The impact of reducing and eliminating user fees on facility-based delivery

A controlled interrupted time series in Burkina Faso

Bibliographic Data

ID11490308
AuthorsHoa Nguyen (0000-0001-7417-5725, Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, Germany), Hoa Thi Nguyen (0000-0002-4858-803X, University Hospital Heidelberg, corresponding author), David Zombré (0000-0002-7038-4738, Department of Social and Preventive Medicine, University of Montreal Public Health Research Institute – IRSPUM, Pavillon 7101 avenue du Parc, C.P 6128 Succursale C, local 3224, Montréal, Québec, Canada), Valery Ridde (0000-0001-9299-8266, Department of Social and Preventive Medicine, University of Montreal Public Health Research Institute – IRSPUM, Pavillon 7101 avenue du Parc, C.P 6128 Succursale C, local 3224, Montréal, Québec, Canada), Manuela De Allegri (0000-0002-8677-1337, Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, Germany)
Year2018
Volume33
Issue8
Pages948-956
Publication date2018-10-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czy077
PMID30256941
OpenAlexW2894234659
LanguageEN
Citations received18
References cited35

User fee reduction and removal policies have been the object of extensive research, but little rigorous evidence exists on their sustained effects in relation to use of delivery care services, and no evidence exists on the effects of partial reduction compared with full removal of user fees. We aimed to fill these knowledge gaps by assessing sustained effects of both partial reduction and complete removal of user fees on utilization of facility-based delivery. Our study took place in four districts in the Sahel region of Burkina Faso, where the national user fee reduction policy (SONU) launched in 2007 (lowering fees at point of use by 80%) co-existed with a user fee removal pilot launched in 2008. We used Health Management Information System data to construct a controlled interrupted time-series analysis and examine both immediate and sustained effects of SONU and the pilot from January 2004 to December 2014. We found that both SONU and the pilot led to a sustained increase in the use of facility-based delivery. SONU produced an accumulative increase of 31.4% (P < 0.01) over 8 years in the four study districts. The pilot further enhanced utilization and produced an additional increase of 23.2% (P < 0.001) over 6 years. These increasing trends did not continue to reach full coverage, i.e. ensuring that all women had a facility-based delivery. Instead, they stabilized 3 years and 4 years after the onset of SONU and the pilot, respectively. Our study provides further evidence that user fee reduction and removal policies are effective in increasing service use in the long term. However, they alone are not sufficient to achieve full coverage. This calls for the need to implement additional measures, targeting for instance geographical barriers and knowledge gaps, to achieve the target of all women delivering in the presence of a skilled attendant.

Business · Delivery system · Interrupted time series · Interrupted Time Series Analysis · Operations management · Political science · Psychological intervention · Statistics · User fee · Engineering · Global Health Care Issues · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing

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