Grant: Travel Awards - Institute Community Support

The rise on the international scene of advocacy for universal health coverage (UHC) in developing countries was accompanied by the promotion of new financing policies. These strategies, which mainly include health insurance, user-fee exemption, and performance-based financing, were presented by donors as relevant instruments for achieving UHC. This scoping review aims at analyzing the literature on Sub-Saharan populations' perceptions of quality after the implementation of donor-driven health financing strategies. We conducted searches in English and French for 2000-2014 on major scientific databases. Twenty-five articles were included and subjected to coding and analysis, using the "Quality-of-Care Framework" (Peabody et al, 1999) and themes emerging from the data. The literature does not show evidence of satisfaction in terms of quality of care after introducing these policies. In several instances, the policies even worsened quality (e.g., poorer communication between patients and physicians). The fact that these policies appear to have produced mixed results in terms of perceived quality of care may be attributable to their "top-down" nature. This invites us to reflect on the limitations of "global" "donor-driven" policies that are not necessarily adapted to local contexts. Because they fail to generate country ownership, these policies often lead to disappointing results.