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. 2020 Sep 8;17(18):6543.
doi: 10.3390/ijerph17186543.

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

Yvonne Beaugé  1 , Manuela De Allegri  1 , Samiratou Ouédraogo  2   3   4 , Emmanuel Bonnet  5 , Naasegnibe Kuunibe  1   6 , Valéry Ridde  7
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Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso

Yvonne Beaugé et al. Int J Environ Res Public Health. .

Abstract

Background: A component of the performance-based financing intervention implemented in Burkina Faso was to provide free access to healthcare via the distribution of user fee exemption cards to previously identified ultra-poor. This study examines the factors that led to the receipt of user fee exemption cards, and the effect of card possession on the utilisation of healthcare services. Methods: A panel data set of 1652 randomly selected ultra-poor individuals was used. Logistic regression was applied on the end line data to identify factors associated with the receipt of user fee exemption cards. Random-effects modelling was applied to the panel data to determine the effect of the card possession on healthcare service utilisation among those who reported an illness six months before the surveys. Results: Out of the ultra-poor surveyed in 2017, 75.51% received exemption cards. Basic literacy (p = 0.03), living within 5 km from a healthcare centre (p = 0.02) and being resident in Diébougou or Gourcy (p = 0.00) were positively associated with card possession. Card possession did not increase health service utilisation (β = -0.07; 95% CI = -0.45; 0.32; p = 0.73). Conclusion: A better intervention design and implementation is required. Complementing demand-side strategies could guide the ultra-poor in overcoming all barriers to healthcare access.

Keywords: Burkina Faso; health service utilisation; performance-based financing; targeting; user fee exemptions.

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Conflict of interest statement

The authors declare that they have no competing interests. Manuela De Allegri was the PI of Impact Evaluation of the of the Performance-Based Financing funded by the World Bank through the Health Results Innovation Trust Fund (HRITF). The Fund was administered by the Medical Faculty of the University of Heidelberg; hence M.D.A received no direct compensation from the World Bank.

Figures

Figure 1
Figure 1
Geographical concentration of the respondents in Diébougou.
Figure 2
Figure 2
Geographical concentration of the respondents in Gourcy.
Figure 3
Figure 3
Geographical concentration of the respondents in Kaya.
Figure 4
Figure 4
Geographical concentration of the respondents in Ouargaye.
See this image and copyright information in PMC

References

    1. Ministère de l’Action Sociale et de la Sécurité Nationale du Burkina Faso MASSN . Synthèse des résultats du comité de réflexion sur l’indigence. Government of Burkina Faso; Ouagadougou, Burkina Faso: 2010.
    1. Ridde V., Yaméogo P. How Burkina Faso used evidence in deciding to launch its policy of free healthcare for children under five and women in 2016. Palgrave Commun. 2018;4:1–9. doi: 10.1057/s41599-018-0173-x. - DOI
    1. Institut National de la Statistique et de la Démographie (INSD) Ministère de l’Économie et des Finances . Enquête Démographique et de Santé et à Indicateurs Multiples (EDSBF-MICS IV). Burkina Faso 2010. Institut National de la Statistique et de la Démographie (INSD); Ouagadougou, Burkina Faso: 2010.
    1. Ministry of Health Burkina Faso . La santé d’après les enquêtes statistiques nationales. Une synthèse des résultats disponibles depuis l’indépendance du Burkina Faso. Ministry of Health; Ouagadougou, Burkina Faso: 2010.
    1. WHO Global Health Expenditure Database. Burkina Faso. [(accessed on 17 April 2019)]; Available online: https://apps.who.int/nha/database.

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