Out-of-pocket payments in the context of a free maternal health care policy in Burkina Faso: a national cross-sectional survey

Ivlabèhiré Bertrand Meda,Valéry Ridde,Henri Gautier Ouédraogo,Adama Baguiya,Alexandre Dumont,Seni Kouanda

doi:10.1186/s13561-019-0228-8

Abstract

BackgroundIn April 2016, Burkina Faso introduced a free health care policy for women. Instead of reimbursing health facilities, as many sub-Saharan countries do, the government paid them prospectively for covered services to avoid reimbursement delays, which are cited as a reason for the persistence of out-of-pocket (OOP) payments. This study aimed to (i) estimate the direct expenditures of deliveries and covered obstetric care, (ii) determine the OOP payments, and (iii) identify the patient and health facility characteristics associated with OOP payments.MethodsA national cross-sectional study was conducted in September and October 2016 in 395 randomly selected health facilities. A structured questionnaire was administered to women (n = 593) who had delivered or received obstetric care on the day of the survey. The direct health expenditures included fees for consultations, prescriptions, paraclinical examinations, hospitalization and ambulance transport. A two-part model with robust variances was performed to identify the factors associated with OOP payments.ResultsA total of 587 women were included in the analysis. The median direct health expenses were US$5.38 [interquartile range (IQR):4.35–6.65], US$24.72 [IQR:16.57–46.09] and US$136.39 [IQR: 108.36–161.42] for normal delivery, dystocia and cesarean section, respectively. Nearly one-third (29.6%, n = 174) of the women reported having paid for their care. OOP payments ranged from US$0.08 to US$98.67, with a median of US$1.77 [IQR:0.83–7.08]). Overall, 17.5% (n = 103) of the women had purchased drugs at private pharmacies, and 11.4% (n = 67) had purchased cleaning products for a room or equipment. OOP payments were more frequent with age, for emergency obstetric care and among women who work. The women’s health region of origin was also significantly associated with OOP payments. For those who made OOP payments, the amounts paid decreased with age but were higher in urban areas, in hospitals, and among the most educated women. The amounts paid were lower among students and were associated with health region.ConclusionThe policy is effective for financial protection. However, improvements in the management and supply system of health facilities’ pharmacies could further reduce OOP payments in the context of the free health care policy in Burkina Faso.

Highlights

In April 2016, Burkina Faso introduced a free health care policy for women
The women were surveyed from 299 public health facilities, including 228 Centre de Santé et de Promotion Sociale (CSPS), 21 Medical center (MC), 39 district hospitals, 8 regional hospitals and 3 university hospitals. 67% of these women had no education and 19.2% had a primary school education level
The results show that almost one-third of women made OOP payments for direct health care expenses incurred in deliveries or emergency obstetric care (EmOC), even though this care should be completely fee-free

Summary

Introduction

In April 2016, Burkina Faso introduced a free health care policy for women. Instead of reimbursing health facilities, as many sub-Saharan countries do, the government paid them prospectively for covered services to avoid reimbursement delays, which are cited as a reason for the persistence of out-of-pocket (OOP) payments. It has been found to expose households to a risk of catastrophic expenditure and to impoverishment [1, 2] For those reasons, in the late 1990s and early 2000s, several countries in Sub-Saharan Africa introduced public policies that eliminated or reduced fees for specific social groups or specific types of care [3]. In the late 1990s and early 2000s, several countries in Sub-Saharan Africa introduced public policies that eliminated or reduced fees for specific social groups or specific types of care [3] These policies were intended to speed up the achievement of some of the Millennium Development Goals (MDGs), including maternal, newborn and child health related goals. These policies vary by country in terms of the services covered, the social groups benefited and the cost mitigation level [4]

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