Effects of the free healthcare policy on health services’ usage by children under 5 years in Burkina Faso: a controlled interrupted time-series analysis

• Published in: BMJ open Vol. 12; no. 11; p. e058077
• Main Authors: Debe, Siaka, Ilboudo, Patrick G, Kabore, Lassane, Zoungrana, Noelie, Gansane, Adama, Ridde, Valéry, De Brouwere, Vincent, Samandoulougou, Fati Kirakoya
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 21.11.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Childrens health; community child health; Fees & charges; Health care policy; Health facilities; Health Policy; Health services; health services administration & management; Health services utilization; Intervention; Life Sciences; Malaria; Morbidity; Mortality; Pediatrics; Pregnancy; Preschool children; Public health; Public services; Santé publique et épidémiologie; Time series; Trends; User fees; Validity; Variables; Burkina Faso; BURKINA FASO
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-058077

ObjectivesThis 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.SettingWe 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.ParticipantsThe 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.InterventionThe intervention was the introduction of the free healthcare policy for women and children under 5 years from April 2016.OutcomeThe primary outcome was the monthly mean rate of health services visits by children.ResultsAmong 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.ConclusionFindings 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.