Choice of Malaria Care Services in Sissala West District in the Upper West Region of Ghana

Malaria poses a threat to the Ghanaian health system and a huge burden to the economy. In the Sissala West District, the trend of Out-Patients Department (OPD) attendance due to malaria keeps increasing even though the national figures show a decline. The study investigates malaria care provider choice in Sissala West District, using a multinomial logistic regression model. A cross-sectional survey design was used and data was collected from 400 malaria infected individuals or their caretakers in the district. The results showed that travel time and waiting time negatively influence the choice of all categories of malaria care providers in the district. Similarly, cost of treatment negatively influence self-medication and consultation at chemical store. The income level of respondents also influences self-medication and traditional medical practitioner while severity of infection influences the choice of chemical store and selfmedication. The study recommends the provision of more health facilities in the district, the intensification of public education on malaria prevention and control and the monitoring of the use of affordable anti-malaria drugs such as the Artemisinin based Combination Therapy (ACTs).Key words: Choice, Multinomial Logit, Marginal Effects, Self-medication, Indirect Cost

L'utilisation des services de santé par les indigent-e-s du Burkina Faso

Une composante de l'intervention de financement basée sur la performance appliquée au Burkina Faso était de fournir un accès gratuit aux soins de santé par la distribution de cartes d'exemption des paiements directs à des personnes indigentes préalablement identifiées. La présente étude examine les facteurs qui ont conduit à l'obtention de cartes d'exemption par des indigent-e-s et l'effet de la possession de la carte sur l'utilisation des services de santé. Un ensemble de données de panel de 1 652 individus indigent-es sélectionné-e-s au hasard a été utilisé. Parmi les personnes indigentes interrogées en 2017, 75,51/100 ont reçu des cartes d'exemption. L'alphabétisation de base, vivre à moins de 5 km d'un centre de santé et résider à Diébougou ou Gourcy étaient positivement associés à la possession d'une carte. La possession d'une carte n'a pas augmenté l'utilisation des services de santé pour les indigent-e-s. Une meilleure conception et mise en oeuvre des interventions, accompagnées de stratégies complémentaires comme la mise en place de navigateurs patients et de navigatrices patientes, pourraient aider les personnes indigentes à surmonter tous les obstacles d'accès et d'utilisation des services de santé

Health care access among underserved groups

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 (ß = -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

Les dépenses excessives de santé des indigent-e-s après l'arrêt du FBR au Burkina Faso

Mesurer les progrès réalisés vers la protection contre les risques financiers pour les plus pauvres est essentiel dans le cadre de la couverture sanitaire universelle. L'étude a évalué le niveau des dépenses directes et les facteurs associés à des dépenses directes de santé excessives pour les indigent-e-s qui avaient été ciblé-e-s et exempté-e-s dans le cadre du financement basé sur la performance au Burkina Faso. Les résultats montrent que 83,64/100 des personnes interrogées affirment disposer d'une carte d'exemption du paiement. Les indigent-e-s affirment avoir dépensé en moyenne 23051,62 FCFA (39,18 USD) pour recevoir des services de santé dans des formations sanitaires publiques alors qu'ils étaient censés être gratuits. De plus, la probabilité d'engager des dépenses excessives était associée de manière négative au fait d'être une femme et d'avoir une carte d'exemption

Do targeted user fee exemptions reach the ultra-poor and increase their healthcare utilisation ? : a panel study from Burkina Faso

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 (ß = -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

Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF : a cross-sectional study in Burkina Faso

Background Measuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in Burkina Faso. Ultra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge. Methods We performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in Diebougou district. Multivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. The analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. Excessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure. Results Exemption card ownership was reported by 83.64% of the respondents. With an average of FCFA 23051.62 (USD 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. The probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (beta = - 2.072, p = 0.00, ME = - 0.324; p = 0.000) and having an exemption card (beta = - 1.787, p = 0.025; ME = - 0.279, p = 0.014). Conclusions User fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. Our results demonstrate the importance of free care and better implementation of existing exemption policies. The ultra-poor's elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection