Out-of-pocket payments in the context of a free maternal health care policy in Burkina Faso: a national cross-sectional survey

Abstract

BackgroundIn April 2016, Burkina Faso introduced a free health care policy for women. Instead of reimbursing health facilities, as many sub-Saharan countries do, the government paid them prospectively for covered services to avoid reimbursement delays, which are cited as a reason for the persistence of out-of-pocket (OOP) payments. This study aimed to (i) estimate the direct expenditures of deliveries and covered obstetric care, (ii) determine the OOP payments, and (iii) identify the patient and health facility characteristics associated with OOP payments.MethodsA national cross-sectional study was conducted in September and October 2016 in 395 randomly selected health facilities. A structured questionnaire was administered to women (n = 593) who had delivered or received obstetric care on the day of the survey. The direct health expenditures included fees for consultations, prescriptions, paraclinical examinations, hospitalization and ambulance transport. A two-part model with robust variances was performed to identify the factors associated with OOP payments.ResultsA total of 587 women were included in the analysis. The median direct health expenses were US$5.38 [interquartile range (IQR):4.35–6.65], US$24.72 [IQR:16.57–46.09] and US$136.39 [IQR: 108.36–161.42] for normal delivery, dystocia and cesarean section, respectively. Nearly one-third (29.6%, n = 174) of the women reported having paid for their care. OOP payments ranged from US$0.08 to US$98.67, with a median of US$1.77 [IQR:0.83–7.08]). Overall, 17.5% (n = 103) of the women had purchased drugs at private pharmacies, and 11.4% (n = 67) had purchased cleaning products for a room or equipment. OOP payments were more frequent with age, for emergency obstetric care and among women who work. The women’s health region of origin was also significantly associated with OOP payments. For those who made OOP payments, the amounts paid decreased with age but were higher in urban areas, in hospitals, and among the most educated women. The amounts paid were lower among students and were associated with health region.ConclusionThe policy is effective for financial protection. However, improvements in the management and supply system of health facilities’ pharmacies could further reduce OOP payments in the context of the free health care policy in Burkina Faso.

Is it home delivery or health facility? Community perceptions on place of childbirth in rural Northwest Tanzania using a qualitative approach

“…Previous research has also reported that cultural factors such as women's delivery preferences and how the placenta is handled after the birth can significantly influence women's decisions on place of delivery [35,38,43]. In the present study, a common theme that emerged was that health facilities were not supportive of women's delivery preferences (i.e., squatting) and as a result, women did not feel that they could or that they wanted to deliver at these facilities.…”

“…In this study, out of pocket costs were a significant factor that negatively influenced utilization of health facilities for delivery. Research has reported that in LMICs the costs associated with health facility delivery dissuaded women from using these facilities due to the financial burden that this imposed on the family [25,26,28] and that these costs were associated with home delivery persistence even in countries that had eliminated user fees for childbirth [13,43,45]. Hidden costs for drugs, supplies (i.e., gloves, syringes, kanga, kerosene, and plastic cover), referrals and transport reduced the affordability of maternal and childcare services in these disadvantaged communities.…”

“…So, although there may be no user fees for basic maternal and child facility delivery services in many LMICs, the hidden costs associated with childbirth impose a significant financial burden on families, particularly those who are of lower socioeconomic status. Previous studies have reported that this financial burden can result in the selling of property, cutting of consumption expenditures, and taking loans [13,43], which in turn places families at greater financial risk. Therefore, the elimination of user fees may not be sufficient by itself to ensure that health care services are affordable for disadvantaged or marginalized populations as the hidden cost associated with these services may place poorer women in an inequitable position in terms of accessing health facilities for delivery.…”

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

“…Several advantages related to the implementation of partial or total free health care have been described in the literature [1,2,[5][6][7][8][9]. It allows for financial protection of populations [7] and a reduction in household health expenditure [5,8]. It strengthens women's empowerment in health decision-making [9] and benefits the poor [6].…”

Household Costs Associated With Seeking Malaria Treatment During Pregnancy: Evidence From Burkina Faso and The Gambia

“…Health facilities are paid prospectively according to a fee-for-service method with scheduled fees. A recent study showed that while the policy has provided effective nancial protection, a signi cant proportion of women continue to pay for services and consumables that should be free of charge [27]. Even if there is no fee attached to ANC visits and IPTp, there are still costs associated with visiting xed.…”