Effects of the Free Healthcare Policy on Maternal and Child Health in Burkina Faso: a Nationwide Evaluation Using Interrupted Time-series Analysis

Overview

Journal Health Econ Rev

Publisher Biomed Central

Specialty Public Health

Date 2023 May 5

PMID 37145306

Authors

Patrick Gueswende Ilboudo

Alain Siri

Affiliations

Soon will be listed here.

Abstract

Background: Burkina Faso has recently instituted a free healthcare policy for women and children under five. This comprehensive study examined the effects of this policy on the use of services, health outcomes, and removal of costs.

Methods: Interrupted time-series regressions were used to investigate the effects of the policy on the use of health services and health outcomes. In addition, an analysis of household expenditures was conducted to assess the effects of spending on delivery, care for children, and other exempted (antenatal, postnatal, etc.) services on household expenditures.

Results: The findings show that the user fee removal policy significantly increased the use of healthcare facilities for child consultations and reduced mortality from severe malaria in children under the age of five years. It also has increased the use of health facilities for assisted deliveries, complicated deliveries, and second antenatal visits, and reduced cesarean deliveries and intrahospital infant mortality, although not significantly. While the policy has failed to remove all costs, it decreased household costs to some extent. In addition, the effects of the user fee removal policy seemed higher in districts with non-compromised security for most of the studied indicators.

Conclusions: Given the positive effects, the findings of this investigation support the pursuit of implementing the free healthcare policy for maternal and child care.

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References

Hangoma P, Robberstad B, Aakvik A . Does Free Public Health Care Increase Utilization and Reduce Spending? Heterogeneity and Long Term Effects. World Dev. 2018; 101:334-350. PMC: 5798631. DOI: 10.1016/j.worlddev.2017.05.040. View

Nguyen H, Zombre D, Ridde V, De Allegri M . The impact of reducing and eliminating user fees on facility-based delivery: a controlled interrupted time series in Burkina Faso. Health Policy Plan. 2018; 33(8):948-956. DOI: 10.1093/heapol/czy077. View

Campbell O, Graham W . Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006; 368(9543):1284-99. DOI: 10.1016/S0140-6736(06)69381-1. View

Goudar S, Goco N, Somannavar M, Vernekar S, Mallapur A, Moore J . Institutional deliveries and perinatal and neonatal mortality in Southern and Central India. Reprod Health. 2015; 12 Suppl 2:S13. PMC: 4464025. DOI: 10.1186/1742-4755-12-S2-S13. View

Pattinson R, Kerber K, Buchmann E, Friberg I, Belizan M, Lansky S . Stillbirths: how can health systems deliver for mothers and babies?. Lancet. 2011; 377(9777):1610-23. DOI: 10.1016/S0140-6736(10)62306-9. View

Moyer C, Dako-Gyeke P, Adanu R . Facility-based delivery and maternal and early neonatal mortality in sub-Saharan Africa: a regional review of the literature. Afr J Reprod Health. 2013; 17(3):30-43. View

Kuunibe N, Lohmann J, Hillebrecht M, Nguyen H, Tougri G, De Allegri M . What happens when performance-based financing meets free healthcare? Evidence from an interrupted time-series analysis. Health Policy Plan. 2020; 35(8):906-917. DOI: 10.1093/heapol/czaa062. View

Meda I, Baguiya A, Ridde V, Ouedraogo H, Dumont A, Kouanda S . Out-of-pocket payments in the context of a free maternal health care policy in Burkina Faso: a national cross-sectional survey. Health Econ Rev. 2019; 9(1):11. PMC: 6734235. DOI: 10.1186/s13561-019-0228-8. View

McKinnon B, Harper S, Kaufman J, Bergevin Y . Removing user fees for facility-based delivery services: a difference-in-differences evaluation from ten sub-Saharan African countries. Health Policy Plan. 2014; 30(4):432-41. PMC: 4385820. DOI: 10.1093/heapol/czu027. View

10.

Rutherford M, Mulholland K, Hill P . How access to health care relates to under-five mortality in sub-Saharan Africa: systematic review. Trop Med Int Health. 2010; 15(5):508-19. DOI: 10.1111/j.1365-3156.2010.02497.x. View

11.

Borghi J, Hanson K, Acquah C, Ekanmian G, Filippi V, Ronsmans C . Costs of near-miss obstetric complications for women and their families in Benin and Ghana. Health Policy Plan. 2003; 18(4):383-90. DOI: 10.1093/heapol/czg046. View

12.

McPake B, Brikci N, Cometto G, Schmidt A, Araujo E . Removing user fees: learning from international experience to support the process. Health Policy Plan. 2011; 26 Suppl 2:ii104-117. DOI: 10.1093/heapol/czr064. View

13.

Lagarde M, Palmer N . The impact of user fees on access to health services in low- and middle-income countries. Cochrane Database Syst Rev. 2011; (4):CD009094. PMC: 10025428. DOI: 10.1002/14651858.CD009094. View

14.

Druetz T, Fregonese F, Bado A, Millogo T, Kouanda S, Diabate S . Abolishing Fees at Health Centers in the Context of Community Case Management of Malaria: What Effects on Treatment-Seeking Practices for Febrile Children in Rural Burkina Faso?. PLoS One. 2015; 10(10):e0141306. PMC: 4621040. DOI: 10.1371/journal.pone.0141306. View

15.

Zombre D, De Allegri M, Platt R, Ridde V, Zinszer K . An Evaluation of Healthcare Use and Child Morbidity 4 Years After User Fee Removal in Rural Burkina Faso. Matern Child Health J. 2018; 23(6):777-786. PMC: 6510853. DOI: 10.1007/s10995-018-02694-0. View

16.

Ilboudo P, Russell S, DExelle B . The long term economic impact of severe obstetric complications for women and their children in Burkina Faso. PLoS One. 2013; 8(11):e80010. PMC: 3818276. DOI: 10.1371/journal.pone.0080010. View

17.

Hatt L, Makinen M, Madhavan S, Conlon C . Effects of user fee exemptions on the provision and use of maternal health services: a review of literature. J Health Popul Nutr. 2014; 31(4 Suppl 2):67-80. View

18.

Anand S, Barnighausen T . Human resources and health outcomes: cross-country econometric study. Lancet. 2004; 364(9445):1603-9. DOI: 10.1016/S0140-6736(04)17313-3. View

19.

Xu K, Evans D, Kadama P, Nabyonga J, Ogwal P, Nabukhonzo P . Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Soc Sci Med. 2005; 62(4):866-76. DOI: 10.1016/j.socscimed.2005.07.004. View

20.

Bhutta Z, Das J, Bahl R, Lawn J, Salam R, Paul V . Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?. Lancet. 2014; 384(9940):347-70. DOI: 10.1016/S0140-6736(14)60792-3. View