Since the 1980s in West Africa, women have had to pay for antenatal care consultations and deliveries. This system, known as user fees, imposes financial barriers for poor households. Evidence shows that deliveries in a health care centre with qualified staff reduces maternal and infant mortality.
In this paper, the authors investigate the agenda-setting criteria used by policy entrepreneurs directly involved in the implementation of user-fee abolition and reduction policies for maternal care in West Africa. They use a method called best-worst scaling to innovatively collect respondents’ answers to determine the most and least relevant criteria considered when making decisions about these policies. The results suggest that political commitment and impact on health are the most important factors leading to these decisions, while international pressure and donor money are rarely considered. The authors conclude their findings with two strategies: policy implementation must be mediated by equity considerations, and policy decisions must be accompanied by adequate implementation measures and must receive necessary funding.