Challenges of scaling up and of knowledge transfer in an action research project in Burkina Faso to exempt the worst-off from health care user fees

<p>Abstract</p> <p>Background</p> <p>Systems to exempt the indigent from user fees have been put in place to prevent the worst-off from being excluded from health care services for lack of funds. Yet the implementation of these mechanisms is as rare as the operational research on this topic. This article analyzes an action research project aimed at finding an appropriate solution to make health care accessible to the indigent in a rural district of Burkina Faso.</p> <p>Research</p> <p>This action research project was initiated in 2007 to study the feasibility and effectiveness of a community-based, participative and financially sustainable process for exempting the indigent from user fees. A interdisciplinary team of researchers from Burkina Faso and Canada was mobilized to document this action research project.</p> <p>Results and knowledge sharing</p> <p>The action process was very well received. Indigent selection was effective and strengthened local solidarity, but coverage was reduced by the lack of local financial resources. Furthermore, the indigent have many other needs that cannot be addressed by exemption from user fees. Several knowledge transfer strategies were implemented to share research findings with residents and with local and national decision-makers.</p> <p>Partnership achievements and difficulties</p> <p>Using a mixed and interdisciplinary research approach was critical to grasping the complexity of this community-based process. The adoption of the process and the partnership with local decision-makers were very effective. Therefore, at the instigation of an NGO, four other districts in Burkina Faso and Niger reproduced this experiment. However, national decision-makers showed no interest in this action and still seem unconcerned about finding solutions that promote access to health care for the indigent.</p> <p>Lessons learned</p> <p>The lessons learned with regard to knowledge transfer and partnerships between researchers and associated decision-makers are: i) involve potential users of the research results from the research planning stage; ii) establish an ongoing partnership between researchers and users; iii) ensure that users can participate in certain research activities; iv) use a variety of strategies to disseminate results; and v) involve users in dissemination activities.</p

Ressources financières des comités de gestion du Burkina Faso peuvent améliorer l'équité d'accès au sytstème de santé

Abstract and keywords provided in EnglishAvec l’avènement du système de recouvrement des coûts dans les années 1990 au Burkina Faso, les patients contribuent au financement des centres de sante´ (CSPS) gérés par les comités de gestion (COGES). Mais en demandant aux patients de payer, une barrière financière s’impose aux plus pauvres. L’objectif de cet article est d’étudier la manière dont les ressources financières tirées du recouvrement des coûts peuvent contribuer à améliorer l’équité´ d’accès aux soins de santé´. L’étude se déroule dans le district sanitaire de Ouargaye. La méthodologie consiste a` documenter la situation financière de 17 COGES sur une période de 12 mois au moyen des données comptables. Les résultats montrent que les COGES ont dépensé en moyenne sept millions de francs CFA (FCFA), dont 65 % pour l’achat des médicaments, 15 % pour les frais de fonctionnement, 7 % pour le salaire du personnel et les primes aux COGES et 3,4 % pour les ristournes aux agents de sante´. Les recettes moyennes par COGES sont de 7,3 millions de FCFA. La vente des médicaments essentiels génériques correspond a` 82 % des recettes, et la tarification des actes a` 10 %. Le résultat comptable moyen annuel est de 300 000 FCFA. Le taux de recouvrement des dépenses est de 104 % en moyenne. La marge bénéficiaire sur la vente des médicaments est de 31 % en moyenne. Les ristournes aux agents de sante´ correspondent a` 30 % des recettes de la tarification des actes en moyenne. La trésorerie moyenne est de 3,1 millions de FCFA. Les COGES disposent d’une bonne capacité´ financière. Ils pourraient améliorer l’accès aux soins en respectant les normes des ristournes aux agents (20 %), en supprimant la tarification des actes, en réduisant les marges sur la vente des médicaments ou en utilisant une partie des bénéfices pour exonérer du paiement les plus pauvres.With the advent of cost-recovery system in the 1990s in Burkina Faso, patients contribute to the financing of health centres (CSPS), which are managed by management committees (COGES). Asking patients to pay, however, erects a financial barrier to treatment for the poorest. The aim of this paper is to study how the financial resources from cost recovery can be used to improve equity of access to health care. The study took place in the health district of Ouargaye and documents the financial position of 17 COGES over a period of 12 months, with their accounting data. The results show that COGES spent an average of 7 million francs CFA, 65% for the purchase of medicines, 15% for operating costs, 7% for staff salaries and bonuses to COGES and 3.4% for discounts for health workers. Average revenue per COGES was 7.3 million FCFA. The sale of generic drugs accounted for 82% of revenue and fees for medical care to 10%. The average profit was 300 000 FCFA. The cost recovery rate averaged 104% and the profit margin on the sale of drugs 31%. Discounts to health workers represented 30% of the revenues from medical fees. The average cash position of a COGES was 3.1 million FCFA. The financial standing of the COGES is thus good. They could improve access to care and provide the standards discount to employees (20%) by removing fees for services, reducing the margins on the sale of drugs, or by using a portion of profits to exempt the poorest from payment

Maternal health fee exemptions; policy brief

Sixty participants from 10 countries including four English-speaking (Ghana, Kenya, Nigeria, Sierra Leone) and six French-speaking (Benin, Burkina Faso, Mali, Morocco, Niger, Senegal) attended the workshop, which presented data from the ten countries as the basis for discussion and comparison of content, costs and financing of maternal health fee exemption policies. Countries also identified priority activities to implement to improve their maternal health fee exemption policies upon their return home. There is a lack of coordination both among different fee exemption policies in place (children under five, pregnant women, etc.) and other major initiatives designed to improve financial access