The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso

Ridde, Valéry; Agier, Isabelle; Jahn, Albrecht; Mueller, Olaf; Tiendrebéogo, Justin; Yé, M.; Allegri, Manuela De

doi:10.1007/s10198-013-0553-5

Cited by 35 publications

(48 citation statements)

References 33 publications

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“…Reversely, increased use of health care services also increases one’s chances of being offered the test through frequent encounters with providers. Similarly, in line with prior evidence[ 46 ][ 32 ], through exposure to the repeated studies that have taken place in the HDSS area[ 24 , 26 , 47 , 48 ], it is plausible to assume that both providers and communities in this area have better knowledge of both HIV and HIV services than people residing outside the HDSS area. On the onehand, this is likely to induce providers to offer the test more frequently.…”

Section: Discussionmentioning

confidence: 60%

“…In line with the overall sampling strategy applied to the household survey, only men aged 20 and above were interviewed as household heads. Details of the household selection procedures have been described in detail in earlier manuscripts which relied on previous rounds of the panel survey to answer other research questions[ 30 – 32 ]. In brief, first, clusters were defined according to the catchment area of each CSPS.…”

Section: Methodsmentioning

confidence: 99%

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Factors Affecting the Uptake of HIV Testing among Men: A Mixed-Methods Study in Rural Burkina Faso

et al. 2015

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BackgroundThis study aimed to explore factors shaping the decision to undergo Human Immunodeficiency Virus (HIV) testing among men in rural Burkina Faso.MethodsThe study took place in 2009 in the Nouna Health District and adopted a triangulation mixed methods design. The quantitative component relied on data collected through a structured survey on a representative sample of 1130 households. The qualitative component relied on 38 in-depth interviews, with men purposely selected to represent variation in testing decision, age, and place of residence. A two-part model was conducted, with two distinct outcome variables, i.e. “being offered an HIV test” and “having done an HIV test”. The qualitative data analysis relied on inductive coding conducted by three independent analysts.ResultOf the 937 men, 357 had been offered an HIV test and 97 had taken the test. Younger age, household wealth, living in a village under demographic surveillance, and knowing that HIV testing is available at primary health facilities were all positively associated with the probability of being offered an HIV test. Household wealth and literacy were found to be positively associated, and distance was found to be negatively associated with the probability of having taken an HIV test. Qualitative findings indicated that the limited uptake of HIV testing was linked to poor knowledge on service availability and to low risk perceptions.ConclusionWith only 10% of the total sample ever having tested for HIV, our study confirmed that male HIV testing remains unacceptably low in Sub-Saharan Africa. This results from a combination of health system factors, indicating general barriers to access, and motivational factors, such as one’s own knowledge of service availability and risk perceptions. Our findings suggested that using antenatal care and curative services as the exclusive entry points into HIV testing may not be sufficient to reach large portions of the male population. Thus, additional strategies are urgently needed to increase service uptake.

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Section: Discussionmentioning

confidence: 60%

Section: Methodsmentioning

confidence: 99%

Factors Affecting the Uptake of HIV Testing among Men: A Mixed-Methods Study in Rural Burkina Faso

et al. 2015

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“… 21 There is some evidence that the policy in Burkina Faso reduced out-of-pocket expenses and did not have an adverse effect on quality. 22 23 A further interesting point why uptake may have been greater in Burkina Faso was because the fee set for normal deliveries was significantly higher than the real cost. As highlighted in our interviews, the guidelines on how this money should be allocated were not clear, and in particular what proportion could be claimed by staff as bonuses.…”

Section: Resultsmentioning

confidence: 99%

Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis

Leone¹,

Cetorelli²,

Neal

et al. 2016

BMJ Open

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ObjectivesEvidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population.SettingWomen's experience of user fees in 5 African countries.Primary and secondary outcome measuresUsing quasi-experimental regression analysis we tested the impact of user fee reforms on facilities’ births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries’ choice.ParticipantsWe analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria).ResultsUser fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana.ConclusionsFindings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care.

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“…In particular, attention ought to be paid to adjusting payments to health providers according to comorbidity and illness severity to ensure that costs are not informally shifted to service users. The experience accrued during the implementation of the national maternal care user fee reduction policy (2007‐2016) suggests that payments are easily shifted to users when state subsidies are not accurately calculated in the first place …”

Section: Discussionmentioning

confidence: 99%

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

Nakovics

Brenner

Robyn

et al. 2019

Health Planning & Management

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Summary Introduction Overwhelming evidence suggests that out‐of‐pocket expenditures (OOPEs) hamper access to care and impose a heavy economic burden across sub‐Saharan Africa (SSA). Still, current user fee reduction and removal policies often target specific groups and services, leaving large sections of the population exposed to OOPE. Methods To estimate the magnitude and the determinants of OOPE for curative services in Burkina Faso, we used data from a household survey conducted in 24 districts between October 2013 and March 2014 (n = 7844). Given a context of medical pluralism, we purposely focused on total OOPE irrespective of type of care sought. We used a two‐part regression model to estimate determinants of OOPE. Results Nearly 60% of those who reported an illness episode incurred a positive expenditure, with an average amount of 9362.52 FRS CFA per episode (1 USD = 577.94 FRS CFA). The first model revealed that the probability of incurring a positive OOPE was positively associated with perceived illness severity (P < .001), hospitalization (P < .001), and negatively associated with age (P = .026), distance (P = .060), and poorest wealth quintile (P = .054). The second model revealed that the magnitude of OOPE was positively associated with age (P = .087), education (P = .025), being household head (P = .015), having a chronic comorbidity (P = .025), perceived illness severity (P = .029), and hospitalization (P < .001) and negatively associated with symptoms unlikely to lead to adverse outcomes if not attended to in time (P = .056). Conclusion Our findings indicate that OOPEs remain a problem in Burkina Faso and that broader spectrum policy reforms are urgently needed to ensure adequate financial protection.

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The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso

Abstract: The Burkinabè policy led to a significant and sustained reduction in household OOP health spending across all socio-economic groups, but failed to properly target the poorest by ensuring a progressive payment system.

Cited by 35 publications

References 33 publications

Factors Affecting the Uptake of HIV Testing among Men: A Mixed-Methods Study in Rural Burkina Faso

Factors Affecting the Uptake of HIV Testing among Men: A Mixed-Methods Study in Rural Burkina Faso

Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis

Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso

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