Improving equity by removing healthcare fees for children in Burkina Faso

Ridde, Valéry; Haddad, Slim; Heinmüller, Rolf

doi:10.1136/jech-2012-202080

Cited by 37 publications

(48 citation statements)

References 23 publications

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“…Given the low illness reporting rates observed in this study and already documented in prior literature, our sample was not sufficiently large to systematically explore district differences in OOPE. It is probable, however, that average values mask important variation within and across districts, given the presence of small‐scale user fee removal pilots and community‐based health insurance schemes in selected locations …”

Section: Discussionsupporting

confidence: 77%

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

Nakovics

Brenner

Robyn

et al. 2019

Health Planning & Management

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Summary Introduction Overwhelming evidence suggests that out‐of‐pocket expenditures (OOPEs) hamper access to care and impose a heavy economic burden across sub‐Saharan Africa (SSA). Still, current user fee reduction and removal policies often target specific groups and services, leaving large sections of the population exposed to OOPE. Methods To estimate the magnitude and the determinants of OOPE for curative services in Burkina Faso, we used data from a household survey conducted in 24 districts between October 2013 and March 2014 (n = 7844). Given a context of medical pluralism, we purposely focused on total OOPE irrespective of type of care sought. We used a two‐part regression model to estimate determinants of OOPE. Results Nearly 60% of those who reported an illness episode incurred a positive expenditure, with an average amount of 9362.52 FRS CFA per episode (1 USD = 577.94 FRS CFA). The first model revealed that the probability of incurring a positive OOPE was positively associated with perceived illness severity (P < .001), hospitalization (P < .001), and negatively associated with age (P = .026), distance (P = .060), and poorest wealth quintile (P = .054). The second model revealed that the magnitude of OOPE was positively associated with age (P = .087), education (P = .025), being household head (P = .015), having a chronic comorbidity (P = .025), perceived illness severity (P = .029), and hospitalization (P < .001) and negatively associated with symptoms unlikely to lead to adverse outcomes if not attended to in time (P = .056). Conclusion Our findings indicate that OOPEs remain a problem in Burkina Faso and that broader spectrum policy reforms are urgently needed to ensure adequate financial protection.

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Section: Discussionsupporting

confidence: 77%

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

Nakovics

Brenner

Robyn

et al. 2019

Health Planning & Management

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“…Our findings argue for the subsidisation for tuberculosis care and control (Ridde et al . ). However, the magnitude of the financial catastrophe borne by care users, even within a free disease control strategy, clearly calls for a better coverage of patients who are already enrolled in the programme and further development of financial protection interventions for all.…”

Section: Resultsmentioning

confidence: 97%

Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities

Laokri

Dramaix-Wilmet

Kassa

et al. 2014

Tropical Med Int Health

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“…A range of interventions were tested: unconditional or conditional cash transfers [78, 82, 84, 86, 87, 90, 92], fee exemptions [77, 79, 80, 88, 89], and food incentive schemes [83, 85]. …”

Section: Resultsmentioning

confidence: 99%

A systematic review of strategies to increase access to health services among children in low and middle income countries

Bright

Felix

Kuper

et al. 2017

BMC Health Serv Res

101

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BackgroundUniversal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. Failure to access healthcare is an important contributor to child mortality in these settings. Barriers to access have been widely studied, however effective interventions to overcome barriers and increase access to services for children are less well documented.MethodsWe conducted a systematic review of effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC. Four databases (EMBASE, Global Health, MEDLINE, and PSYCINFO) were searched in January 2016. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation uptake; and compliance with medication or referral. Randomised controlled trials and non-randomised controlled study designs were included in the review. A narrative approach was used to synthesise results.ResultsFifty seven studies were included in the review. Approximately half of studies (49%) were conducted in sub-Saharan Africa. Most studies were randomised controlled trials (n = 44; 77%) with the remaining studies employing non-randomised designs. Very few studies were judged as high quality. Studies evaluated a diverse range of interventions and various outcomes. Supply side interventions included: delivery of services at or closer to home and service level improvements (eg. integration of services). Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes. A consistent pattern was not noted for the remaining studies.ConclusionsThis review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can be used to increase access for children aged ≤5 years in LMIC. It highlights some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home. However, given the methodological limitations found in existing studies, the results of this review must be interpreted with caution.Systematic review registrationPROSPERO CRD420160334200 Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2180-9) contains supplementary material, which is available to authorized users.

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Improving equity by removing healthcare fees for children in Burkina Faso

Cited by 37 publications

References 23 publications

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities

A systematic review of strategies to increase access to health services among children in low and middle income countries

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