Objectives: The aim of this work is to examine the effects of the free care policy on the access, management and practice of cesarean section in Niger. The secondary data collected from the various health facilities as well as the national health information system made it possible to analyze the impact of the risk and organizational factors on the practice of cesarean section in Niger before and after this policy.
Methods: A panel analysis was conducted with the same data to determine the impact of this policy on the evolution of these factors and the likelihood of delivery by cesarean section in Niger. In these models, the need for Caesarean is justified by the existence of a medical matrix of gravity and a matrix of explanatory variables of organizational order. Two different models are estimated. The first explains the practice of cesarean section in Niger with data collected from all regions of the country. The second explains Caesarean section practice in the three regions that have a national maternity reference. The data collected covers the period 2006-2014. A total of 2,250 files were studied in the eight regions of the country.
Results: When considering only the period after free care, the results obtained indicate that the risk factors were less important in explaining the occurrence of a caesarean section than before. This is valid for both the medical severity variables and the organizational variables.
Discussion: These results confirm those of the statistical analysis in which the national rate of caesarean section has been observed to be changing, slowing down and declining.
Thus, alongside the policy of care for pregnant women and cesarean section, the State must also make efforts to improve the health card, the proper functioning of the care system to through the timely reimbursement of factors issued and the availability of human resources in quantity and quality to hope to achieve the objectives pursued through this policy.