Is the process for selecting indigents to receive free care in Burkina Faso equitable?

Abstract

BackgroundIn Burkina Faso, patients are required to pay for healthcare. This constitutes a barrier to access for indigents, who are the most disadvantaged. User fee exemption systems have been created to facilitate their access. A community-based initiative was thus implemented in a rural region of Burkina Faso to select the worst-off and exempt them from user fees. The final selection was not based on pre-defined criteria, but rather on community members’ tacit knowledge of the villagers. The objective of this study was to analyze the equitable nature of this community-based selection process.MethodBased on a cross-sectional study carried out in 2010, we surveyed 1,687 indigents. The variables collected were those that determine healthcare use according to the Andersen-Newman model (1969): sociodemographic variables; income; occupation; access to financial, food or instrumental assistance; presence of chronic illness; and disabilities related to vision, muscle strength, or mobility. Bivariate analyses and logistic regression were performed.ResultsUser fee exemptions were given mainly to indigents who were widowed (OR = 1.40; CI 95% [1.10–1.78]), had no financial assistance from their household for healthcare (OR = 1.58; CI 95% [1.26–1.97], lived alone (OR = 1.28; CI 95% [1.01–1.63]), lived with their spouses, (OR = 2.00; CI 95% [1.35-2.96], had vision impairments (OR = 1.45; CI 95% [1.14–1.84]), or had poor muscle strength and good mobility (OR = 1.73; CI 95% [1.28–2.33]). The indigent selection was not determined by household income, self-reported chronic illness, or previous use of services.ConclusionThe community selection process took into account factors related to social vulnerability and functional limitations. However, we cannot affirm that the selection process was perfectly equitable, as it was very restrictive due to the limited budget available and the State’s lack of engagement in this matter. Exemption processes should be temporary solutions, and the State should make a commitment to move toward universal healthcare coverage.

An exploratory study assessing psychological distress of indigents in Burkina Faso: a step forward in understanding mental health needs in West Africa

“…In line with previous works conducted by our team [ 19 , 38 , 59 , 60 ], the current study suggests that the poorest in rural Burkina Faso may face health needs that differ from those of the general population. Hence, specific evidence-based health policies focused on this group’s precarious situation are needed to improve mental health care access.…”

Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso

“…Instead, we assume that their old age, the seriousness of the illness and a possible latestage of seeking care (not able to walk, stand, sit alone without assistance) might demand that ultra-poor be transported in a specific way, e.g. making it necessary to have accompanied transportation with a borrowed vehicle (involving fuel costs) [32,47,48]. Looking specifically at the results of the regression models, it was striking to see that the exemption card, which respondents received in early February 2016 in Diébougou within the PBF intervention (3 years before the data collection), decreased the probability of incurring excessive OOPE by 28 percentage points.…”

“…Sex was a dichotomous variable (male/ . We dichotomised the variable (no education and education) as done by previous studies [32,33]. We did so because the educational level of the ultra-poor people is generally very low.…”

Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso

“…Enabling factors: Educational level was a categorical variable with 16 categories (1 none; 2 nursery school; 3 CP1 4 CP2; 5 CE1 6 CE2; 7 CM1; 8 CM2; 9 Sixième; 10 Cinquième; 11 Quatrième; 12 Troisième 13 Seconde; 14 Première; 15 Terminale; 16 Supérieur). As done by previous studies performed in a rural African context [ 29 ], the original variable educational level was transformed into a binary variable (no education and education). Less than 6% of the study samples (ultra-poor population) received any form of education.…”