Skip to main content

Advertisement

SpringerLink
Log in

Expanding access to primary care without additional budgets? A case study from Burkina Faso

  • Original paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

The aim of this study is to demonstrate the impact of increased access to primary care on provider costs in the rural health district of Nouna, Burkina Faso. This study question is crucial for health care planning in this district, as other research work shows that the population has a higher need for health care services. From a public health perspective, an increase of utilisation of first-line health facilities would be necessary. However, the governmental budget that is needed to finance improved access was not known. The study is based on data of 2004 of a comprehensive provider cost information system. This database provides us with the actual costs of each primary health care facility (Centre de Santé et de Promotion Sociale, CSPS) in the health district. We determine the fixed and variable costs of each institution and calculate the average cost per service unit rendered in 2004. Based on the cost structure of each CSPS, we calculate the total costs if the demand for health care services increased. We conclude that the total provider costs of primary care (and therefore the governmental budget) would hardly rise if the coverage of the population were increased. This is mainly due to the fact that the highest variable costs are drugs, which are fully paid for by the customers (Bamako Initiative). The majority of other costs are fixed. Consequently, health care reforms that improve access to health care institutions must not fear dramatically increasing the costs of health care services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hammer, G.P., Some, F., et al: Pattern of cause-specific childhood mortality in a malaria endemic area of Burkina Faso. Malar. J. 5, 47 (2006)

    Article  Google Scholar 

  2. Muller, O., Becher, H.: Malnutrition and childhood mortality in developing countries. Lancet 367(9527), 1978 (2006)

    Article  Google Scholar 

  3. Bodart, C., Servais, G., et al: The influence of health sector reform and external assistance in Burkina Faso. Health Policy Plan 16(1), 74–86 (2001)

    Article  Google Scholar 

  4. Haddad, S., Nougtara, A., et al: Learning from health system reforms: lessons from Burkina Faso. Trop. Med. Int. Health 11(12), 1889–1897 (2006)

    Article  Google Scholar 

  5. Krause, G., Benzler, J., Heinmüller, R., et al: Performance of village pharmacies and patient compliance after implementation of an essential drug programme in rural Burkina Faso. Health Policy Plan 13, 159–166 (1998)

    Article  Google Scholar 

  6. Bodart, C., Servais, G., Mohamed, Y.I., et al: The influence of health sector reform and external assistance in Burkina Faso. Health Policy Plan 16, 74–86 (2001)

    Article  Google Scholar 

  7. Musgisha, F., Kouyate, B., Dong, H., et al: The two faces of enhancing utilization of health-care services: determinants of patient initiation and retention in rural Burkina Faso. Bull. World Health Organ. 82, 572–579 (2004)

    Google Scholar 

  8. Krause, G., Schleiermacher, D., et al: Diagnostic quality in rural health centres in Burkina Faso. Trop. Med. Int. Health 3(2), 100–107 (1998)

    Article  Google Scholar 

  9. De Allegri, M., Sauerborn, R.: Community based health insurance in developing countries. Bmj 334(7607), 1282–3 (2007)

    Article  Google Scholar 

  10. Waelkens, M., Criel, B.: Les Mutuelles de Santé en Afrique Sub-Saharienne: Ètat des Lieux et Réflexions sur un Agenda de Recherche. HNP Discussion Paper Washington D.C., The World Bank (2004)

  11. Ridde, V.: Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative. Bull. World Health Organ. 81, 532–538 (2003)

    Google Scholar 

  12. Carrin, G., Waelkens, M.P., et al: Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Trop. Med. Int. Health 10(8), 799–811 (2005)

    Article  Google Scholar 

  13. Criel, B., Van der Stuyft, P., et al: The Bwamanda hospital insurance scheme: effective for whom? A study of its impact on hospital utilization patterns. Soc. Sci. Med. 48(7), 897–911 (1999)

    Article  Google Scholar 

  14. Dong, H., Kouyate, B., et al: Inequality in willingness-to-pay for community-based health insurance. Health Policy 72(2), 149–156 (2005)

    Article  Google Scholar 

  15. Sauerborn, R., Nougtara, A., et al: The elasticity of demand for health care in Burkina Faso: differences across age and income groups. Health Policy Plan 9(2), 185–192 (1994)

    Article  Google Scholar 

  16. Flessa, S., Dung, N.T.: Costing of services of Vietnamese hospitals: identifying costs in one central, two provincial and two district hospitals using a standard methodology. Int. J. Health Plann. Manage. 19(1), 63–77 (2004)

    Article  Google Scholar 

  17. Barnum H., Kutzin J.: Public hospitals in developing countries. Resource use, cost, financing. The John Hopkins University Press, Baltimore (1993)

    Google Scholar 

  18. Mills, A.: The economics of hospitals in developing countries. Part I: expenditure patterns. Health Policy Plan 5, 107–117 (1990)

    Article  Google Scholar 

  19. Mills, A.: The economics of hospitals in developing countries. Part II: costs and sources of income. Health Policy Plan 5, 203–218 (1990)

    Article  Google Scholar 

  20. Guiness, L., Ali, B., Naeem, A., Vassal, A.: Costs of hospital care for HIV-positive and HIV-negative patients at Kenyatta National Hospital, Nairobi, Kenya. Aids 16, 180–186 (2002)

    Article  Google Scholar 

  21. Mills, A., Kalalamula, J., Chisimbi, S.: The cost of the district hospital: a case study in Malawi. Bull. World Health Organ. 71, 329–339 (1993)

    Google Scholar 

  22. Ministère de la Santé: Annuaire statistique/santé. Ouagadougou (2006)

  23. Ministère du Commerce, de la Promotion de l’Entreprise et de l’Artisanat, Ministère de la Santé: Arrête No. 2006 pour fixation des prix de vente au Public des Médicaments Essentiels Génériques (MEG) sous Dénomination Commune International (DCI) au Burkina Faso. Ouagadougou (2006)

  24. Su, T.T., Kouyate, B., Flessa, S.: Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bull. World Health Organ. 84(1), 21–27 (2006)

    Article  Google Scholar 

  25. Su, T.T., Pokhrel, S., et al: Determinants of household health expenditure on western institutional health care. Eur. J. Health Econ. 7(3), 199–207 (2006)

    Article  Google Scholar 

  26. Su, T.T., Sanon, M., et al: Assessment of indirect cost-of-illness in a subsistence farming society by using different valuation methods. Health Policy (2007)

  27. Fleßa, S.: Gesundheitsreformen in Entwicklungsländern. Lembeck, Frankfurt a.M (2003)

  28. Sauerborn, R., Mugisha, F., Somé, F., Becher, H., Gbangou, A., Kouyaté, B.: Population-based, actuarial data for estimating the needs for curative health care under community-based insurance in Burkina Faso. Discussion paper, University of Heidelberg (2003)

  29. Würthwein, R.: Measuring the local burden of disease. A study of years of life lost in sub-Saharan Africa. Int. J. Epidemiol. 3, 501–508 (2001)

    Article  Google Scholar 

  30. Su, T.T., Pokhrel, S., et al: Determinants of household health expenditure on western institutional health care. Eur. J. Health Econ. 7(3), 199–207 (2006)

    Article  Google Scholar 

  31. Mugisha, F., Kouyate, B., Dong, H., Chep’ngeno, G., Sauerborn, R.: The two faces of enhancing utilization of health-care services: determinants of patient initiation and retention in rural Burkina Faso. Bull. World Health Organ. 82(8), 572–579 (2004)

    Google Scholar 

  32. Mugisha, F., Kouyate, B., Gbangou, A., Sauerborn, R.: Examining out-of-pocket expenditure on health care in Nouna, Burkina Faso: implication for health policy. Trop. Med. Int. Health 7, 187–196 (2002)

    Article  Google Scholar 

  33. WHO: World Health Report 2007. World Health Organisation, Geneva (2007)

  34. Unicef and WHO: Immunization Summary 2006. A Statistical Reference. Data through 2004 (2006)

  35. Unger, J., Yada, A.: Should medicines be distributed by health services of pharmacies? A preleminary evaluation of the Boulgou project in Burkina Faso. Health Policy Plan 8, 240–246 (1993)

    Article  Google Scholar 

  36. Su T.T.: Household Cost-of-Illness Study in the Nouna Health District, Burkina Faso. Ruprecht-Karls-Universität Heidelberg, Heidelberg (2005)

    Google Scholar 

  37. Ridde, V., Girard, J.E.: Douze ans après l’initiative de Bamako : constats et implications politiques pour l’équité d’accès aux services de santé des indigents africains. Santé Publique 15, 37–51 (2004)

    Google Scholar 

  38. Cocking C., Flessa S., et al: Locating health facilities in Nouna district, Burkina Faso. In: Haasis, H.D., Kopfer, H. et al (eds.): Operations Research Proceedings 2005. Selected papers of the Annual International Conference of the German Operations Society. Bremen, 7–9 September 2005. Springer, Berlin, pp. 431–436 (2006)

  39. Litvack, J.I., Bodart, C.: User fees plus quality equals improved access to health care: results of a field experiment in Cameroon. Soc. Sci. Med. 37(3), 369–83 (1993)

    Article  Google Scholar 

  40. Mariko, M.: Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components. Soc. Sci. Med. 56(6), 1183–96 (2003)

    Article  Google Scholar 

  41. Flessa S.: Gesundheitsökonomik Eine Einführung in das wirtschaftliche Denken für Mediziner. Springer, Berlin (2005)

    Google Scholar 

  42. Ministère de la Santé: Tableau de bord des indicateurs de santé en 2004. Ouagadougou (2006)

  43. Su, T.T., Kouyate, B., Flessa, S.: Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bull. World Health Organ. 84, 21–27 (2006)

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Ali Sié, Bocar Kouyate, Maurice Yé, Mamadou Mariko and Dimitri Poda for their support during the data collection.

Author information

Authors and Affiliations

  1. Department of Health Care Management, University of Greifswald, Friedrich-Loeffler-Str. 70, 17489, Greifswald, Germany

    Paul Marschall & Steffen Flessa

Authors
  1. Paul Marschall
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steffen Flessa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Marschall.

Additional information

This study was supported by a research grant of the German Research Foundation (Deutsche Forschungsgemeinschaft).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marschall, P., Flessa, S. Expanding access to primary care without additional budgets? A case study from Burkina Faso. Eur J Health Econ 9, 393–403 (2008). https://doi.org/10.1007/s10198-007-0095-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-007-0095-9

Keywords

Search

Navigation