title: Why do women pay more than they should? A mixed methods study of the implementation gap in a policy to subsidize the costs of deliveries in Burkina Faso.
abstract: In 2007, Burkina Faso launched a public policy to subsidize 80% of the cost of normal deliveries. Although women are required to pay only the remaining 20%, i.e., 900F CFA (1.4 Euros), some qualitative evidence suggests they actually pay more. The aim of this study is to test and then (if confirmed) to understand the hypothesis that the amounts paid by women are more than the official fee, i.e., their 20% portion. A mixed method sequential explanatory design giving equal priority to both quantitative (n=883) and qualitative (n=50) methods was used in a rural health district of Ouargaye. Half (50%, median) of the women reported paying more than the official fee for a delivery. Health workers questioned the methodology of the study and the veracity of the women's reports. The three most plausible explanations for this payment disparity are: (i) the payments were for products used that were not part of the delivery kit covered by the official fee; (ii) the implementers had difficulty in understanding the policy; and (iii) there was improper conduct on the part of some health workers. Institutional design and organizational practices, as well as weak rule enforcement and organizational capacity, need to be considered more carefully to avoid an implementation gap in this public policy.
authors.affiliation: Research Centre of the University of Montreal Hospital Centre (CRCHUM), Canada. valery.ridde@umontreal.ca
authors.forename: Valéry
authors.initials: V
authors.lastname: Ridde
authors.forename: Seni
authors.initials: S
authors.lastname: Kouanda
authors.forename: Maurice
authors.initials: M
authors.lastname: Yameogo
authors.forename: Kadidiatou
authors.initials: K
authors.lastname: Kadio
authors.forename: Aristide
authors.initials: A
authors.lastname: Bado
mesh_terms: D000328:Adult; D002050:Burkina Faso; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000191:economics*; D005251:Fees, Medical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008483:Medical Assistance / Q000706:statistics & numerical data*; D057766:Policy; D012959:Socioeconomic Factors