Skip to main content
Log in

The impact of targeted subsidies for facility-based delivery on access to care and equity – Evidence from a population-based study in rural Burkina Faso

  • Original Article
  • Published:
Journal of Public Health Policy Aims and scope Submit manuscript

Abstract

We conducted the first population-based impact assessment of a financing policy introduced in Burkina Faso in 2007 on women's access to delivery services. The policy offers an 80 per cent subsidy for facility-based delivery. We collected information on delivery in five repeated cross-sectional surveys carried out from 2006 to 2010 on a representative sample of 1050 households in rural Nouna Health District. Over the 5 years, the proportion of facility-based deliveries increased from 49 to 84 per cent (P<0.001). The utilization gap across socio-economic quintiles, however, remained unchanged. The amount received for all services associated with births decreased by 67 per cent (P<0.001), but women continued to pay on average 1423 CFA (€1=655 CFA), about 500 CFA more than the set tariff of 900 CFA. Our findings indicate the operational effectiveness of the policy in increasing the use of facility-based delivery services for women. The potential to reduce maternal mortality substantially has not yet been assessed by health outcome measures of neonatal and maternal mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  • Hogan, M.C. et al (2010) Maternal mortality for 181 countries, 1980–2008: A systematic analysis of progress towards Millennium Development Goal 5. Lancet 375 (9726): 1609–1623.

    Article  Google Scholar 

  • UNICEF. (2009) The State of the World's Children 2009: Maternal and Newborn Health. New York: UNICEF.

  • De Brouwere, V., Richard, F. and Witter, S. (2010) Access to maternal and perinatal health services: Lessons from successful and less successful examples of improving access to safe delivery and care of the newborn. Tropical Medicine & International Health 15 (8): 901–909.

    Article  Google Scholar 

  • Yazbeck, A. (ed.) (2009) Attacking Inequality in the Health Sector: A Synthesis of Evidence and Tools. Washington DC: World Bank.

    Book  Google Scholar 

  • Amnesty International. (2009) Giving Life, Risking Death: Maternal Mortality in Burkina Faso. London: Amnesty International Publications.

  • Kippenberg, J., Sahokwasama, J.B. and Amon, J.J. (2008) Detention of insolvent patients in Burundian hospitals. Health Policy & Planning 23 (1): 14–23.

    Article  Google Scholar 

  • Ridde, V. and Morestin, F. (2011) A scoping review of the literature on the abolition of user fees in heathcare services in Africa. Health Policy Plan 26 (1): 1–11.

    Article  Google Scholar 

  • The Global Campaign for the Health Millennium Development Goals. (2009) Leading by Example – Protecting the Most Vulnerable during the Economic Crisis. Oslo, Norway: Office of the Prime Minister of Norway.

  • Campbell, O.M. and Graham, W.J. (2006) Strategies for reducing maternal mortality: Getting on with what works. Lancet 368 (9543): 1284–1299.

    Article  Google Scholar 

  • Graham, H., Bell, J. and Bullough, C. (2001) Can skilled attendance at delivery reduce maternal mortality in developing countries? In: V. de Brouwere and W. Van Lerberghe (eds.) Safe Motherhood Strategies: A Review of the Evidence. Antwerp, Belgium: ITG Press, pp. 97–130.

    Google Scholar 

  • Ridde, V., Richard, F., Bicaba, A., Queuille, L. and Conombo, G. (2011) The national subsidy for deliveries and emergency obstetric care in Burkina Faso. Health Policy Plan 2 (26): ii30–ii40.

    Google Scholar 

  • Sombié, I., Yaogo, M., Ouédraogo, M., Konaté, B., Belemsaga, D. and Ouédraogo, T. (2007) Evaluation de la mise en place de la subvention des accouchements et des soins obstétricaux et néonataux d’urgence au Burkina. Rapport préliminaire. Ouagadougou: Ministere de la Santé, GREFsAD.

  • Muller, O. et al (2008) Distribution systems of insecticide-treated bed nets for malaria control in rural Burkina Faso: Cluster-randomized controlled trial. PLoS One 3 (9): e3182.

    Article  Google Scholar 

  • Milligan, P., Nije, A. and Bennett, S. (2004) Comparison of two cluster sampling methods for health surveys in developing countries. International Journal of Epidemiology 33 (3): 476–496.

    Article  Google Scholar 

  • Filmer, D. and Pritchett, L.H. (2001) Estimating wealth effects without expenditure data – or tears: An application to educational enrollments in states of India. Demography 38 (1): 115–132.

    Google Scholar 

  • O'Donnell, O., van Doorslaer, E., Wagstaff, A. and Lindelow, M. (2008) Analyzing Health Equity using Household Survey Data – A Guide to Techniques and their Implementation. Washington DC: The International Bank for Reconstruction and Development; The World Bank.

    Google Scholar 

  • Witter, S., Arhinful, D.K., Kusi, A. and Zakariah Akoto, S. (2007) The experience of Ghana in implementing a user fee exemption policy to provide free delivery care. Reproductive Health Matters 15 (30): 61–70.

    Article  Google Scholar 

  • Haddad, S., Ridde, V., Bekele, Y. and Queuille, L. (2012) Increased subsidies for delivery costs translate into more women giving birth in health centres. Montréal, Teasdale Corti Research Team Website: UdeM/CRCHUM/HELP, http://www.vesa-tc.umontreal.ca/pdf/publications/2011_05_Brief_DeliverySubsidyBurkina_eng.pdf, accessed 13 February 2012.

  • Ministère de la santé. (2010) Annuaire statistique 2010. Ouagadougou, Burkina Faso: ministère de la santé, DGISS.

  • Gabrysch, S., Zanger, P., Seneviratne, H., Mbewe, R. and Campbell, O. (2011) Tracking progress towards safe motherhood: Meeting the benchmark yet missing the goal? An appeal for better use of health-system output indicators with evidence from Zambia and Sri Lanka. Tropical Medicine & International Health 16 (5): 627–639.

    Article  Google Scholar 

  • Gabrysch, S. and Campbell, O.M. (2009) Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 9: 34.

    Article  Google Scholar 

  • Parmar, D., De Allegri, M., Savadogo, G. and Sauerborn, R. (Submitted) Do community-based health insurance schemes fulfil the promise of equity? A study from Burkina Faso. Health Policy & Planning.

  • Shadish, W.R., Cook, T.D. and Campbell, D.T. (2002) Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Boston, MA: Houghton Mifflin.

    Google Scholar 

  • Victora, C.G., Vaughan, J.P., Barros, F.C., Silva, A.C. and Tomasi, E. (2000) Explaining trends in inequities: Evidence from Brazilian child health studies. Lancet 356 (9235): 1093–1098.

    Article  Google Scholar 

  • Ridde, V., Kouanda, S., Bado, A., Bado, N. and Haddad, S. (2012) Reducing the medical cost of deliveries in Burkina Faso is good for everyone, including the poor. PLoS ONE 7 (3): e33082.

    Article  Google Scholar 

  • Penfold, S., Harrison, E., Bell, J. and Fitzmaurice, A. (2007) Evaluation of the delivery fee exemption policy in Ghana: Population estimates of changes in delivery service utilization in two regions. Ghana Medical Journal 41 (3): 100–109.

    Google Scholar 

  • Ahmed, S. and Khan, M.M. (2011) Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh. Social Science & Medicine 72 (10): 1704–1710.

    Article  Google Scholar 

  • Deininger, K. and Mpuga, P. (2004) Economic and welfare impact of the abolition of health user fees: Evidence from Uganda. Journal of African Economies 14 (1): 55–91.

    Article  Google Scholar 

  • Yates, J., Cooper, R. and Holland, J. (2006) Social protection and health: Experiences in Uganda. Development Policy Review 24 (3): 339–356.

    Article  Google Scholar 

  • Witter, S., Armar-Klemesu, M. and Dieng, T. (2008) National fee exemption schemes for deliveries: Comparing the recent experiences of Ghana and Senegal. In: F. Richard, S. Witter and V. De Brouwere (eds.) Reducing Financial Barriers to Obstetric Care in Low-Income Countries: SHSOP Series: Studies in Health Services Organisation & Policy. Antwerp: ITG Press, pp. 167–198.

    Google Scholar 

  • Asante, F.A., Chikwama, C., Daniels, A. and Armar-Klemesu, M. (2007) Evaluating the economic outcomes of the policy of fee exemption for maternal delivery care in Ghana. Ghana Medical Journal 41 (3): 110–117.

    Google Scholar 

  • INSD. (2009) Annuaire statistique, Édition 2008, Ouagadougou, Burkina Faso: INSD.

  • Kruk, M.E., Mbaruku, G., Rockers, P.C. and Galea, S. (2008) User fee exemptions are not enough: Out-of-pocket payments for ‘free’ delivery services in rural Tanzania. Tropical Medicine & International Health 13 (12): 1442–1451.

    Article  Google Scholar 

  • Witter, S. (2009) Service- and population-based exemptions: Are these the way forward for equity and efficiency in health financing in low-income countries? Advances in Health Economics & Health Services Research 21: 251–288.

    Google Scholar 

  • Richard, F., Witter, S. and de Brouwere, V. (eds.) (2008) Reducing Financial Barriers to Obstetric Care in Low-Income Countries. Antwerp, Belgium: ITG Press.

    Google Scholar 

  • Sarpong, N. et al (2010) National health insurance coverage and socio-economic status in a rural district of Ghana. Tropical Medicine & International Health 15 (2): 191–197.

    Article  Google Scholar 

  • USAID. (2005) Perspectives on Unmet Need for Family Planning in West Africa. Burkina Faso: USAID.

  • Ahmed, S., Li, Q., Liu, L. and Tsui, A.O. (2012) Maternal deaths averted by contraceptive use: An analysis of 172 countries. The Lancet 380 (9837): 111–125.

    Article  Google Scholar 

  • Cleland, J., Conde-Agudelo, A., Peterson, H., Ross, J. and Tsui, A. (2012) Contraception and health. The Lancet 380 (9837): 149–156.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Manuela De Allegri.

Additional information

Valéry Ridde and Manuela De Allegri contributed equally to this manuscript.

This first population-based impact assessment of a financing policy introduced in Burkina Faso in 2007 indicates that the policy increases use of facility-based delivery services for women. Based on studies elsewhere, this a strategy known to reduce maternal mortality.

Rights and permissions

Reprints and permissions

About this article

Cite this article

De Allegri, M., Ridde, V., Louis, V. et al. The impact of targeted subsidies for facility-based delivery on access to care and equity – Evidence from a population-based study in rural Burkina Faso. J Public Health Pol 33, 439–453 (2012). https://doi.org/10.1057/jphp.2012.27

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/jphp.2012.27

Keywords

Navigation