Les interventions de subvention du paiement des soins renforcent l’empowerment des communautés au Burkina Faso

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As a step towards universal health coverage, African countries need to develop funding systems that are effective, equitable, and tailored to national circumstances. To support policy makers in Burkina Faso, we present a review of research on interventions related to user fees, prepayment plans, and user fee subsidies. We compiled a narrative summary of articles published in scientific journals between 1980 and 2012. In all, 64 articles were selected. A thematic analysis was performed. User fees are a barrier to access to care; they curtail the use of health services and exclude the worst-off. People prefer prepayment plans in which each household pays an annual premium. However, the insurance premium remains a barrier to membership. Insurance does not benefit the poor but increases the use of health services by the insured. The subsidy for facility-based deliveries was not sufficiently well planned and difficulties have been observed in its implementation. While it helps reduce costs and improves access to care, it has not reduced inequalities. Community-based and participatory interventions have been useful for identifying the worst-off in order to exempt them from user fees. While prepayment is being promoted internationally as a financing model for universal health coverage, the evidence in favour of this system in Burkina Faso is still very limited. Further studies, more representative of the national context, must be conducted on this option, while at the same time, continuing efforts must be made to identify solutions for the poor who are unable to pay.

Section: • La Perception Des Acteurs Sur Ces Mesures D'exemptionunclassified

Les modalités de collecte du financement de la santé au Burkina Faso de 1980 à 2012

Ridde¹,

Belaid²,

Samb³

et al. 2014

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Les difficultés d'accès aux soins de santé des indigents vivant dans des ménages non pauvres

Kadio¹,

Ridde²,

Samb³

2014

The community perceives poverty in terms other simply economic aspects. The social dimension of poverty (including the inability to fully participate in community life) has a major impact on the choice of the CVS, leading to the selection of indigents from households that appear to have a high economic level. This community process which takes into account contextual factors, identified these people who do not necessarily have access to the household resources for health care.

L'évaluation, une voie pour faire progresser la promotion de la santé en Afrique ?

Jabot¹,

Ridde²,

Wone³

et al. 2014

Les méthodes utilisées pour évaluer les interventions en promotion de la santé en Afrique sont-elles adaptées aux spécificités de ce domaine ? Telle est la question à laquelle les auteurs s’efforcent de répondre à partir d’une analyse réflexive de quatre évaluations qu’ils ont conduites au Bénin, Burkina Faso et Mali. Les expériences rapportées témoignent de la volonté d’inscrire la démarche d’évaluation en accord avec les principes de la promotion de la santé mais aussi des difficultés à surmonter les écueils de l’exercice. Il reste encore du chemin à parcourir pour que l’évaluation concilie pleinement les attentes des acteurs et les valeurs de la promotion de la santé : rendre compte de l’ensemble des dynamiques générées par les interventions en promotion en la santé, inscrire l’équité au cœur de la réflexion, soutenir les pratiques innovantes en vue de leur pérennité. Parce qu’elle facilite l’émergence et le partage des visions plurielles de ce concept encore mal cerné, l’évaluation est une voie pour faire progresser la promotion de la santé en Afrique.