A scoping review of agenda setting and implementation of the free emergency obstetric care policy in sub Saharan Africa from 2007 to 2024
- 1African Center of Excellence for the Prevention and Control of Communicable Diseases, University of Conakry
- 2Maferinyah National Center for Training and Research in Rural Health
Abstract
Introduction Sub-Saharan Africa continues to experience the highest maternal mortality rates globally. In response, several countries have adopted free maternal healthcare policies to reduce inequities in access and utilization of services. This study aimed to synthesize existing evidence on the drivers of agenda-setting for these policies and assess the effectiveness of their implementation across the region. Methods This was a scoping review of the literature, analyzing data from 40 studies published between 2007 and 2024 in sub-Saharan Africa. Kingdon’s multiple streams framework guided the analysis of data on the agenda-setting of free policy. Results Poor maternal and child health indicators were the main catalysts pushing free maternal healthcare policies onto political agendas. Francophone countries primarily adopted user fee exemptions or targeted free delivery and caesarean services, whereas Anglophone countries tended to expand insurance schemes covering a wider range of maternal and child health services. Internal political drivers included electoral dynamics, leadership changes, and the pursuit of state legitimacy, while external influences involved international advocacy and donor funding. Implementation remained uneven due to delayed reimbursements, policy misinterpretation, stock-outs, patient out-of-pocket expenses, and provider workload and demotivation. Conclusion Free maternal healthcare policies in sub-Saharan Africa emerged from both domestic health challenges and global advocacy. However, persistent implementation barriers highlight the need for context-specific approaches. Strengthening policy clarity, ensuring timely financing, supporting healthcare providers, and securing essential supplies are key to achieving equitable and sustainable maternal healthcare delivery within the region.
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BibTeX
@article{deguenon2026scoping,
title = {{A scoping review of agenda setting and implementation of the free emergency obstetric care policy in sub Saharan Africa from 2007 to 2024}},
author = {Sèhouèdé Christelle Judith Deguenon and Delphin Kolié and Abdoulaye Sow and Niouma Nestor Leno and Mahoutondji Fernandez Lauclair Lainé and Artémise Clisthène Alésia Mahoutin Gbaguidi and Alioune Camara and Abdoul Habib Beavogui and Alexandre Delamou},
journal = {Discover Health Systems},
year = {2026},
month = oct,
doi = {10.1007/s44250-026-00370-7},
url = {https://doi.org/10.1007/s44250-026-00370-7},
note = {CC BY},
}
RIS
TY - JOUR
TI - A scoping review of agenda setting and implementation of the free emergency obstetric care policy in sub Saharan Africa from 2007 to 2024
AU - Sèhouèdé Christelle Judith Deguenon
AU - Delphin Kolié
AU - Abdoulaye Sow
AU - Niouma Nestor Leno
AU - Mahoutondji Fernandez Lauclair Lainé
AU - Artémise Clisthène Alésia Mahoutin Gbaguidi
AU - Alioune Camara
AU - Abdoul Habib Beavogui
AU - Alexandre Delamou
PY - 2026
DA - 2026/10/25
JO - Discover Health Systems
DO - 10.1007/s44250-026-00370-7
UR - https://doi.org/10.1007/s44250-026-00370-7
AB - Introduction Sub-Saharan Africa continues to experience the highest maternal mortality rates globally. In response, several countries have adopted free maternal healthcare policies to reduce inequities in access and utilization of services. This study aimed to synthesize existing evidence on the drivers of agenda-setting for these policies and assess the effectiveness of their implementation across the region. Methods This was a scoping review of the literature, analyzing data from 40 studies published between 2007 and 2024 in sub-Saharan Africa. Kingdon’s multiple streams framework guided the analysis of data on the agenda-setting of free policy. Results Poor maternal and child health indicators were the main catalysts pushing free maternal healthcare policies onto political agendas. Francophone countries primarily adopted user fee exemptions or targeted free delivery and caesarean services, whereas Anglophone countries tended to expand insurance schemes covering a wider range of maternal and child health services. Internal political drivers included electoral dynamics, leadership changes, and the pursuit of state legitimacy, while external influences involved international advocacy and donor funding. Implementation remained uneven due to delayed reimbursements, policy misinterpretation, stock-outs, patient out-of-pocket expenses, and provider workload and demotivation. Conclusion Free maternal healthcare policies in sub-Saharan Africa emerged from both domestic health challenges and global advocacy. However, persistent implementation barriers highlight the need for context-specific approaches. Strengthening policy clarity, ensuring timely financing, supporting healthcare providers, and securing essential supplies are key to achieving equitable and sustainable maternal healthcare delivery within the region.
SN - 2731-7501
ER -