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

  • Journal of Public Health Policy, Volume 33, No. 4, Year 2012

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Study Justification:
– The study aimed to assess the impact of a financing policy introduced in Burkina Faso in 2007 on women’s access to delivery services.
– The policy offered an 80% subsidy for facility-based delivery.
– This study was the first population-based impact assessment of the policy.
– The study collected information on delivery in five repeated cross-sectional surveys from 2006 to 2010.
Study Highlights:
– Over the 5 years of the study, the proportion of facility-based deliveries increased from 49% to 84%.
– The utilization gap across socio-economic quintiles remained unchanged, indicating that the policy did not improve equity in access to care.
– The amount received for all services associated with births decreased by 67%.
– Women continued to pay, on average, 1423 CFA (about €1655), which was 500 CFA more than the set tariff of 900 CFA.
Recommendations for Lay Reader and Policy Maker:
– The policy of offering an 80% subsidy for facility-based delivery has been effective in increasing the use of these services.
– However, the policy has not improved equity in access to care, as the utilization gap across socio-economic quintiles remained unchanged.
– There is a need to assess the impact of the policy on maternal and neonatal mortality to determine its potential to reduce maternal mortality substantially.
– Further research and interventions are needed to address the remaining barriers to accessing facility-based delivery services, particularly for women from lower socio-economic backgrounds.
Key Role Players:
– Ministry of Health: Responsible for implementing and monitoring the policy.
– Health Facilities: Provide the necessary infrastructure and services for facility-based deliveries.
– Community Health Workers: Play a crucial role in educating and mobilizing women to utilize facility-based delivery services.
– Non-Governmental Organizations: Can provide support and resources to improve access to care and address barriers.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers.
– Infrastructure improvements in health facilities.
– Outreach and education programs targeting women and communities.
– Monitoring and evaluation of the policy’s impact.
– Research to assess the health outcomes and cost-effectiveness of the policy.

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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 (P0.001). The utilization gap across socio-economic quintiles, however, remained unchanged. The amount received for all services associated with births decreased by 67 per cent (P0.001), but women continued to pay on average 1423 CFA ([euro]1655 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. © 2012 Macmillan Publishers Ltd.

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The innovation described in the study is the introduction of targeted subsidies for facility-based delivery in Burkina Faso. This policy offers an 80% subsidy for women who choose to deliver their babies in healthcare facilities. The study found that this policy led to a significant increase in the proportion of facility-based deliveries, from 49% to 84% over a 5-year period. However, the utilization gap across socio-economic quintiles remained unchanged, indicating that the policy did not improve equity in access to maternal health services. Additionally, the amount received for all services associated with births decreased by 67%, but women still had to pay an average of 1423 CFA, which was higher than the set tariff of 900 CFA. The study concludes that while the policy effectively increased the use of facility-based delivery services, its impact on reducing maternal mortality has not been assessed.
AI Innovations Description
The recommendation from the study is to implement targeted subsidies for facility-based delivery in order to improve access to maternal health. The study conducted in rural Burkina Faso found that offering an 80% subsidy for facility-based delivery resulted in a significant increase in the proportion of facility-based deliveries, from 49% to 84% over a 5-year period. However, the study also found that the utilization gap across socio-economic quintiles remained unchanged, indicating that further efforts may be needed to ensure equitable access to maternal health services. Additionally, the study found that the amount received for services associated with births decreased by 67%, but women still had to pay an average of 1423 CFA, which is higher than the set tariff of 900 CFA. Therefore, it is recommended to assess the potential impact of the policy on reducing maternal mortality and to address any remaining financial barriers to accessing facility-based delivery services.
AI Innovations Methodology
Based on the provided description, the innovation of targeted subsidies for facility-based delivery has been implemented in Burkina Faso to improve access to maternal health. This policy offers an 80% subsidy for facility-based delivery, aiming to increase the utilization of these services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology can be developed as follows:

1. Define the research question: The research question could be “What is the impact of targeted subsidies for facility-based delivery on access to maternal health in rural Burkina Faso?”

2. Study design: Conduct a population-based study using a repeated cross-sectional survey approach. This involves collecting information on delivery from a representative sample of households in rural Nouna Health District over a specific period, as mentioned in the description (2006 to 2010).

3. Data collection: Collect data on the utilization of facility-based delivery services, including the proportion of facility-based deliveries, the amount received for services associated with births, and the amount paid by women.

4. Data analysis: Analyze the collected data to assess the impact of targeted subsidies on access to maternal health. This can involve comparing the proportion of facility-based deliveries before and after the introduction of the policy, using statistical tests to determine the significance of any changes observed.

5. Assess equity: Evaluate the impact of the policy on equity by analyzing the utilization gap across socio-economic quintiles. This will help determine if the policy has effectively reduced disparities in access to maternal health services.

6. Assess cost-effectiveness: Calculate the cost-effectiveness of the policy by comparing the amount received for services associated with births and the amount paid by women. This will provide insights into the financial burden on women and the overall effectiveness of the subsidy.

7. Assess health outcomes: While not mentioned in the provided description, it is important to assess health outcome measures such as neonatal and maternal mortality to determine the potential impact of the policy on reducing maternal mortality.

8. Interpret and report findings: Analyze the results of the study and draw conclusions about the impact of targeted subsidies on access to maternal health. Report the findings, including any limitations of the study, to inform policymakers and stakeholders.

By following this methodology, researchers can simulate the impact of targeted subsidies for facility-based delivery on improving access to maternal health in rural Burkina Faso and provide evidence-based recommendations for further improvements.

Statistics:
Citations: 50
Authors: 8
Identifiers:
DOI: 10.1057/jphp.2012.27
ISSN: 01975897
Research Areas:
Health System and Policy, Maternal and Child Health, Quality of Care
Study Countries:
Burkina Faso
Study Design:
Cross Sectional Study
Participants Gender:
Female
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