Reducing financial barriers to emergency obstetric care: experience of cost-sharing mechanism in a district hospital in burkina faso.

REDUCING FINANCIAL BARRIERS TO EMERGENCY OBSTETRIC CARE: EXPERIENCE OF COST-SHARING MECHANISM IN A DISTRICT HOSPITAL IN BURKINA FASO. CONTENTS * Abstract * Citation * Links ABSTRACT

Objective: To describe the implementation of a cost-sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year

of activity. Methods: Service availability and use, service quality, knowledge of the cost-sharing system in the community and financial viability of the system were measured before and

after the system was implemented. Different sources of data were used: community survey, anthropological study, routine data from hospital files and registers and specific data collected on

major obstetric interventions (MOI) in all the hospitals utilized by the district population. Direct costs of MOI were collected for each patient through an individual form and monitored

during the year 2005. Rates of MOI for absolute maternal indications (AMI) were calculated for the period 2003-2005. Results: The direct cost of a MOI was on average 136US$, including

referral cost. Through the cost-sharing system this amount was shared between families (46US$), health centres (15US$), Ministry of Health (38US$) and local authority (37US$). The scheme was

started in January 2005. The rate of cost recovery was 91.3% and the balance at the end of 2005 was slightly positive (4.7% of the total contribution). The number of emergency referrals by

health centres increased from 84 in 2004 to 683 in 2005. MOI per 100 expected births increased from 1.95% in 2003 to 3.56% in 2005 and MOI for AMI increased from 0.75% to 1.42%. Conclusions:

The dramatic increase in MOI suggests that the cost-sharing scheme decreased financial and geographical barriers to emergency obstetric care. Other positive effects on quality of care were

documented but the sustainability of such a system remains uncertain in the dynamic context of Burkina Faso (decentralization). CITATION Tropical Medicine and International Health, Volume

12, Issue 8, Pages 972-981, 2007 LINKS Reducing financial barriers to emergency obstetric care: experience of cost-sharing mechanism in a district hospital in Burkina Faso. UPDATES TO THIS

PAGE Published 1 January 2007 Contents