Evaluation of a knowledge transfer strategy from a user fee exemption program for vulnerable populations in Burkina Faso

As part of this special issue contributing to the development of knowledge on vulnerability and health in Africa, this article analyzes one example of a knowledge transfer strategy aimed at improving the use of research results that could help reduce the vulnerability of certain populations. In this case, since September 2008, the Non-Governmental Organization (NGO) Hilfe zur Selbsthilfe e.V. (HELP) has conducted a trial of subsidizing 100% of the costs of health care for vulnerable populations in two health districts of Burkina Faso. A scientific partnership was created to produce evidence on the intervention, and a knowledge transfer strategy was developed to promote the use of that evidence by stakeholders (decision-makers, people working in the health system, funding partners, etc.). The results showed that considerable efforts were invested in knowledge transfer activities and that these led to all types of use (instrumental, conceptual, persuasive). However, considerable variation in use was observed from one setting to another. This article presents some lessons to be drawn from this experience.

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Scaling-Up Performance-Based Financing in Burkina Faso: From PBF to User Fees Exemption Strategic Purchasing

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.209 ◽

2020 ◽

Author(s):

Mathieu Seppey ◽

Valéry Ridde ◽

Paul-André Somé

Keyword(s):

Burkina Faso ◽

Scale Up ◽

Scaling Up ◽

Healthcare Services ◽

Decision Makers ◽

Strategic Purchasing ◽

Performance Based Financing ◽

Fee Exemption ◽

Exemption Policy ◽

User Fee

Background: Numerous countries have undertaken performance-based financing (PBF) reforms to improve quality and quantity of healthcare services. However, only few reforms have successfully managed to achieve the different scale-up phases. In Burkina Faso, a pilot project was implemented, but was put on hold before being scaled. During the writing of this article, discussions to scale-up were still ongoing on a national strategic purchasing strategy within a government led user fee exemption policy. Methods: This study’s objective is to identify facilitators and barriers to scaling-up for that pilot, based on the World Health Organization’s (WHO’s) theoretical framework. Interviews were conducted in three health centres and in Ouagadougou to discuss the scale-up with different actors. The software QDA Miner© was used to help in the framework analysis. Results: The low involvement of some key stakeholders (mainly decision-makers) and the unstable context hindered ownership of the project, thus its priority on the political agenda. PBF reform therefore lost its momentum to the benefit of a user fee exemption policy. This latter program was seen to be more beneficial since it addressed access to healthcare services, in comparison to service quality, which was the PBF’s relative advantage. A scale-up of some PBF elements (eg, strategic purchasing tools) is however still in discussion in 2019, but would be integrated within the user fee exemption program. Increased costs during the PBF’s implementation gave the impression that the project was too costly and not scalable. The involvement of an important funding agency (World Bank, WB) also fed the impression of high costs, which demotivated the actors, especially decision-makers. Conclusion: Contextual factors remain central to the implementation of PBF, while their evaluation and mitigation have remained unclear. The participation of key actors in scaling-up operations and the use of social science as tools to better understand the context is therefore primordial.

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Research use at the Ministry of Health in Burkina Faso: the decision-makers’ perspective

Implementation Science Communications ◽

10.1186/s43058-021-00126-9 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Christian Dagenais

Keyword(s):

Decision Making ◽

Knowledge Transfer ◽

Burkina Faso ◽

Informed Decision ◽

Communication Strategy ◽

Decision Makers ◽

Research Use ◽

Informed Decision Making ◽

Ministry Of Health ◽

Policy Makers

Abstract Background Despite the increased emphasis placed on the use of evidence for policy development, relatively few initiatives have been developed to support evidence-informed decision-making, especially in West Africa. Moreover, studies examining the conditions under which policy-makers use research-based evidence are still scarce, but they show that their attitudes and opinions about research are one of the main determinants of such use. In February 2017, Burkina Faso’s Minister of Health planned to create a unit to promote evidence-informed decision-making within the ministry. Before the unit was set up, documenting the attitudes towards research at the highest levels of his Ministry appeared profitable to the unit’s planning. Method Individual interviews were conducted by the author with 14 actors positioned to consider evidence during decision-making from the Burkina Faso’s Minister of health cabinet. An interview grid was used to explore several themes such as attitudes towards research, obstacles and facilitators to research use, example of research use in decision-making and finally, ways to increase decision-makers’ participation in knowledge transfer activities. Interviews were partially transcribed and analysed by the author. Results The results show a mixed attitude towards research and relatively little indication of research use reported by respondents. Important obstacles were identified: evidence inaccessibility, lack of implementation guidelines, absence of clear communication strategy and studies’ lack of relevance for decision-making. Many suggestions were proposed such as raising awareness, improving access and research communication and prioritizing interactions with researchers. Respondents agree with the low participation of decision-makers in knowledge transfer activities: more leadership from the senior officials was suggested and greater awareness of the importance of their presence. Conclusions The conclusion presents avenues for reflection and action to increase the potential impact of the knowledge transfer unit planned within the Ministry of Health of Burkina Faso. This innovative initiative will be impactful if the obstacles identified in this study and policy-makers’ preferences and needs are taken into account during its development and implementation.

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Immediate and sustained effects of user fee exemption on healthcare utilization among children under five in Burkina Faso: A controlled interrupted time-series analysis

Social Science & Medicine ◽

10.1016/j.socscimed.2017.02.027 ◽

2017 ◽

Vol 179 ◽

pp. 27-35 ◽

Cited By ~ 20

Author(s):

David Zombré ◽

Manuela De Allegri ◽

Valéry Ridde

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Burkina Faso ◽

Healthcare Utilization ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Under Five ◽

Sustained Effects ◽

Fee Exemption ◽

User Fee

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Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17186543 ◽

2020 ◽

Vol 17 (18) ◽

pp. 6543 ◽

Cited By ~ 1

Author(s):

Yvonne Beaugé ◽

Manuela De Allegri ◽

Samiratou Ouédraogo ◽

Emmanuel Bonnet ◽

Naasegnibe Kuunibe ◽

...

Keyword(s):

Panel Data ◽

Burkina Faso ◽

Healthcare Access ◽

Panel Study ◽

Healthcare Services ◽

Free Access ◽

Service Utilisation ◽

Data Set ◽

Fee Exemption ◽

User Fee

Background: A component of the performance-based financing intervention implemented in Burkina Faso was to provide free access to healthcare via the distribution of user fee exemption cards to previously identified ultra-poor. This study examines the factors that led to the receipt of user fee exemption cards, and the effect of card possession on the utilisation of healthcare services. Methods: A panel data set of 1652 randomly selected ultra-poor individuals was used. Logistic regression was applied on the end line data to identify factors associated with the receipt of user fee exemption cards. Random-effects modelling was applied to the panel data to determine the effect of the card possession on healthcare service utilisation among those who reported an illness six months before the surveys. Results: Out of the ultra-poor surveyed in 2017, 75.51% received exemption cards. Basic literacy (p = 0.03), living within 5 km from a healthcare centre (p = 0.02) and being resident in Diébougou or Gourcy (p = 0.00) were positively associated with card possession. Card possession did not increase health service utilisation (β = −0.07; 95% CI = −0.45; 0.32; p = 0.73). Conclusion: A better intervention design and implementation is required. Complementing demand-side strategies could guide the ultra-poor in overcoming all barriers to healthcare access.

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User fee exemption and maternal health care utilisation at mission health facilities in Malawi: An application of disequilibrium theory of demand and supply

Health Economics ◽

10.1002/hec.3856 ◽

2019 ◽

Vol 28 (4) ◽

pp. 461-474 ◽

Cited By ~ 1

Author(s):

Gerald Manthalu

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Care Utilisation ◽

Maternal Health Care ◽

Health Facilities ◽

Demand And Supply ◽

Care Utilisation ◽

Fee Exemption ◽

User Fee ◽

Disequilibrium Theory

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Women’s decision-making power in a context of free reproductive healthcare and family planning in rural Burkina Faso

BMC Women s Health ◽

10.1186/s12905-021-01411-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Camille Beaujoin ◽

Alice Bila ◽

Frank Bicaba ◽

Véronique Plouffe ◽

Abel Bicaba ◽

...

Keyword(s):

Decision Making ◽

Family Planning ◽

Social Norms ◽

Burkina Faso ◽

Care Delivery ◽

Childbearing Age ◽

Fee Exemption ◽

Exemption Policy ◽

User Fee ◽

Reproductive Healthcare

Abstract Background In 2016, the national user fee exemption policy for women and children under five was introduced in Burkina Faso. It covers most reproductive healthcare services for women including prenatal care, delivery, and postnatal care. In subsequent years, the policy was gradually extended to include family planning. While studies have shown that user fee abolition policies increase visits to health centers and improve access to reproductive healthcare and family planning, there are also indications that other barriers remain, notably women’s lack of decision-making power. The objective of the study is to investigate women’s decision-making power regarding access to reproductive health and family planning in a context of free healthcare in rural Burkina Faso. Methods A descriptive qualitative study was carried out in rural areas of the Cascades and Center-West regions. Qualitative data were collected using individual semi-structured interviews (n = 20 participants) and focus groups (n = 15 participants) with Burkinabe women of childbearing age, their husbands, and key informants in the community. Data was analyzed using thematic analysis. Results A conceptual framework describing women’s participation in the decision-making process was built from the analysis. Results show that the user fee exemption policy contributes to improving access to reproductive care and family planning by facilitating the negotiation processes between women and their families within households. However, social norms and gender inequalities still limit women’s decision-making power. Conclusion In light of these results, courses of action that go beyond the user fee exemption policy should be considered to improve women’s decision-making power in matters of health, particularly with regard to family planning. Interventions that involve men and community members may be necessary to challenge the social norms, which act as determinants of women’s health and empowerment.

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