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Eze P, Ilechukwu S, Lawani LO. Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0287600. [PMID: 37368882 DOI: 10.1371/journal.pone.0287600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND To systematically evaluate the empirical evidence on the impact of community-based health insurance (CBHI) on healthcare utilization and financial risk protection in low- and middle-income countries (LMIC). METHODS We searched PubMed, CINAHL, Cochrane CENTRAL, CNKI, PsycINFO, Scopus, WHO Global Index Medicus, and Web of Science including grey literature, Google Scholar®, and citation tracking for randomized controlled trials (RCTs), non-RCTs, and quasi-experimental studies that evaluated the impact of CBHI schemes on healthcare utilization and financial risk protection in LMICs. We assessed the risk of bias using Cochrane's Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions tools for RCTs and quasi/non-RCTs, respectively. We also performed a narrative synthesis of all included studies and meta-analyses of comparable studies using random-effects models. We pre-registered our study protocol on PROSPERO: CRD42022362796. RESULTS We identified 61 articles: 49 peer-reviewed publications, 10 working papers, 1 preprint, and 1 graduate dissertation covering a total of 221,568 households (1,012,542 persons) across 20 LMICs. Overall, CBHI schemes in LMICs substantially improved healthcare utilization, especially outpatient services, and improved financial risk protection in 24 out of 43 studies. Pooled estimates showed that insured households had higher odds of healthcare utilization (AOR = 1.60, 95% CI: 1.04-2.47), use of outpatient health services (AOR = 1.58, 95% CI: 1.22-2.05), and health facility delivery (AOR = 2.21, 95% CI: 1.61-3.02), but insignificant increase in inpatient hospitalization (AOR = 1.53, 95% CI: 0.74-3.14). The insured households had lower out-of-pocket health expenditure (AOR = 0.94, 95% CI: 0.92-0.97), lower incidence of catastrophic health expenditure at 10% total household expenditure (AOR = 0.69, 95% CI: 0.54-0.88), and 40% non-food expenditure (AOR = 0.72, 95% CI: 0.54-0.96). The main limitations of our study are the limited data available for meta-analyses and high heterogeneity persisted in subgroup and sensitivity analyses. CONCLUSIONS Our study shows that CBHI generally improves healthcare utilization but inconsistently delivers financial protection from health expenditure shocks. With pragmatic context-specific policies and operational modifications, CBHI could be a promising mechanism for achieving universal health coverage (UHC) in LMICs.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Penn State University, University Park, PA, United States of America
| | - Stanley Ilechukwu
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health Projects, South Saharan Social Development Organization (SSDO), Independence Layout, Enugu, Nigeria
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Maroof SAU, Sangmi MUD. Assessing financial impact of a health intervention program and controlling spillover effects. DECISION 2021. [DOI: 10.1007/s40622-020-00257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Degroote S, Ridde V, De Allegri M. Health Insurance in Sub-Saharan Africa: A Scoping Review of the Methods Used to Evaluate its Impact. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:825-840. [PMID: 31359270 PMCID: PMC7716930 DOI: 10.1007/s40258-019-00499-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We conducted a scoping review with the objective of synthesizing available literature and mapping what designs and methods have been used to evaluate health insurance reforms in sub-Saharan Africa. We systematically searched for scientific and grey literature in English and French published between 1980 and 2017 using a combination of three key concepts: "Insurance" and "Impact evaluation" and "sub-Saharan Africa". The search led to the inclusion of 66 articles with half of the studies pertaining to the evaluation of National Health Insurance schemes, especially the Ghanaian one, and one quarter pertaining to Community-Based Health Insurance and Mutual Health Organization schemes. Sixty-one out of the 66 studies (92%) included were quantitative studies, while only five (8%) were defined as mixed methods. Most studies included applied an observational design (n = 37; 56%), followed by a quasi-experimental (n = 27; 41%) design; only two studies (3%) applied an experimental design. The findings of our scoping review are in line with the observation emerging from prior reviews focused on content in pointing at the fact that evidence on the impact of health insurance is still relatively weak as it is derived primarily from studies relying on observational designs. Our review did identify an increase in the use of quasi-experimental designs in more recent studies, suggesting that we could observe a broadening and deepening of the evidence base on health insurance in Africa over the next few years.
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Affiliation(s)
- Stéphanie Degroote
- French Institute For Research on Sustainable Development (IRD), IRD Paris Descartes University (CEPED), 45 rue des Saints Pères, 75006, Paris, France
| | - Valery Ridde
- French Institute For Research on Sustainable Development (IRD), IRD Paris Descartes University (CEPED), 45 rue des Saints Pères, 75006, Paris, France
- Paris Sorbonne Cities University, Erl Inserm Sagesud, Paris, France
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany.
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Impact of voluntary community-based health insurance on child stunting: Evidence from rural Uganda. Soc Sci Med 2019; 245:112738. [PMID: 31855728 DOI: 10.1016/j.socscimed.2019.112738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 01/07/2023]
Abstract
While community-based health insurance increasingly becomes part of the health financing landscape in developing countries, there is still limited research about its impacts on health outcomes. Using cross-sectional data from rural south-western Uganda, we apply a two-stage residual inclusion instrumental variables method to study the impact of insurance participation on child stunting in under-five children. We find that one year of a household's participation in community-based health insurance was associated with a 4.3 percentage point less probability of stunting. Children of two years or less dominated the effect but there were also statistically significant benefits of enrolling in insurance after a child's birth. The expansion of community-based health insurance might have more dividends to improving health, in addition to financial protection and service utilisation in rural developing countries.
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Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PLoS One 2019; 14:e0219731. [PMID: 31461458 PMCID: PMC6713352 DOI: 10.1371/journal.pone.0219731] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Expanding public health insurance seeks to attain several desirable objectives, including increasing access to healthcare services, reducing the risk of catastrophic healthcare expenditures, and improving health outcomes. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years. METHODS We reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. No language restrictions were applied. Our focus was on both randomised and observational studies, particularly those including explicitly attempts to tackle selection bias in estimating the treatment effect of health insurance. The main outcomes are: (1) utilisation of health services, (2) financial protection for the target population, and (3) changes in health status. FINDINGS 8755 abstracts and 118 full-text articles were assessed. Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. Overall, health insurance schemes in low- and middle-income countries (LMICs) have been found to improve access to health care as measured by increased utilisation of health care facilities (32 out of 40 studies). There also appeared to be a favourable effect on financial protection (26 out of 46 studies), although several studies indicated otherwise. There is moderate evidence that health insurance schemes improve the health of the insured (9 out of 12 studies). INTERPRETATION Increased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage.
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Affiliation(s)
- Darius Erlangga
- Department of Health Sciences, University of York, York, England, United Kingdom
| | - Marc Suhrcke
- Centre of Health Economics, University of York, York, England, United Kingdom
- Luxembourg Institute of Socio-economic Research (LISER), Luxembourg
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, England, United Kingdom
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Karen Bloor
- Department of Health Sciences, University of York, York, England, United Kingdom
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Ko H, Kim H, Yoon CG, Kim CY. Social capital as a key determinant of willingness to join community-based health insurance: a household survey in Nepal. Public Health 2018; 160:52-61. [PMID: 29734013 DOI: 10.1016/j.puhe.2018.03.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/12/2017] [Accepted: 03/24/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Although community-based health insurance (CBHI) schemes have been considered as an intermediate stage to achieve universal health coverage (UHC) in low-resource settings, there is a knowledge gap on ways to make it better. STUDY DESIGN More than 4000 Nepalese households were randomly selected and surveyed. METHODS Logistic and multivariate multinomial regressions were estimated. RESULTS Overall, 88% of included household heads were willing to join CBHI, 61% were willing to pay annual premium less than 600 Nepalese rupees (US$5.6) per household, and more than a half (53%) responded that the government should subsidize a significant portion of the premium. Results showed that a higher level of social capital was significantly related with an increase in odds of accepting higher premiums, while individuals' health status and age did not have such associations. Individuals with bonding social capital were more likely to be inclined to join CBHI. Persons who said they can lend money for a living expense (bonding capital) did not want the government to subsidize the scheme, while this negative association would be reversed if persons had both bonding and bridging social capitals. CONCLUSION We found significantly positive relationships between social capital and willingness to join and willingness to pay for CBHI in Nepal. Policymakers, aiming to achieve UHC, should be advised that bonding and bridging social capital have differing relationships with willingness to cooperate the external funding sources.
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Affiliation(s)
- Hansoo Ko
- Division of Health Policy and Administration, University of Illinois at Chicago School of Public Health, USA
| | - Hwajun Kim
- Health Care Management and Policy, Seoul National University Graduate School of Public Health, Republic of Korea
| | - Chang-Gyo Yoon
- Health Care Management and Policy, Seoul National University Graduate School of Public Health, Republic of Korea
| | - Chang-Yup Kim
- Health Care Management and Policy, Seoul National University Graduate School of Public Health, Republic of Korea.
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Gankpe GF, Gankpe EC, Baleba AN, Zinsou L, Mesenge C. [Does mutual health insurance reproduce health inequalities in Benin?]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2018; 30:389-396. [PMID: 30541268 DOI: 10.3917/spub.183.0389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The factors leading to exclusion of a part of the population from mutual health insurance were studied by examining the profile of members, the social dynamics and the mode of functioning of this type of health insurance. METHODS A cross-sectional survey was conducted in Parakou; Benin by selecting 50 patients from three healthcare centres selected at random from the ten "Réseau des Soins Coordonnés" centres. Individual interviews and focus groups were conducted with mutual health insurance beneficiaries and non-beneficiaries. RESULTS Thirty-seven of the 50 patients did not have any mutual health insurance and 35 of them were under the age of 35 years with a female predominance (23 out of 37) with a low monthly income (less than CFA30,000). Factors such as group dynamics, the feeling of belonging to a group and confidence in mutual insurance management committees were related to the presence or absence of mutual health insurance. CONCLUSION In the absence of universal health insurance coverage in Benin, mutual health insurance constitutes almost the only solution for populations, but few people take out this insurance. Consequently, the contribution of mutual health insurance in this region of Benin to access to healthcare remains marginal, as the most deprived populations cannot afford this insurance.
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Oraro T, Ngube N, Atohmbom GY, Srivastava S, Wyss K. The influence of gender and household headship on voluntary health insurance: the case of North-West Cameroon. Health Policy Plan 2017; 33:163-170. [DOI: 10.1093/heapol/czx152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 11/12/2022] Open
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Habib SS, Perveen S, Khuwaja HMA. The role of micro health insurance in providing financial risk protection in developing countries--a systematic review. BMC Public Health 2016; 16:281. [PMID: 27004824 PMCID: PMC4802630 DOI: 10.1186/s12889-016-2937-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/08/2016] [Indexed: 11/24/2022] Open
Abstract
Background Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting. Methods We conducted a systematic search for published literature using the search terms “Community based health insurance AND developing countries”, “Micro health insurance AND developing countries”, “Mutual health insurance AND developing countries”, “mutual OR micro OR community based health insurance” “Health insurance AND impact AND poor” “Health insurance AND financial protection” and “mutual health organizations” on three databases, Pubmed, Google Scholar and Science Direct (Elsevier). Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization. Results Twenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa). Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure, household borrowings and poverty. MHI also had a positive safeguarding effect on household savings, assets and consumption patterns. Conclusion Our review suggests that MHI, targeted at the low-income households and tailored to suit the cultural and geographical structures in the various areas of Pakistan, may contribute towards providing protection to the households from catastrophe and impoverishment resulting from health expenditures. This paper emphasizes the need for further research to fill the knowledge gap that exists about the impact of MHI, using robust study designs and impact indicators.
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Affiliation(s)
- Shifa Salman Habib
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 74800, Karachi, Pakistan.
| | - Shagufta Perveen
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 74800, Karachi, Pakistan
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De Allegri M, Tiendrebéogo J, Müller O, Yé M, Jahn A, Ridde V. Understanding home delivery in a context of user fee reduction: a cross-sectional mixed methods study in rural Burkina Faso. BMC Pregnancy Childbirth 2015; 15:330. [PMID: 26653013 PMCID: PMC4676832 DOI: 10.1186/s12884-015-0764-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 11/25/2015] [Indexed: 11/25/2022] Open
Abstract
Background Several African countries have recently reduced/removed user fees for maternal care, producing considerable increases in the utilization of delivery services. Still, across settings, a conspicuous number of women continue to deliver at home. This study explores reasons for home delivery in rural Burkina Faso, where a successful user fee reduction policy is in place since 2007. Methods The study took place in the Nouna Health District and adopted a triangulation mixed methods design, combining quantitative and qualitative data collection and analysis methods. The quantitative component relied on use of data from the 2011 round of a panel household survey conducted on 1130 households. We collected data on utilization of delivery services from all women who had experienced a delivery in the previous twelve months and investigated factors associated with home delivery using multivariate logistic regression. The qualitative component relied on a series of open-ended interviews with 55 purposely selected households and 13 village leaders. We analyzed data using a mixture of inductive and deductive coding. Results Of the 420 women who reported a delivery, 47 (11 %) had delivered at home. Random effect multivariate logistic regression revealed a clear, albeit not significant trend for women from a lower socio-economic status and living outside an area to deliver at home. Distance to the health facility was found to be positively significantly associated with home delivery. Qualitative findings indicated that women and their households valued facility-based delivery above home delivery, suggesting that cultural factors do not shape the decision where to deliver. Qualitative findings confirmed that geographical access, defined in relation to the condition of the roads and the high transaction costs associated with travel, and the cost-sharing fees still applied at point of use represent two major barriers to access facility-based delivery. Conclusions Findings suggest that the current policy in Burkina Faso, as similar policies in the region, should be expanded to remove fees at point of use completely and to incorporate benefits/solutions to support the transport of women in labor to the health facility in due time.
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Affiliation(s)
- Manuela De Allegri
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany.
| | | | - Olaf Müller
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany.
| | - Maurice Yé
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
| | - Albrecht Jahn
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany.
| | - Valéry Ridde
- University of Montreal School of Public Health (ESPUM), Montreal, Canada. .,Institut de recherche en santé publique de l'université de Montréal (IRSPUM), Montreal, Canada.
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Ridde V, Turcotte-Tremblay AM, Souares A, Lohmann J, Zombré D, Koulidiati JL, Yaogo M, Hien H, Hunt M, Zongo S, De Allegri M. Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso. Implement Sci 2014; 9:149. [PMID: 25304365 PMCID: PMC4201720 DOI: 10.1186/s13012-014-0149-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/19/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications. METHODS/DESIGN The study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods. DISCUSSION Performance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.
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Affiliation(s)
- Valéry Ridde
- University of Montreal Hospital Research Center (CRCHUM), 850 Saint-Denis, 3rd Floor, Montréal, QC, H2X 0A9, Canada.
- University of Montreal School of Public Health, 7101 Avenue du Parc, 3rd Floor, Montréal, QC H3N 1X9, Canada.
| | - Anne-Marie Turcotte-Tremblay
- University of Montreal Hospital Research Center (CRCHUM), 850 Saint-Denis, 3rd Floor, Montréal, QC, H2X 0A9, Canada.
- University of Montreal School of Public Health, 7101 Avenue du Parc, 3rd Floor, Montréal, QC H3N 1X9, Canada.
| | - Aurélia Souares
- Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
| | - Julia Lohmann
- Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
| | - David Zombré
- University of Montreal Hospital Research Center (CRCHUM), 850 Saint-Denis, 3rd Floor, Montréal, QC, H2X 0A9, Canada.
- University of Montreal School of Public Health, 7101 Avenue du Parc, 3rd Floor, Montréal, QC H3N 1X9, Canada.
| | - Jean Louis Koulidiati
- Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
| | - Maurice Yaogo
- AFRICSanté & Université Catholique de l'Afrique de l'Ouest - Unité Universitaire de Bobo-Dioulasso, 01 BP 298, Bobo-Dioulasso, Burkina Faso.
| | - Hervé Hien
- Centre MURAZ, 01 BP, Bobo-Dioulasso, Burkina Faso.
- Institut de recherche en sciences de la santé (IRSS) du CNRST, 03 BP 7192 03, Ouagadougou, Burkina Faso.
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, 2nd Floor, Montréal, QC H3G 1Y5, Canada.
| | - Sylvie Zongo
- Institut des Sciences des Sociétés (INSS-CNRST), 03 BP 7047, Ouagadougou, Burkina Faso.
| | - Manuela De Allegri
- Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
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Robyn PJ, Bärnighausen T, Souares A, Traoré A, Bicaba B, Sié A, Sauerborn R. Provider payment methods and health worker motivation in community-based health insurance: a mixed-methods study. Soc Sci Med 2014; 108:223-36. [PMID: 24681326 DOI: 10.1016/j.socscimed.2014.01.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/16/2014] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
In a community-based health insurance (CBHI) introduced in 2004 in Nouna health district, Burkina Faso, poor perceived quality of care by CBHI enrollees has been a key factor in observed high drop-out rates. The poor quality perceptions have been previously attributed to health worker dissatisfaction with the provider payment method used by the scheme and the resulting financial risk of health centers. This study applied a mixed-methods approach to investigate how health workers working in facilities contracted by the CBHI view the methods of provider payment used by the CBHI. In order to analyze these relationships, we conducted 23 in-depth interviews and a quantitative survey with 98 health workers working in the CBHI intervention zone. The qualitative in-depth interviews identified that insufficient levels of capitation payments, the infrequent schedule of capitation payment, and lack of a payment mechanism for reimbursing service fees were perceived as significant sources of health worker dissatisfaction and loss of work-related motivation. Combining qualitative interview and quantitative survey data in a mixed-methods analysis, this study identified that the declining quality of care due to the CBHI provider payment method was a source of significant professional stress and role strain for health workers. Health workers felt that the following five changes due to the provider payment methods introduced by the CBHI impeded their ability to fulfill professional roles and responsibilities: (i) increased financial volatility of health facilities, (ii) dissatisfaction with eligible costs to be covered by capitation; (iii) increased pharmacy stock-outs; (iv) limited financial and material support from the CBHI; and (v) the lack of mechanisms to increase provider motivation to support the CBHI. To address these challenges and improve CBHI uptake and health outcomes in the targeted populations, the health care financing and delivery model in the study zone should be reformed. We discuss concrete options for reform based on the study findings.
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Affiliation(s)
- Paul Jacob Robyn
- University of Heidelberg, Institute of Public Health, Germany; The World Bank, Washington, DC, USA.
| | - Till Bärnighausen
- Harvard School of Public Health, Department of Global Health and Population, USA; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa
| | - Aurélia Souares
- University of Heidelberg, Institute of Public Health, Germany
| | - Adama Traoré
- Nouna Health Research Centre, Ministry of Health, Burkina Faso
| | - Brice Bicaba
- Nouna Health Research Centre, Ministry of Health, Burkina Faso; Nouna Health District, Ministry of Health, Burkina Faso
| | - Ali Sié
- Nouna Health Research Centre, Ministry of Health, Burkina Faso
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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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Cofie P, De Allegri M, Kouyaté B, Sauerborn R. Effects of information, education, and communication campaign on a community-based health insurance scheme in Burkina Faso. Glob Health Action 2013; 6:20791. [PMID: 24314344 PMCID: PMC3856340 DOI: 10.3402/gha.v6i0.20791] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 10/31/2013] [Accepted: 11/05/2013] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The study analysed the effect of Information, Education, and Communication (IEC) campaign activities on the adoption of a community-based health insurance (CHI) scheme in Nouna, Burkina Faso. It also identified the factors that enhanced or limited the campaign's effectiveness. DESIGN Complementary data collection approaches were used. A survey was conducted with 250 randomly selected household heads, followed by in-depth interviews with 22 purposively selected community leaders, group discussions with the project management team, and field observations. Bivariate analysis and multivariate logistic regression models were used to assess the association between household exposure to campaign and acquisition of knowledge as well as household exposure to campaign and enrolment. RESULTS The IEC campaign had a positive effect on households' knowledge about the CHI and to a lesser extent on household enrolment in the scheme. The effectiveness of the IEC strategy was mainly influenced by: (1) frequent and consistent IEC messages from multiple media channels (mass and interpersonal channels), including the radio, a mobile information van, and CHI team, and (2) community heads' participation in the CHI scheme promotion. Education was the only significantly influential socio-demographic determinant of knowledge and enrolment among household heads. The relatively low effects of the IEC campaign on CHI enrolment are indicative of other important IEC mediating factors, which should be taken into account in future CHI campaign evaluation. CONCLUSION The study concludes that an IEC campaign is crucial to improving the understanding of the CHI scheme concept, which is an enabler to enrolment, and should be integrated into scheme designs and evaluations.
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Beiersmann C, Bermejo Lorenzo J, Bountogo M, Tiendrébeogo J, Gabrysch S, Yé M, Jahn A, Müller O. Malnutrition determinants in young children from Burkina Faso. J Trop Pediatr 2013; 59:372-9. [PMID: 23748475 DOI: 10.1093/tropej/fmt037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Childhood malnutrition remains a major challenge to public health in poor countries. Data on malnutrition determinants in African children are scarce. A cross-sectional survey was performed in eight villages of Burkina Faso in June 2009, including 460 children aged 6-31 months. Demographic, socioeconomic, parasitological, clinical and anthropometric characteristics were collected. The main outcome variable was weight-for-length (WFL) z-score (i.e. wasting). A multiple regression model identified village, age group, religion and the presence of younger siblings as significantly associated with wasting. Villages differed in their mean WFL z-score by up to one unit. Compared with younger children, the mean WFL z-score of children aged 24-35 months was 0.63 units higher than the WFL z-score in younger children. This study confirms the still unacceptable high level of malnutrition in young children of rural West Africa and supports the fact that childhood malnutrition is a complex phenomenon highly influenced by contextual variables.
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Affiliation(s)
- Claudia Beiersmann
- Institute of Public Health, University Hospital Heidelberg, INF 324, 69120 Heidelberg, Germany
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De Allegri M, Louis VR, Tiendrébeogo J, Souares A, Yé M, Tozan Y, Jahn A, Mueller O. Moving towards universal coverage with malaria control interventions: achievements and challenges in rural Burkina Faso. Int J Health Plann Manage 2012; 28:102-21. [DOI: 10.1002/hpm.2116] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 04/19/2012] [Accepted: 05/10/2012] [Indexed: 11/10/2022] Open
Affiliation(s)
- Manuela De Allegri
- Institute of Public Health; University of Heidelberg; Heidelberg; Germany
| | - Valérie R Louis
- Institute of Public Health; University of Heidelberg; Heidelberg; Germany
| | | | - Aurelia Souares
- Institute of Public Health; University of Heidelberg; Heidelberg; Germany
| | - Maurice Yé
- Centre de Recherche en Santé de Nouna; Nouna; Burkina Faso
| | | | - Albrecht Jahn
- Institute of Public Health; University of Heidelberg; Heidelberg; Germany
| | - Olaf Mueller
- Institute of Public Health; University of Heidelberg; Heidelberg; Germany
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