title: Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative.
abstract: OBJECTIVE
  To gauge the effects of operating the Bamako Initiative in Kongoussi district, Burkina Faso.
  
  
  METHODS
  Qualitative and quasi-experimental quantitative methodologies were used.
  
  
  RESULTS
  Following the introduction of fees-for-services in July 1997, the number of consultations for curative care fell over a period of three years by an average of 15.4% at "case" health centres but increased by 30.5% at "control" health centres. Moreover, although the operational results for essential drugs depots were not known, expenditure increased on average 2.7 times more than income and did not keep pace with the decline in the utilization of services. Persons in charge of the management committees had difficulties in releasing funds to ensure access to care for the poor.
  
  
  CONCLUSIONS
  The introduction of fees-for-services had an adverse effect on service utilization. The study district is in a position to bear the financial cost of taking care of the poor and the community is able to identify such people. Incentives must be introduced by the state and be swiftly applied so that the communities agree to a more equitable system and thereby allow access to care for those excluded from services because they are unable to pay.
authors.affiliation: Department of Social and Preventive Medicine, Faculty of Medicine, Universit Laval, Quebec, Canada G1K 7P4. acd161@agora.ulaval.ca
authors.forename: Valéry
authors.initials: V
authors.lastname: Ridde
mesh_terms: D002050:Burkina Faso; D003151:Community Health Centers / Q000191:economics* / Q000706:statistics & numerical data; D017047:Cost Sharing; D018954:Drugs, Essential / Q000191:economics; D016568:Drugs, Generic / Q000191:economics; D018588:Fee-for-Service Plans; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics*; D006302:Health Services Research; D011203:Poverty; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D012935:Social Justice
chemical_list: D018954:Drugs, Essential; D016568:Drugs, Generic