Feb 25, 2014 | equity of access to healthcare
Druetz, T., Ridde, V., & Haddad, S. (2014). The divergence between community case management of malaria and renewed calls for primary healthcare. Critical Public Health, (Février 2014), 1–13. doi:10.1080/09581596.2014.886761
Résumé
Thirty years after Alma-Ata, there has been an upsurge of interest in community health workers (CHWs) in low- and middle-income countries. This echoes several strategic policies recently endorsed by the World Health Organization and its global call to re-establish the primary healthcare (PHC) policy. However, we are witnessing a reframing of this approach rather than its renewal. In particular, the way CHWs are conceptualized has changed considerably. Far from serving as promoters of social change and community empowerment, today we expect them to act as front-line clinicians. This medicalization of CHWs results from a systemic erosion of health promotion’s influence over the last 20 years. Community case management of malaria perfectly illustrates this shift towards a pragmatic, medically centered, use of CHWs. Taking this example, we will discuss the pitfalls of this task-shifting strategy put forward by international health actors, and make suggestions to reattribute a mission of health promotion to CHWs, as intended by the Alma-Ata’s PHC policy.
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Feb 4, 2014 | equity of access to healthcare, health policy analysis
Queuille, L., & Ridde, V. (2013). User fees exemption: one step on the path toward universal access to healthcare. Pilot experience in Burkina Faso (DVD).
In 2008, the regional health department (RHD) of the Sahel region in Burkina Faso and the German NGO HELP, funded by the European Community Humanitarian Office (ECHO), decided to experiment with user fee exemptions for children under five years of age and pregnant and nursing women. The objectives of this initiative were to provide healthcare services to vulnerable populations and to improve the national health policy. The project established a scientific partnership with the University of Montreal (CRCHUM). This DVD presents the results of studies carried out between 2008 and 2013, including nearly 70 scientific articles, a book, book chapters, policy briefs, publications for the general public, and documentary films in French and /or English.
To obtain a copy of the DVD, please contact us.
Visit the project page for more information.
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Jan 27, 2014 | equity of access to healthcare, health policy analysis
Ridde, V., Agier, I., Jahn, A., Mueller, O., Tiendrebéogo, J., Yé, M., & De Allegri, M. (2014). The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso. The European journal of health economics : HEPAC : health economics in prevention and care, 5. doi:10.1007/s10198-013-0553-5.
Résumé
Background
User fee removal policies have been extensively evaluated in relation to their impact on access to care, but rarely, and mostly poorly, in relation to their impact on household out-of-pocket (OOP) spending. This paucity of evidence is surprising given that reduction in household economic burden is an explicit aim for such policies. Our study assessed the equity impact on household OOP spending for facility-based delivery of the user fee reduction policy implemented in Burkina Faso since 2007 (i.e. subsidised price set at 900 Communauté Financière Africaine francs (CFA) for all, but free for the poorest). Taking into account the challenges linked to implementing exemption policies, we aimed to test the hypothesis that the user fee reduction policy had favoured the least poor more than the poor.
Methods
We used data from six consecutive rounds (2006-2011) of a household survey conducted in the Nouna Health District. Primary outcomes are the proportion of households being fully exempted (the poorest 20 % according to the policy) and the actual level of household OOP spending on facility-based delivery. The estimation of the effects relied on a Heckman selection model. This allowed us to estimate changes in OOP spending across socio-economic strata given changes in service utilisation produced by the policy.
Findings
A total of 2,316 women reported a delivery between 2006 and 2011. Average household OOP spending decreased from 3,827 CFA in 2006 to 1,523 in 2011, without significant differences across socio-economic strata, neither in terms of households being fully exempted from payment nor in terms of the amount paid. Payment remained regressive and substantially higher than the stipulated 900 CFA.
Conclusions
The Burkinabè policy led to a significant and sustained reduction in household OOP health spending across all socio-economic groups, but failed to properly target the poorest by ensuring a progressive payment system.
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Oct 9, 2013 | equity of access to healthcare
Ly, A., Ridde, V., Kouanda, S., & Queuille, L. (2013). [Heath staff workload in a context of user fees exemption policy for health care in Burkina Faso and Niger]. Bulletin de la Societe de pathologie exotique (1990), 1–8. doi:10.1007/s13149-013-0307-8. Article in French [pdf]
Abstract
User fees exemption policy supported by NGOs in Burkina Faso and Niger resulted in a higher utilization of health services in primary health care facilities. We conducted a survey in 2 health districts in Burkina Faso and Niger in 2011. The study objective was to assess whether the higher utilization associated with the user fees exemption policy, may result in an overload for health staff at the front line in health facilities. The WHO’s recommended WISN method was used to compute a ratio of actual/required staff using a comparative study with 4 control facilities and 4 intervention sites where the user fees exemption policy was provided by local NGOs in both countries. Overall, 8 primary health facilities both in Burkina Faso and Niger were involved. In Burkina Faso, the ratio was ≥1 in all facilities both control and intervention, i.e. a sufficient staff in facilities. In Niger, 3 out of the 4 intervention facilities in Keita district were found to have a ratio ≤1, i.e. understaffed. In the 4 control facilities, the staff was sufficient with a ratio ≥1. In Burkina Faso, the actual number of staff in facilities appeared enough to face the higher utilization of health services that may follow the user fees exemption policy supported by local NGOs unlike Niger where we found that the actual number of staff was insufficient to face a possible higher utilization resulting from the same policy in intervention facilities.
Sep 19, 2013 | equity of access to healthcare, humanitarian aid
Belaid, L., Baudry, M., Queuille, L., & Ridde, V. (2013). Pharmacy system performance and integration: two essential conditions for the success of free healthcare measures in Côte d’Ivoire.
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Sep 3, 2013 | equity of access to healthcare
Samb, O. M., Belaid, L., & Ridde, V. (2013). Burkina Faso : la gratuité des soins aux dépens de la relation entre les femmes et les soignants ? Revue Humanitaire, 35, 34–43. [html]
Abstract
Les trois auteurs de cet article ont mené deux études en 2010 et 2011 dans deux régions du Burkina Faso durant six mois passés sur le terrain. S’ils constatent que la gratuité des soins permet indéniablement un meilleur accès des femmes au système de santé, ils remarquent qu’elle ne met pas fin pour autant aux discriminations dont ces dernières sont victimes. Ce faisant, ils font leur cette affirmation d’Amartya Sen : « L’indépendance économique tout comme l’émancipation sociale des femmes créent une dynamique qui remet en cause les principes gouvernant les divisions, au sein de la famille et dans l’ensemble de la société et influence tout ce qui est implicitement reconnu comme étant leurs “droits”. »
