Burkina Faso removed user fees for health care for children under five and for maternity care in 2008. Johri and colleagues  evaluated the effect on uptake of services (coverage), and then modelled the expected gains in mortality contingent on improved coverage using a tool called the “Lives Saved Tool”. Service uptake increased nearly two-fold following the elimination of user fees. There was a substantial increase in use of potentially life-saving treatments. Sensitivity analyses took into account uncertainty in the data. It was estimated that the contingent reduction in child mortality would amount to 11% of all deaths, thanks to care made available to children with pneumonia, diarrhoea, malaria, and neonatal illnesses. Quantity of prescriptions was used as a proxy for quality of care and no deterioration was noted in the post-intervention period, thereby mitigating concern that safety would suffer as a result of increased clinical workloads. Abolishing user fees is particularly advantageous for very poor families; that is to say it improves equity of outcome.
— Richard Lilford, CLAHRC WM Director
- Johri M, Riddle V, Heinmüller R, Haddad S. Estimation of maternal and child mortality one year after use-fee elimination: an impact evaluation and modelling study in Burkina Faso. Bull World Health Organ. 2014; 92: 706-15.
- Winfrey W, McKinnon R, Stober J. Methods used in the Lives Saved Tool (LisT). BMC Public Health. 2011; 11(s3):s32.