Examining out‐of‐pocket expenditure on health care in Nouna, Burkina Faso: implications for health policy

Abstract

SummaryOBJECTIVE OBJ ECTIVE To examine household out-of-pocket expenditure on health care, particularly malaria treatment, in rural Burkina Faso.METHOD METHO D Comprehensive analysis of out-of-pocket expenditure on health care through a descriptive analysis and a second, multivariate analysis using the Tobit model with emphasis on malaria, based on 800 urban and rural households in Nouna health district. RESULTSRES ULTS Households will spend less on malaria, either in or outside the health facility, if given the choice to do so, because they feel con®dent to self-treat malaria. Seeking health care from a quali®ed health worker incurs more out-of-pocket expenditure than self-treatment and traditional healers, and if necessary, households sell off assets to offset the expenditure. More than 80% of household out-ofpocket expenditure is allocated to drugs.CONCLUSION CONCLUSION This has policy implications for malaria control and the Roll Back Malaria Initiative. Communities need to be educated on the risks of malaria complications and the potential risk of inappropriate diagnosis and treatment. Drug or health services pricing policy needs to create an incentive to use the health services. In the ®ght against malaria, building alliances between households, traditional healers and health workers is essential.keywords out-of-pocket expenditure, malaria, Burkina Faso, household, age bias, gender bias correspondence Frederick Mugisha,

Understanding enrolment in community health insurance in sub-Saharan Africa: a population-based case–control study in rural Burkina Faso

“…39 Revealing the reasons behind ethnic differences, however, is beyond the reach of quantitative analysis relying on household survey data 30 and requires a complementary qualitative enquiry to explore how social dynamics within specific communities influence health-related behaviours, including the decision to enrol in CHI. 17 The positive association between enrolment and judgement of the ad--equacy of traditional systems of care as being mediocre or poor is also in line with previous studies exploring healthcare-seeking behaviour in the region 40,41 and can be understood intuitively. Our study is insufficient, however, to identify measures that could be used to promote enrolment by acting to alter percep--tions of substitute systems of health care provision.…”

Use of proxy measures in estimating socioeconomic inequalities in malaria prevalence

“…Whilst the study results imply that self-reported malaria or fever should not be used for studies interested in the socioeconomic gradient in malaria prevalence, the measure is still appropriate for use in studies interested in household responses to malaria illness, for example, the economic burden of malaria; this is because it is the perception of illness (and its associated severity) that determines behaviour such as treatment seeking (Mugisha et al 2002).…”

Costing of Malaria treatment in a rural district hospital

“…The low occupancy rates and general underutilisation of health care in Nouna health district [29][30][31] and Burkina Faso as a whole [32] lead to high average cost per patient especially for staff [11,33]. To improve efficiency utilisation should be enhanced.…”