title: The impact of targeted subsidies for facility-based delivery on access to care and equity - evidence from a population-based study in rural Burkina Faso.
abstract: We conducted the first population-based impact assessment of a financing policy introduced in Burkina Faso in 2007 on women's access to delivery services. The policy offers an 80 per cent subsidy for facility-based delivery. We collected information on delivery in five repeated cross-sectional surveys carried out from 2006 to 2010 on a representative sample of 1050 households in rural Nouna Health District. Over the 5 years, the proportion of facility-based deliveries increased from 49 to 84 per cent (P<0.001). The utilization gap across socio-economic quintiles, however, remained unchanged. The amount received for all services associated with births decreased by 67 per cent (P<0.001), but women continued to pay on average 1423 CFA (\[euro]1=655 CFA), about 500 CFA more than the set tariff of 900 CFA. Our findings indicate the operational effectiveness of the policy in increasing the use of facility-based delivery services for women. The potential to reduce maternal mortality substantially has not yet been assessed by health outcome measures of neonatal and maternal mortality.
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany. manuela.de.allegri@urz.uni-heidelberg.de
authors.forename: Manuela
authors.initials: M
authors.lastname: De Allegri
authors.forename: Valéry
authors.initials: V
authors.lastname: Ridde
authors.forename: Valérie R
authors.initials: VR
authors.lastname: Louis
authors.forename: Malabika
authors.initials: M
authors.lastname: Sarker
authors.forename: Justin
authors.initials: J
authors.lastname: Tiendrebéogo
authors.forename: Maurice
authors.initials: M
authors.lastname: Yé
authors.forename: Olaf
authors.initials: O
authors.lastname: Müller
authors.forename: Albrecht
authors.initials: A
authors.lastname: Jahn
mesh_terms: D000328:Adult; D002050:Burkina Faso; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005380:Financing, Government / Q000191:economics / Q000458:organization & administration; D005382:Financing, Personal / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008427:Maternal Health Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D012424:Rural Population