980 to 2.672). The effect of the intervention was 32.766% higher in facilities with higher workforce density (IRR: 1.328; 95% CI (1.209–1.446)) and during the rainy season (IRR:1.2001; 95% CI: 1.0953–1.3149), but not significant in facilities with higher dispersed populations (IRR: 1.075; 95% CI: (0.942–1.207)). Although the intervention effect was substantially significant immediately following its inception, the pace of growth, while positive over a first phase, decelerated to stabilize itself three years and 7 months later before starting to decrease slowly towards the end of the study period. Conclusion This study provides additional evidence to support user fee exemption policies complemented by improvements in health care quality. Future work should include an assessment of the impact of user fee exemption on infant morbidity and mortality and better discuss factors that could explain the slowdown in this upward trend of utilization rates three and a half years after the intervention onset.
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