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Guissou RM, Amaratunga C, de Haan F, Tou F, Cheah PY, Yerbanga RS, Moors EHM, Dhorda M, Tindana P, Boon WPC, Dondorp AM, Ouédraogo JB. The impact of anti-malarial markets on artemisinin resistance: perspectives from Burkina Faso. Malar J 2023; 22:269. [PMID: 37705004 PMCID: PMC10498571 DOI: 10.1186/s12936-023-04705-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Widespread artemisinin resistance in Africa could be catastrophic when drawing parallels with the failure of chloroquine in the 1970s and 1980s. This article explores the role of anti-malarial market characteristics in the emergence and spread of arteminisin resistance in African countries, drawing on perspectives from Burkina Faso. METHODS Data were collected through in-depth interviews and focus group discussions. A representative sample of national policy makers, regulators, public and private sector wholesalers, retailers, clinicians, nurses, and community members were purposively sampled. Additional information was also sought via review of policy publications and grey literature on anti-malarial policies and deployment practices in Burkina Faso. RESULTS Thirty seven in-depth interviews and 6 focus group discussions were conducted. The study reveals that the current operational mode of anti-malarial drug markets in Burkina Faso promotes arteminisin resistance emergence and spread. The factors are mainly related to the artemisinin-based combination therapy (ACT) supply chain, to ACT quality, ACT prescription monitoring and to ACT access and misuse by patients. CONCLUSION Study findings highlight the urgent requirement to reform current characteristics of the anti-malarial drug market in order to delay the emergence and spread of artemisinin resistance in Burkina Faso. Four recommendations for public policy emerged during data analysis: (1) Address the suboptimal prescription of anti-malarial drugs, (2) Apply laws that prohibit the sale of anti-malarials without prescription, (3) Restrict the availability of street drugs, (4) Sensitize the population on the value of compliance regarding correct acquisition and intake of anti-malarials. Funding systems for anti-malarial drugs in terms of availability and accessibility must also be stabilized.
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Affiliation(s)
- Rosemonde M Guissou
- Institut de Recherche en Sciences de la Sante, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso.
| | - Chanaki Amaratunga
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Freek de Haan
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Fatoumata Tou
- Institut des Sciences et Techniques, Bobo-Dioulasso, Burkina Faso
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - R Serge Yerbanga
- Institut de Recherche en Sciences de la Sante, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
- Institut des Sciences et Techniques, Bobo-Dioulasso, Burkina Faso
| | - Ellen H M Moors
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Mehul Dhorda
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paulina Tindana
- School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Wouter P C Boon
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Debe S, Ilboudo PG, Kabore L, Zoungrana N, Gansane A, Ridde V, De Brouwere V, Samandoulougou FK. Effects of the free healthcare policy on health services' usage by children under 5 years in Burkina Faso: a controlled interrupted time-series analysis. BMJ Open 2022; 12:e058077. [PMID: 36410840 PMCID: PMC9680150 DOI: 10.1136/bmjopen-2021-058077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to analyse, at national level, the effects of the free healthcare policy for children on the use of health services by children under five in Burkina Faso. We hypothesised that this policy has led to an immediate and sustained increase in the use of health services for these children in the country. SETTING We conducted a controlled interrupted time series. Monthly data at district level, spanning from January 2013 to December 2018 and corresponding to 72 monthly data points (39 before and 33 after), were extracted from the Burkina Faso National Health Information System. The analysed dataset included data from all the 70 health districts of the country. PARTICIPANTS The study consisted of aggregated data from children under five as the target for the policy with children aged between 5 and 14 years old as control group. INTERVENTION The intervention was the introduction of the free healthcare policy for women and children under 5 years from April 2016. OUTCOME The primary outcome was the monthly mean rate of health services visits by children. RESULTS Among the children under five, the rate of visits increased of 57% (incidence rate ratio (IRR)=1.57; 95% CI 1.2 to 2.0) in the month immediately following the launching of the free healthcare policy. An increase in the rate of health facility visits of 1% (IRR=1.01; 95% CI 1.0 to 1.1) per month was also noted during postintervention. Compared with the control group, we observed an increase in the rate of visits of 2.5% (IRR=1.025; 95% CI 1.023 to 1.026) per month. CONCLUSION Findings suggest that the free healthcare policy increased the use of health facilities for care in Burkina Faso immediately after the implementation of the policy with a small increase in the rate overtime. Strategies to maintain the policy effect over time are necessary.
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Affiliation(s)
- Siaka Debe
- Recherche Clinique, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Patrick G Ilboudo
- Nutrition and Food System, African Population and Health Research Center, Nairobi, Kenya
| | - Lassane Kabore
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Noelie Zoungrana
- Service d'information et d'épidémiologie, Hôpital de Tengandogo, Ouagadougou, Burkina Faso
| | - Adama Gansane
- Recherche Clinique, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Valéry Ridde
- IRD, Inserm, Ceped, Université Sorbonne Paris Cité, Paris, France
| | | | - Fati Kirakoya Samandoulougou
- Centre de Recherche en Epidemiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Bruxelles, Belgique
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Sia D, Dondbzanga BDG, Carabali M, Bonnet E, Enok Bonong PR, Ridde V. Effect of a free healthcare policy on health services utilisation for non-malarial febrile illness by children under five years in Burkina Faso: an interrupted time series analysis. Trop Med Int Health 2020; 25:1226-1234. [PMID: 32686252 DOI: 10.1111/tmi.13468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effect of a free healthcare policy for children under five years old implemented in Burkina Faso since April 2016, on the use of health care of non-malarial febrile illnesses (NMFI). METHODS To assess the immediate and long-term effect of the free healthcare policy in place, we conducted an interrupted time series analysis of routinely collected data on febrile illnesses from three urban primary health centres of Ouagadougou between 1 January 2015 and 31 December 2016. RESULTS Of the 39 046 febrile cases reported in the study period, 17 017 NMFI were included in the study. Compared to the period before the intervention, we observed an immediate, non-statistically significant increase of 7% in the number of NMFI (IRR = 1.07; 95% CI = 0.75, 1.51). Compared to the trend that would have been expected in absence of the intervention, the results showed a small but sustained increase of 6% in the trend of monthly number of NMFI during the intervention period (IRR = 1.06; 95%CI = 1.01, 1.12). CONCLUSION Our study highlighted an increase in the uptake of healthcare services, specifically for NMFI by children under five years of age, after the implementation of a free care policy. This analysis contributes to informing decision makers on the need to strengthen the capacities of healthcare centres and to anticipate the challenges of the sustainability of this policy.
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Affiliation(s)
- D Sia
- University of Québec in Outaouais, Saint-Jérôme, QC, Canada
| | | | - M Carabali
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - E Bonnet
- IRD (French Institute for Research on Sustainable Development), UMI Résiliences, Bondy, France
| | - P R Enok Bonong
- Department of Médecine Préventive, University of Montréal, Montreal, Canada
| | - V Ridde
- IRD (French Institute for Research on Sustainable Development), UMI Résiliences, Bondy, France
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Wu S, Roychowdhury I, Khan M. Evaluations of training programs to improve human resource capacity for HIV, malaria, and TB control: a systematic scoping review of methods applied and outcomes assessed. Trop Med Health 2017; 45:16. [PMID: 28680324 PMCID: PMC5493875 DOI: 10.1186/s41182-017-0056-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/16/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Owing to the global health workforce crisis, more funding has been invested in strengthening human resources for health, particularly for HIV, tuberculosis, and malaria control; however, little is known about how these investments in training are evaluated. This paper examines how frequently HIV, malaria, and TB healthcare provider training programs have been scientifically evaluated, synthesizes information on the methods and outcome indicators used, and identifies evidence gaps for future evaluations to address. METHODS We conducted a systematic scoping review of publications evaluating postgraduate training programs, including in-service training programs, for HIV, tuberculosis, and malaria healthcare providers between 2000 and 2016. Using broad inclusion criteria, we searched three electronic databases and additional gray literature sources. After independent screening by two authors, data about the year, location, methodology, and outcomes assessed was extracted from eligible training program evaluation studies. Training outcomes evaluated were categorized into four levels (reaction, learning, behavior, and results) based on the Kirkpatrick model. FINDINGS Of 1473 unique publications identified, 87 were eligible for inclusion in the analysis. The number of published articles increased after 2006, with most (n = 57, 66%) conducted in African countries. The majority of training evaluations (n = 44, 51%) were based on HIV with fewer studies focused on malaria (n = 28, 32%) and TB (n = 23, 26%) related training. We found that quantitative survey of trainees was the most commonly used evaluation method (n = 29, 33%) and the most commonly assessed outcomes were knowledge acquisition (learning) of trainees (n = 44, 51%) and organizational impacts of the training programs (38, 44%). Behavior change and trainees' reaction to the training were evaluated less frequently and using less robust methods; costs of training were also rarely assessed. CONCLUSIONS Our study found that a limited number of robust evaluations had been conducted since 2000, even though the number of training programs has increased over this period to address the human resource shortage for HIV, malaria, and TB control. Specifically, we identified a lack evaluation studies on TB- and malaria-related healthcare provider training and very few studies assessing behavior change of trainees or costs of training. Developing frameworks and standardized evaluation methods may facilitate strengthening of the evidence base to inform policies on and investments in training programs.
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Affiliation(s)
- Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Imara Roychowdhury
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Mishal Khan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore.,Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
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Zombré D, De Allegri M, Ridde V. Immediate and sustained effects of user fee exemption on healthcare utilization among children under five in Burkina Faso: A controlled interrupted time-series analysis. Soc Sci Med 2017; 179:27-35. [PMID: 28242542 DOI: 10.1016/j.socscimed.2017.02.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about the long-term effects of user fee exemption policies on health care use in developing countries. We examined the association between user fee exemption and health care use among children under five in Burkina Faso. We also examined how factors related to characteristics of health facilities and their environment moderate this association. METHOD We used a multilevel controlled interrupted time-series design to examine the strength of effect and long term effects of user fee exemption policy on the rate of health service utilization in children under five between January 2004 and December 2014. RESULTS The initiation of the intervention more than doubled the utilization rate with an immediate 132.596% increase in intervention facilities (IRR: 2.326; 95% CI: 1.980 to 2.672). The effect of the intervention was 32.766% higher in facilities with higher workforce density (IRR: 1.328; 95% CI (1.209-1.446)) and during the rainy season (IRR:1.2001; 95% CI: 1.0953-1.3149), but not significant in facilities with higher dispersed populations (IRR: 1.075; 95% CI: (0.942-1.207)). Although the intervention effect was substantially significant immediately following its inception, the pace of growth, while positive over a first phase, decelerated to stabilize itself three years and 7 months later before starting to decrease slowly towards the end of the study period. CONCLUSION This study provides additional evidence to support user fee exemption policies complemented by improvements in health care quality. Future work should include an assessment of the impact of user fee exemption on infant morbidity and mortality and better discuss factors that could explain the slowdown in this upward trend of utilization rates three and a half years after the intervention onset.
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Affiliation(s)
- David Zombré
- University of Montreal Public Health Research Institute - IRSPUM, Canada; School of Public Health, Montreal, Québec, Canada.
| | - Manuela De Allegri
- Institute of Public Health, Medical Faculty, Heidelberg University, Germany
| | - Valéry Ridde
- University of Montreal Public Health Research Institute - IRSPUM, Canada; School of Public Health, Montreal, Québec, Canada
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Abdou Illou MM, Haddad S, Agier I, Ridde V. The elimination of healthcare user fees for children under five substantially alleviates the burden on household expenses in Burkina Faso. BMC Health Serv Res 2015; 15:313. [PMID: 26253339 PMCID: PMC4529705 DOI: 10.1186/s12913-015-0957-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/14/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Since September 2008, an intervention has made it possible to provide free care to children under five in public health facilities in two districts of Burkina Faso. This study evaluated the intervention's impact on household expenses incurred for services (consultations and medications) to the children targeted. METHODS The study is based on a survey of a representative panel of 1,260 households encountered in two waves, one month before and 12 months after the introduction of the intervention. The questions explored the illness episodes of all children under five in the 30 days before each wave. The analysis of health expenses incurred during an illness episode distinguished between total expenses and those incurred in public health facilities (charges for services and medications). Analyses based on multilevel simultaneous equation models were used to estimate the probability of spending and the amount spent, in a context where a large number of observations returned a count of zero. RESULTS The burden on household expenses was greatly alleviated under the intervention. Average expenditure dropped from US$11 per episode of care to less than US$2 after the intervention was implemented. The risk of incurring an expense at a public health facility was reduced by two-thirds. The facility users' savings were primarily related to medication purchases. In rural areas, where barriers to access health services are more acute, both poor and non-poor families benefited from the intervention. The probability of spending on medications dropped dramatically for both the poor and the non-poor under the exemption (-75% vs.-77%), and the reduction in expenses for medications generated by the intervention was comparable for both groups in relative values (-86% vs.-89%). CONCLUSION User fees abolition at the point of service substantially alleviated the burden on household expenses. The intervention benefited both poor and non-poor families and provided financial protection.
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Affiliation(s)
- Mahaman Mourtala Abdou Illou
- Cellule d'Analyse et de Prospective en Développement (CAPED), Cabinet du Premier Ministre, République du Niger, 28, Avenue du Mounio, BP 13.568, Niamey, Niger.
| | - Slim Haddad
- Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Québec, Canada.
- Centre de recherche du CHU de Québec, 1050 chemin de Ste-Foy, Québec, QC, G1S-4L8, Canada.
| | - Isabelle Agier
- University of Montreal Hospital Research Centre (CRCHUM), Saint-Antoine Tower, 850 Saint-Denis St., Montreal, QC, H2X 0A9, Canada.
| | - Valéry Ridde
- University of Montreal Hospital Research Centre (CRCHUM), Saint-Antoine Tower, 850 Saint-Denis St., Montreal, QC, H2X 0A9, Canada.
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Johri M, Ridde V, Heinmüller R, Haddad S. Estimation of maternal and child mortality one year after user-fee elimination: an impact evaluation and modelling study in Burkina Faso. Bull World Health Organ 2014; 92:706-15. [PMID: 25378724 PMCID: PMC4208477 DOI: 10.2471/blt.13.130609] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 03/04/2014] [Accepted: 03/17/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate the impact on maternal and child mortality after eliminating user fees for pregnant women and for children less than five years of age in Burkina Faso. METHODS Two health districts in the Sahel region eliminated user fees for facility deliveries and curative consultations for children in September 2008. To compare health-care coverage before and after this change, we used interrupted time series, propensity scores and three independent data sources. Coverage changes were assessed for four variables: women giving birth at a health facility, and children aged 1 to 59 months receiving oral rehydration salts for diarrhoea, antibiotics for pneumonia and artemesinin for malaria. We modelled the mortality impact of coverage changes in the Lives Saved Tool using several scenarios. FINDINGS Coverage increased for all variables, however, the increase was not statistically significant for antibiotics for pneumonia. For estimated mortality impact, the intervention saved approximately 593 (estimate range 168-1060) children's lives in both districts during the first year. This lowered the estimated under-five mortality rate from 235 deaths per 1000 live births in 2008 to 210 (estimate range 189-228) in 2009. If a similar intervention were to be introduced nationwide, 14,000 to 19,000 (estimate range 4000-28,000) children's lives could be saved annually. Maternal mortality showed a modest decrease in all scenarios. CONCLUSION In this setting, eliminating user fees increased use of health services and may have contributed to reduced child mortality.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Tour Saint-Antoine (Porte S03-458), 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Valéry Ridde
- Institut de Recherche en Sciences de la Santé, Centre national de la recherche scientifique et technologique du Burkina Faso, Ouagadougou, Burkina Faso
| | - Rolf Heinmüller
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Tour Saint-Antoine (Porte S03-458), 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Slim Haddad
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Tour Saint-Antoine (Porte S03-458), 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
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Ridde V, Belaid L, Mallé Samb O, Faye A. Les modalités de collecte du financement de la santé au Burkina Faso de 1980 à 2012. SANTÉ PUBLIQUE 2014. [DOI: 10.3917/spub.145.0715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ridde V, Haddad S, Heinmüller R. Improving equity by removing healthcare fees for children in Burkina Faso. J Epidemiol Community Health 2013; 67:751-7. [PMID: 23776054 PMCID: PMC3756435 DOI: 10.1136/jech-2012-202080] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 02/05/2013] [Accepted: 03/30/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study evaluated the effects on healthcare access inequities of an intervention exempting children under 5 years from user fees in Burkina Faso. METHODS The design consisted of two complementary studies. The first was an interrupted time series (56 months before and 12 months after) study of daily curative consultations according to distance (<5, 5-9 and ≥10 km) in a stratified random sample of 18 health centres: 12 with the intervention and 6 without. The second was a household panel survey (n=1214) assessing the evolution of health-seeking behaviours. Multilevel regression was used throughout. RESULTS Attendance doubled under the intervention, after adjusting for Centres de Santé et de Promotion Sociale size, districts, secular trend and seasonal variation. Utilisation increased for all distance ranges and in all of the 12 health centres of the intervention area. The exemption benefited all children (rate ratios (RR)=1.52 (1.23 to 1.88)), whether their health needs were high (RR=1.69 (1.22 to 2.32)) or not (RR=1.46 (1.10 to 1.93)) and whether the children lived near (RR=1.42 (1.09 to 1.85)) or far from a health centre (RR=1.79 (1.31 to 2.43)). The exemption benefited the children of poor families when health need was high and services near (RR=5.23; (1.30 to 20.99)). The amount saved for a child's treatment by the exemption was on average and median 2500 F CFA (≈US$5). CONCLUSIONS Exempting children under five from user fees is effective and helps reduce inequities of access. It benefits vulnerable populations, although their service utilisation remains constrained by limitations in geographic accessibility of services.
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Affiliation(s)
- V Ridde
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.
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Ridde V, Haddad S. Pragmatisme et réalisme pour l’évaluation des interventions de santé publique. Rev Epidemiol Sante Publique 2013; 61 Suppl 2:S95-106. [DOI: 10.1016/j.respe.2013.03.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Olivier de Sardan JP, Ridde V. L'exemption de paiement des soins au Burkina Faso, Mali et Niger. ACTA ACUST UNITED AC 2012. [DOI: 10.3917/afco.243.0011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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