{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T05:45:47Z","timestamp":1750398347940,"version":"3.30.1"},"reference-count":29,"publisher":"CAIRN","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,22]]},"abstract":"<jats:p>Le Tchad a l\u2019un des taux de mortalit\u00e9 maternelle et infantile les plus \u00e9lev\u00e9s au monde. Les efforts visant \u00e0 r\u00e9duire ces taux ont conduit \u00e0 la mise en place d\u2019une politique d\u2019exemption du paiement des soins, associ\u00e9e \u00e0 l\u2019implication des communaut\u00e9s pour encourager l\u2019utilisation des services. Malgr\u00e9 l\u2019introduction de cette initiative, des in\u00e9galit\u00e9s dans l\u2019acc\u00e8s et l\u2019utilisation des \u00e9tablissements de sant\u00e9 persistent. L\u2019objectif de cette \u00e9tude est de comprendre pourquoi et comment cette politique d\u2019exemption, mise en \u0153uvre de mani\u00e8re quasi homog\u00e8ne, a donn\u00e9 des r\u00e9sultats contrast\u00e9s dans plusieurs centres de sant\u00e9. Une \u00e9tude de cas multiples contrast\u00e9s a \u00e9t\u00e9 utilis\u00e9e pour analyser les r\u00e9sultats des consultations p\u00e9diatriques et des accouchements dans quatre centres de sant\u00e9 des districts de B\u00e9noye et Beinamar. Les donn\u00e9es ont \u00e9t\u00e9 recueillies lors des entretiens individuels (n=26) et des groupes de discussion (n=22) aupr\u00e8s des femmes b\u00e9n\u00e9ficiaires, des agents de sant\u00e9 communautaire et des prestataires de soins. Le logiciel QDA\u00a0Miner a \u00e9t\u00e9 utilis\u00e9 pour traiter les donn\u00e9es. L\u2019\u00e9tude a r\u00e9v\u00e9l\u00e9 que les capacit\u00e9s organisationnelles et manag\u00e9riales des prestataires et des acteurs communautaires expliqueraient l\u2019h\u00e9t\u00e9rog\u00e9n\u00e9it\u00e9 des r\u00e9sultats observ\u00e9s. Des facteurs contextuels tels que l\u2019\u00e9loignement des services ou l\u2019impraticabilit\u00e9 et la dangerosit\u00e9 des routes ont accentu\u00e9 les disparit\u00e9s des r\u00e9sultats observ\u00e9s. Dans la mise en place des politiques de sant\u00e9, il est important de tenir compte des facteurs humains et contextuels, car ils participent \u00e0 l\u2019explication de l\u2019h\u00e9t\u00e9rog\u00e9n\u00e9it\u00e9 des effets observ\u00e9s et renforcent la pertinence de ce type d\u2019\u00e9tudes.<\/jats:p>","DOI":"10.3917\/spub.235.0095","type":"journal-article","created":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T14:44:45Z","timestamp":1704293085000},"page":"95-119","source":"Crossref","is-referenced-by-count":1,"title":["Les facteurs contextuels pour comprendre l\u2019h\u00e9t\u00e9rog\u00e9n\u00e9it\u00e9 des r\u00e9sultats d\u2019une politique d\u2019exemption du paiement des soins au Tchad"],"prefix":"10.3917","volume":"Vol. 35","author":[{"given":"Dahab","family":"Manoufi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Val\u00e9ry","family":"Ridde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2273","reference":[{"unstructured":"1. 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