Analyzing the Financial Sustainability of User Fee Removal Policies: A Rapid First Assessment Methodology with a Practical Application for Burkina Faso

  • Jacky MathonnatEmail author
  • Martine Audibert
  • Salam Belem
Practical Application


The purpose of this paper is to briefly present a methodological framework that does not require cumbersome investigations for a first assessment of the financial sustainability of policies aiming to remove or reduce healthcare user fees (the so-called free healthcare policy [FHCP]). This paper is organized in two main sections. The first analyzes the various possibilities available to finance an FHCP. Using several scenarios, it includes a special focus devoted to the calculus of what to consider when assessing the sustainability of expanding fiscal space for financing the FHCP. The second section relies on the current FHCP being implemented in Burkina Faso to illustrate a selection of specific issues raised in the methodological framework. The results suggest that sustainable FHCP financing is not outside the range of the government but does represent a significant challenge, as it will require, both currently and in the future, complex and delicate budget trade-offs at the highest governmental levels, regardless of other policy options to be considered.



This article is based on a research report that was prepared and funded by the Health Care Financing in Sub-Saharan African Collaborative Research Program of the African Economic Research Consortium (AERC; with the support of the FERDI (Fondation pour les Etudes et Recherches sur le Développement International). The authors thank two anonymous referees and the participants of the AERC’s Final Review Workshop (31 May–1 June 2018) and two anonymous referees from this journal for their comments and suggestions. However, the authors are solely responsible for the analyses presented in this article.

Author contributions

JM is the main author for the development of the methodology and the writing of the article. Each co-author contributed to the drafting of the paper and to the reflections and analyses presented therein.

Compliance with Ethical Standards

Conflict of interest

Jacky Mathonnat, Martine Audibert, and Salam Belem have no conflicts of interest that are directly relevant to the content of this review/study.

Supplementary material

40258_2019_506_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jacky Mathonnat
    • 1
    Email author
  • Martine Audibert
    • 2
  • Salam Belem
    • 3
  1. 1.University Clermont Auvergne and FERDI (Fondation pour les Etudes et Recherches sur le Développement International)Clermont-FerrandFrance
  2. 2.University Clermont Auvergne, CERDI (Centre d’Etudes et de Recherches sur le Développement International)Clermont-FerrandFrance
  3. 3.Sahel Demographic Dividend (SWEDD), Health Development Support ProgramMinistry of HealthOuagadougouBurkina Faso

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