Table 2

Summary of objectives, key research questions, data collection techniques, data sources and analytical approaches used

Subparts of the objectivesKey research question
Key themes
Data collection techniques/toolsLevel, data source and sampleAnalysis
Analysing the policy agenda settingHow did user fee for CSs get the government’s attention, as a priority problem to address?
Problem stream, policy stream and political stream
Semistructured interviews with policymakers
Observation in meetings using an observation grid
Document review
Actors at the national, regional and international levels
1 conference and 10 agency meetings observed
24 informants interviewed
32 online media publications screened
Thematic analysis
Analysing the policy formulation and legitimationHow were the objectives of the policy defined?
How was the cost calculated?
What effects were anticipated?
How were the policy instruments selected?
How did policy makers ensure support for the policy and its instruments?
Context, actors, process and content of the policy
Observation in meetings using an observation grid
Structured discussion with key informants
Document review
Observation of implementing facilities
Actors at the national, regional and international levels
1 conference and 10 agency meetings observed
24 informants interviewed
7 implementing hospitals observed
Thematic analysis
Assessing the policy implementation fidelityTo what extent was the Policy implemented as it was designed in the original policy decree? Number of CS elements provided for free (in accordance with the policy)
Remaining charge for households for a CS
Document review
Semistructured interview with key informants
Exit surveys
Routine data extraction
Policy documents at national, regional and local levels Facility health routine data supports
Regional and district medical officers, health workers, facility users and community representatives
Triangulation of the data from the different sources and transformation of qualitative data into quantitative data to compute the number of CSs elements provided for free (in accordance with the policy). A descriptive statistical analysis has been conducted to compute the remaining charge for households for a CS.
Assessing the policy resultsTo what extent was the policy successful in relation to its desired and expected effects?
Impact on CS utilisation
Remaining fees charged for women who delivered by CS as a proportion of GDP per capita
Equity of utilisation: trends in CS rates for different socioeconomic groups
Document review and data extraction
Exit interviews (EI)
Routine data in national health statistics from 2001 to 2015
Demographic and Health Survey (DHS) data for Benin from 1993 to 2011 (n=36 375)
EI conducted with 294 with a CS
Interrupted Time Series particularly the Segmented regression analysis41, of data from routine annual statistics and DHS data
The model was specified as: Yt0 + β1*time + β2*policy + β3*postslope + εt
Yt=outcome variable (caesarean delivery) at time t; time is a continuous variable; policy is a dummy variable indicating whether or not the policy has been implemented at time t; and postslope is coded 0 up to the last point before the introduction of the policy and coded sequentially from 1 thereafter.
Analysis of the EI extracted specific data related to costs for a CS delivery for families, inside and outside hospitals. The expenditures have been computed as a proportion of the GDP per capita in Benin in 2012. The GDP per capita data in local current unit are extracted from the World Bank Open Data website. We used Microsoft Excel 2011 (V.14.6.7) for these analyses.
  • CS, caesarean section; GDP, gross domestic product.