No effect of user fee exemption on perceived quality of delivery care in Burkina Faso: a case-control study

Abstract

BackgroundAlthough many developing countries have developed user fee exemption policies to move towards universal health coverage as a priority, very few studies have attempted to measure the quality of care. The present paper aims at assessing whether women’s satisfaction with delivery care is maintained with a total fee exemption in Burkina Faso.MethodsA quasi-experimental design with both intervention and control groups was carried out. Six health centres were selected in rural health districts with limited resources. In the intervention group, delivery care is free of charge at health centres while in the control district women have to pay 900 West African CFA francs (U$2). A total of 870 women who delivered at the health centre were interviewed at home after their visit over a 60-day range. A series of principal component analyses (PCA) were carried out to identify the dimension of patients’ satisfaction.ResultsWomen’s satisfaction loaded satisfactorily on a three-dimension principal component analysis (PCA): 1-provider-patient interaction; 2-nursing care services; 3-environment. Women in both the intervention and control groups were satisfied or very satisfied in 90% of cases (in 31 of 34 items). For each dimension, average satisfaction was similar between the two groups, even after controlling for socio-demographic factors (p = 0.436, p = 0.506, p = 0.310, respectively). The effects of total fee exemption on satisfaction were similar for any women without reinforcing inequalities between very poor and wealthy women (p ≥ 0.05). Although the wealthiest women were more dissatisfied with the delivery environment (p = 0.017), the poorest were more highly satisfied with nursing care services (p = 0.009).ConclusionContrary to our expectations, total fee exemption at the point of service did not seem to have a negative impact on quality of care, and women’s perceptions remained very positive. This paper shows that the policy of completely abolishing user fees with organized implementation is certainly a way for developing countries to engage in universal coverage while maintaining the quality of care.

Effect of a free healthcare policy on health services utilisation for non‐malarial febrile illness by children under five years in Burkina Faso: an interrupted time series analysis

“…Second, the fact that the policy under study included receiving medical treatment free of charge could have contributed to an increased and sustained uptake of services following the intervention [62]. In addition, some important contextual aspects may have also favoured a sustained effect of this policy: i) free health care does not seem to largely affect the overall quality of care in Burkina Faso [17,18]; ii) there is a documented improvement on quality of care in the management of febrile illnesses based on use of malaria RDTs [64,65]; iii) the free healthcare policy is total and is part of a national strategy to improve access to health care [66]; and iv) the CSPSs involved in the study are from the country's capital urban areas, for which geographical access and patients transportation do not seem to be a major challenge as in rural areas [67]. Our study has some limitations.…”

“…However, if not implemented as planned or expected, free healthcare policies may also result on unexpected effects such as declining quality of care [14,15], the development of strategies by providers to preserve their personal benefits and informal practices [10], reducing income for healthcare centres and limiting drug's availability [2]. Although it has been proven that in a context of free health care, health workers might find a way to use the system to their own advantage [16], the quality (technical and perceived) of care and the quality of drug prescription do not seem altered in Burkina Faso [17,18]. While the effect of free health care on the use of health services is well studied, to our knowledge, there are little or no data specifically for non-malarial febrile illnesses.…”

How do Malawian women rate the quality of maternal and newborn care? Experiences and perceptions of women in the central and southern regions

“…Individual perceptions of care quality are therefore based on what a client considers important to his or her clinical management [ 25 ], as well as the interpersonal relations during the provider-patient encounter [ 20 – 22 , 25 , 26 ], the structural and administrative conditions at the facility [ 22 , 25 ], and the medical and social competence of the care givers [ 20 – 23 , 26 – 32 ]. Based on this theoretical model [ 19 ] and building upon prior empirical research evidence [ 20 – 22 , 25 – 29 , 32 , 34 ], we constructed a scale to measure three dimensions of health care perception: the interpersonal relations (i.e. clients’ experience with the socio-cultural atmosphere during the provider-client interaction), the conditions of the examination rooms (i.e.…”

“…The statements for measurement of each of the three dimensions of perception were adapted from a quality of care perception scale previously used in Burkina Faso to assess women’s perceptions of delivery services [ 34 ]. We first translated these statements from French into English and then into the local language, Chichewa.…”

Health Providers’ Perceptions of Clinical Trials: Lessons from Ghana, Kenya and Burkina Faso

“…In all three countries, total government expenditure on health as a percentage of gross domestic product is well below the 2001 Abuja declaration target of 15% [ 25 ], and the health systems depend largely on external donor funding and out-of-pocket payments through health insurance or at point of care payment [ 26 , 27 ]. At the time of this study, national health sector reforms being implemented in the three countries included a health insurance scheme (NHIS) in Ghana, a direct facility funding initiative (HSSF) in Kenya, and a primary health care subsidy initiative to improve skilled delivery in Burkina Faso [ 28 – 30 ].…”