Economic Evaluation of User-Fee Exemption Policies for Maternal Healthcare in Burkina Faso: Evidence From a Cost-Effectiveness Analysis

Abstract

The reduction and removal of user fees for essential care services have recently become a key instrument to advance universal health coverage in sub-Saharan Africa, but no evidence exists on its cost-effectiveness. We aimed to address this gap by estimating the cost-effectiveness of 2 user-fee exemption interventions in Burkina Faso between 2007 and 2015: the national 80% user-fee reduction policy for delivery care services and the user-fee removal pilot (ie, the complete [100%] user-fee removal for delivery care) in the Sahel region.Methods: We built a single decision tree to evaluate the cost-effectiveness of the 2 study interventions and the baseline. The decision tree was populated with an own impact evaluation and the best available epidemiological evidence.Results: Relative to the baseline, both the national 80% user-fee reduction policy and the user-fee removal pilot are highly cost-effective, with incremental cost-effectiveness ratios of $210.22 and $252.51 per disability-adjusted life-year averted, respectively. Relative to the national 80% user-fee reduction policy, the user-fee removal pilot entails an incremental costeffectiveness ratio of $309.74 per disability-adjusted life-year averted.Conclusions: Our study suggests that it is worthwhile for Burkina Faso to move from an 80% reduction to the complete removal of user fees for delivery care. Local analyses should be done to identify whether it is worthwhile to implement userfee exemptions in other sub-Saharan African countries.

A review of prospective pathways and impacts of COVID-19 on the accessibility, safety, quality, and affordability of essential medicines and vaccines for universal health coverage in Africa

“…Temporarily exempting certain segments of society from user fees payment at public (and potentially private) pharmacies and hospitals could help reduce financial hardship associated with out-of-pocket payments [52][53][54][55][56][57]. These populations could include people living with HIV/AIDS (PLWHA), patients with high-risk pregnancy, pregnant women living distant from health facility, patients under treatment for tuberculosis, households with sick children, communities living in malaria-endemic settings, among others.…”

“…These populations could include people living with HIV/AIDS (PLWHA), patients with high-risk pregnancy, pregnant women living distant from health facility, patients under treatment for tuberculosis, households with sick children, communities living in malaria-endemic settings, among others. However, to adequately improve equitable access to EMV, sustained user fee exemptions for large population groups might be needed [54,57,58]. Historically, these charges were levied due to supposed constraints in public financing, which are compounded by declining national incomes in the context of the current pandemic (as indicated above).…”

Vulnerabilities and Strengths of Pregnant Haitian Adolescents and their Families During Transition to Motherhood

“…Countries, such as Burkina Faso, have developed a recent economic policy that promotes access to prenatal care at no cost to pregnant mothers. 29 Haiti could implement a similar model. Home birth is an economic strategy for disadvantaged teenage girls.…”

The Limits of Free Health Care Schemes: the Case of Access to Care for Beneficiaries of the Moroccan Medical Assistance Scheme (RAMed) Suffering From Cancer

“…Free access to health care has been the subject of much debate and focus [1,2] on Africa, and in particular on sub-Saharan Africa [3,4,5,6,7]. The main criticism of free access is its economic sustainability.…”

“…Free care is currently nanced by the ordinary operating budget of hospitals, whereas it was planned that the care provided would be invoiced and the bills paid by the State according to a mechanism to be put in place. (3) The state of the health infrastructure and its capacity to accommodate RAMed bene ciaries. As indicated in the report on the sectoral strategy of the Ministry of Health for the period 2012-2016 [17], the health infrastructure at the time of the launch of RAMed was already insu cient, since at the time when the Moroccan government was beginning to worry about RAMed's sustainability, the share of the State budget devoted to it was 5.6% (2014), whereas the share recommended by the WHO was 9%.…”