Effectiveness of the Gratuité user fee exemption policy on utilization and outcomes of maternal, newborn and child health services in conflict-affected districts of Burkina Faso from 2013 to 2018: a pre-post analysis

Evidence on effectiveness of user fee exemption policies targeting maternal, newborn, and child health (MNCH) services is limited for conflict-affected settings. In Burkina Faso, a country that has had its fair share of conflicts, user fee exemption policies have been piloted since 2008 and implemen...

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Bibliographic Details
Published in:Conflict and health 2023-07, Vol.17 (1), p.33-33, Article 33
Main Authors: Offosse, Marie-Jeanne, Avoka, Cephas, Yameogo, Pierre, Manli, Astrid Raissa, Goumbri, Aude, Eboreime, Ejemai, Boxshall, Matt, Banke-Thomas, Aduragbemi
Format: Article
Language:English
Subjects:
Analysis
Burkina Faso
Children
Children & youth
Childrens health
Conflict
Costs (Law)
Effectiveness
Health aspects
Health care industry
Health facilities
Health policy
Health services
Infants (Newborn)
Malaria
Medical policy
National health insurance
NGOs
Nongovernmental organizations
Policies
Population
Prenatal care
Public health
Regions
Statistical analysis
Trends
Universal health coverage
User fee
User fees
Utilization
Vector-borne diseases
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Summary:Evidence on effectiveness of user fee exemption policies targeting maternal, newborn, and child health (MNCH) services is limited for conflict-affected settings. In Burkina Faso, a country that has had its fair share of conflicts, user fee exemption policies have been piloted since 2008 and implemented along with a national government-led user fee reduction policy ('SONU': Soins Obstétricaux et Néonataux d'Urgence). In 2016, the government transitioned the entire country to a user fee exemption policy known as Gratuité. Our study objective was to assess the effect of the policy on the utilization and outcomes of MNCH services in conflict-affected districts of Burkina Faso. We conducted a quasi-experimental study comparing four conflict-affected districts which had the user fee exemption pilot along with SONU before transitioning to Gratuité (comparator) with four other districts with similar characteristics, which had only SONU before transitioning (intervention). A difference-in-difference approach was initiated using data from 42 months before and 30 months after implementation. Specifically, we compared utilization rates for MNCH services, including antenatal care (ANC), facility delivery, postnatal care (PNC) and consultation for malaria. We reported the coefficient, including a 95% confidence interval (CI), p value, and the parallel trends test. Gratuité led to significant increases in rates of 6th day PNC visits for women (Coeff 0.15; 95% CI 0.01-0.29), new consultations in children 
ISSN:1752-1505
1752-1505
DOI:10.1186/s13031-023-00530-z