An Evaluation of Healthcare Use and Child Morbidity 4 Years After User Fee Removal in Rural Burkina Faso

Abstract

Objectives Increasing financial access to healthcare is proposed to being essential for improving child health outcomes, but the available evidence on the relationship between increased access and health remains scarce. Four years after its launch, we evaluated the contextual effect of user fee removal intervention on the probability of an illness occurring and the likelihood of using health services among children under 5. We also explored the potential effect on the inequality in healthcare access. Methods We used a comparative cross-sectional design based upon household survey data collected years after the intervention onset in one intervention and one comparison district. Propensity scores weighting was used to achieve balance on covariates between the two districts, which was followed by logistic multilevel modelling to estimate average marginal effects (AME). Results We estimated that there was not a significant difference in the reduced probability of an illness occurring in the intervention district compared to the non-intervention district [AME 4.4; 95% CI 1.0–9.8)]. However, the probability of using health services was 17.2% (95% CI 15.0–26.6) higher among children living in the intervention district relative to the comparison district, which rose to 20.7% (95% CI 9.9–31.5) for severe illness episodes. We detected no significant differences in the probability of health services use according to socio-economic status [χ 2 (5) = 12.90, p = 0.61]. Conclusions for Practice In our study, we found that user fee removal led to a significant increase in the use of health services in the longer term, but it is not adequate by itself to reduce the risk of illness occurrence and socioeconomic inequities in the use of health services.

Stories of change in nutrition in Burkina Faso 1992–2018: a micro-level perspective

“…This appears to concur with a rigorous mapping exercise at the country level which revealed that many nutrition-specific interventions had satisfactory geographical coverage in 2014 (Doudou et al, 2018 ). Free healthcare to pregnant women and children under five was largely cited by community members as a very recent driver of tangible improvement, and has proven to lead to a significant 17% increase in the use of health services in the longer term (Zombré et al, 2019 ). Finally, family planning programs that aim at optimizing age at first pregnancy, family size and inter-pregnancy intervals, lead to better health and nutrition pregnancy outcomes (Bhutta et al, 2013 ); There is currently a large, though declining, unmet need for contraceptives in Burkina Faso, especially for spacing births (Institut Supérieur des Sciences de la Population, 2018 ).…”

Effect of the free healthcare policy on socioeconomic inequalities in care seeking for fever in children under five years in Burkina Faso: a population-based surveys analysis

“…This low-income country has an estimated gross domestic product of 786.895 US dollars, and approximately 40.1% of the entire population lives below the poverty threshold [22]. Children under 5 years of age represent 18% of the entire population, and more than 1 out of every 9 children die before the age of 5 years from preventable febrile illnesses such as malaria, pneumonia and diarrhoeal infections [19,23]. Moreover only 50% of children have access to formal healthcare in Burkina Faso [19].…”

“…Children under 5 years of age represent 18% of the entire population, and more than 1 out of every 9 children die before the age of 5 years from preventable febrile illnesses such as malaria, pneumonia and diarrhoeal infections [19,23]. Moreover only 50% of children have access to formal healthcare in Burkina Faso [19].…”

“…In 2019, a study done in Sierra Leone revealed that inequalities were reduced after the implementation of the Free Healthcare Initiative, albeit some inequalities in favour of the wealthy still observed in two districts [3]. Since the implementation of the FHCP in Burkina Faso, the use of child health services has increased in the rural areas [19] and in facilities with higher workforce density [20], and the effect was stronger during the rainy season when need is greater. However, to date, no study has assessed the effect of this policy in reducing socioeconomic inequities among sick children.…”

The long-term effects of free care on birth outcomes: Evidence from a national policy reform in Zambia

“…The evidence of effects is mixed, and a previous analysis of the reform in Zambia looking at the effect of the policy 1-year post reform showed no change in facility-based deliveries ( Chama-Chiliba & Koch, 2016 ). With the exception of Burkina Faso, where Zombré, De Allegri et al (2019) analysed the effect at four years, there is hardly any evidence on the effects of free care once the policy has matured, even though beneficial effects may take time to appear due to teething problems to implement the policy effectively in the short-term or slow behavioural change ( Carasso, Lagarde et al, 2012 ). As a result, the null effects observed in studies evaluating the short-term effects of policy change can either be explained by a true lack of effectiveness of user fee removal or the challenges associated with the introduction of the policy.…”