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. 2012 Oct 19:12:363.
doi: 10.1186/1472-6963-12-363.

Assessing effectiveness of a community based health insurance in rural Burkina Faso

Sennen Hounton  1 , Peter Byass, Bocar Kouyate
Affiliations

Assessing effectiveness of a community based health insurance in rural Burkina Faso

Sennen Hounton et al. BMC Health Serv Res. .

Abstract

Background: Financial barriers are a recognized major bottleneck of access and use of health services. The aim of this study was to assess effectiveness of a community based health insurance (CBHI) scheme on utilization of health services as well as on mortality and morbidity.

Methods: Data were collected from April to December 2007 from the Nouna's Demographic Surveillance System on overall mortality, utilization of health services, household characteristics, distance to health facilities, membership in the Nouna CBHI. We analyzed differentials in overall mortality and selected maternal health process measures between members and non-members of the insurance scheme.

Results: After adjusting for covariates there was no significant difference in overall mortality between households who could not have been members (because their area was yet to be covered by the stepped-wedged scheme), non-members but whose households could have been members (areas covered but not enrolled), and members of the insurance scheme. The risk of overall mortality increased significantly with distance to health facility (35% more outside Nouna town) and with education level (37% lower when at least primary school education achieved in households).

Conclusion: There was no statistically significant difference in overall mortality between members and non-members. The enrolment rates remain low, with selection bias. It is important that community based health insurances, exemptions fees policy and national health insurances be evaluated on prevention of deaths and severe morbidities instead of on drop-out rates, selection bias, adverse selection and catastrophic payments for health care only. Effective social protection will require national health insurance.

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Figures

Figure 1
Figure 1
Community Based Health Insurance framework (adapted from Bennet S [16]).
Figure 2
Figure 2
Location of Nouna DSS, Burkina Faso (Photo credit: Dr Bocar Kouyate).
Figure 3
Figure 3
Conceptual model of the Nouna community based health insurance scheme.
See this image and copyright information in PMC

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References

    1. Ouimet MJ, Fournier P, Diop I, Haddad S. Solidarity or financial sustainability: an analysis of the values of community-based health insurance subscribers and promoters in Senegal. Can J Public Health. 2007;98(4):341–346. - PMC - PubMed
    1. Jacobs B, Bigdeli M, van Pelt M, Ir P, Salze C, Criel B. Bridging community-based health insurance and social protection for health care–a step in the direction of universal coverage? Trop Med Int Health. 2008;13(2):140–143. doi: 10.1111/j.1365-3156.2007.01983.x. - DOI - PubMed
    1. De Allegri M, Sauerborn R. Community based health insurance in developing countries. BMJ. 2007;334(7607):1282–1283. doi: 10.1136/bmj.39240.632963.80. - DOI - PMC - PubMed
    1. Drummond MF, Sculpher MJ, Torrance GW, Brien BJ O, Stoddart GL. Methods for the economic evaluation of health care programmes. 3. Oxford University Press, New York; 2005.
    1. Dong H, De Allegri M, Gnawali D, Souares A, Sauerborn R. Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso. Health Policy. 2009;92(2–3):174–179. - PubMed

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