Research in Action
In the 1980s, with advice from international organizations, most African countries adopted direct payment for health services as the primary means to finance their health systems. Patients had to pay for health services out-of-pocket, severely hindering access to services for the most vulnerable. New recommendations in the 2000s called for African countries to offer subsidies or abolish payments for certain health services and groups. Until now, the impacts of these reforms in francophone West Africa have not been documented.