Free healthcare for some, fee-paying for the rest: adaptive practices and ethical issues in rural communities in the district of Boulsa, Burkina Faso

Abstract

In Burkina Faso, in July 2016, user fees were removed at all public healthcare facilities, but only for children under 60 months of age and for “mothers”, i.e. for reproductive care. This study was conducted in five rural communities in Boulsa District (Burkina Faso) (1) to understand the perceptions and practices of stakeholders regarding compliance with eligibility criteria for free care and (2) to explore the ethical tensions that may have resulted from this policy. Semi-directed individual interviews ( n = 20) were conducted with healthcare personnel and mothers of young children. Interviews were recorded and transcribed, and a thematic content analysis was conducted. The study reveals the presence of practices to circumvent strict compliance with the eligibility criteria for free access. These include hiding the exact age of children over 60 months and using eligible persons for the benefit of others. These practices result from ethical and economic tensions experienced by the beneficiaries. They also raise dilemmas among healthcare providers, who have to enforce compliance with the eligibility criteria while realizing the households’ deprivation. Informal adjustments are introduced at the community level to reconcile the healthcare providers’ dissonance. Local reinvention mechanisms help in overcoming ethical tensions and in implementing the policy.

Feasibility and Acceptability of a Strategy Deploying Multiple First-Line Artemisinin-Based Combination Therapies for Uncomplicated Malaria in the Health District of Kaya, Burkina Faso

“…The desired uptake would have not been achieved [27]. Targeting segments of the population (children under 5 years of age, patients 5 years old and above, and pregnant women) is part of the health system routine practices, and hence was the most viable option [31]. Indeed, when introducing a national free healthcare policy for children under 5 and pregnant women, HWs adapted their practices accordingly [31].…”

“…The distribution and availability of antimalarials for the three segments, as well as their relatively low cost (as subsidized), were highly appreciated by the populations. Many studies have previously reported that the removal of financial barriers to health services use increases communities' attendance at PHF for care [31,37]. Regardless of the MFT option selected, subsidizing the cost of ACTs should be used to reduce affordability issues.…”

International Research and Philanthropy

“…Burkina Faso has a fee-based healthcare system that uses out-of-pocket payments, although pregnant women and children under five receive free health care and medications. 29 As a result, human landing catch participants diagnosed with malaria after the 21-day period observed by Target Malaria would be responsible for paying for healthcare and medications themselves.…”