This article was published in february 2016 in the Elsevier publication Social Science & Medicine. Isabelle Agier and Valéry Ridde designed the study. This study was funded by the Canadian Institutes of Health Research (CIHR) through the project “Community research studies and interventions for health equity in Burkina Faso”.
Isabelle Agier designed the collection tools with support from Valéry Ridde and Kadidiatou Kadio and performed the statistical analysis; Kadidiatou Kadio, Antarou Ly and Seni Kouanda were in charge of data collection. Isabelle Agier and Valéry Ridde wrote the original draft. All authors reviewed the manuscript, read and approved the final version.
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In West Africa, health system funding rarely involves cross-subsidization among population segments. In some countries, a few community-based or professional health insurance programs are present, but coverage is very low. The financial principles underlying universal health coverage (UHC) sustainability and solidarity are threefold: 1)anticipation of potential health risks; 2) risk sharing and; 3) socio-economic status solidarity. In Burkina Faso, where decision-makers are favorable to national health insurance, we measured endorsement of these principles and discerned which management configurations would achieve the greatest adherence.
We used a sequential exploratory design. In a qualitative step (9 interviews, 12 focus groups), we adapted an instrument proposed by Goudge et al. (2012) to the local context and addressed desirability bias. Then, in a quantitative step (1255 respondents from the general population), we measured endorsement. Thematic analysis (qualitative) and logistic regressions (quantitative) were used.
High levels of endorsement were found for each principle. Actual practices showed that anticipation and risk sharing were not only intentions. Preferences were given to solidarity between socio-economic status (SES) levels and progressivity. Although respondents seemed to prefer the national level for implementation, their current solidarity practices were mainly focused on close family. Thus, contribution levels should be set so that the entire family benefits from healthcare.
Some critical conditions must be met to make UHC financial principles a reality through health insurance in Burkina Faso: trust, fair and mandatory contributions, and education.