User fees for maternal & child health services in Burkina Faso (2012-2014)

"User fees" are the share of costs a patient pays for medical and hospital services. User fees can be levied to reduce unnecessary use of services, to heighten efficiency, and to finance healthcare systems, particularly in contexts where public funding is limited. However, user fees may also discourage needed use of services, especially for poorer populations, inadvertently undermining key public health goals. At the time our study was initiated, preventive care for mothers and children under the age of 5 years was free in Burkina Faso; however, curative services for these groups levied user fees.

Project

This project was conducted to provide evidence for a possible health financing reform to strengthen Universal Health Coverage in Burkina Faso. I led an analysis of the likely mortality impact of abolishing user fees for pregnant women and children in Burkina Faso, by coupling use of a validated mathematical model with rigorous statistical techniques (propensity score and interrupted time-series) for impact assessment. The study PIs (Professeurs Valéry Ridde and Slim Haddad) led the field demonstration project on which the analysis was based and mobilised a consortium of local and international NGOs and government stakeholders to influence policy.

© UNICEF/UNI424529/Benekire

Findings

We found that the user-fee elimination strategy increased health-care coverage for key services (facility delivery, treatment of children's diarrhoea with oral rehydration salts, and receipt of artemesinin for malaria; the increase in delivery of antibiotics for pneumonia treatment was not significant) and thereby reduced child mortality. We also explored the anticipated mortality impact of scaling up a similar intervention to the entire Sahel region and to the national level. We found that if a similar intervention were to be introduced nationwide, 14 000 to 19 000 (estimate range 4000–28 000) children’s lives could be saved annually. Maternal mortality showed a modest decrease in all scenarios.

Impact

Our study was cited by the Minister of Health of Burkina Faso in a 2015-03-23 presentation to international stakeholders as part of the rationale for a new policy to eliminate user-fees for curative child health services. It was the sole scientific study cited. The policy was adopted into law on 2015-09-05.

Research

• Johri M, Ridde V, Heinmuller R and Haddad S: Estimation of maternal and child mortality one year after user-fee elimination: an impact evaluation and modelling study in Burkina Faso. Bull World Health Organ 2014, 92(10):706-715 https://doi.org/10.2471/BLT.13.130609