Exemption policies and community preferences for tropical endemic diseases in the Bamako initiative programme in Nigeria.

We determined the actual written policies/guidelines and practices of fee exemptions aimed at the primary health-care level for tropical diseases treatment within the Bamako initiative system and the community's and decision makers' preferences for exemption in Nigeria. Health policy documents from the federal and state ministries of health were reviewed to determine the guidelines for exemptions, services, goods and category of people to receive exemptions. The records of the local government areas, health centres and community health committees were also reviewed to check who had received exemptions and modalities for doing so. In addition, household surveys using questionnaires was conducted. There is no clear-cut national policy regarding exemption. In areas where exemption exists, these are largely unofficial, as no official documents exist to support exemption. A total of 1594 individuals were surveyed. Community members prefer pregnant women, children and patients with TB, malaria, onchocerciasis and leprosy to be exempted from payment of fees: decision makers prefer the poor, children and patients with malaria, TB and leprosy to be exempted from payment for drugs, registration, consultation and preventive services such as immunization and antenatal services. One area of divergence between the preferences of the community and decision makers is the issue of exempting people with malaria and HIV/AIDS.