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Background: In April 2016, Burkina Faso began free healthcare for children aged from 0 to 5 years. However, its implementation faces challenges, and the goal of this study is to estimate the fees paid for this child care and to determine the causes of these direct payments., Methods: Data gathering involved 807 children aged from 0 to 5 years who had contact with the public healthcare system. The estimation of the determinants of out-of-pocket health payments involved the application of a two-part regression model., Results: About 31% of the children made out-of-pocket payments for healthcare (an average of 3407.77 CFA francs per case of illness). Of these, 96% paid for medicines and 24% paid for consultations. The first model showed that out-of-pocket payments were positively associated with hospitalization, urban area of residence, and severity of illness, were made in the East-Central and North-Central regions, and were negatively associated with the 7 to 23 month age range. The second model showed that hospitalization and severity of illness increased the amount of direct health payments., Conclusion: Children targeted by free healthcare still make out-of-pocket payments. The dysfunction of this policy needs to be studied to ensure adequate financial protection for children in Burkina Faso.

Background: Monitoring financial protection is a key component in achieving Universal Health Coverage, even for health systems that grant their citizens access to care free-of-charge. Our study investigated out-of-pocket expenditure (OOPE) on curative healthcare services and their determinants in rural Malawi, a country that has consistently aimed at providing free healthcare services., Methods: Our study used data from two consecutive rounds of a household survey conducted in 2012 and 2013 among 1639 households in three districts in rural Malawi. Given our explicit focus on OOPE for curative healthcare services, we relied on a Heckman selection model to account for the fact that relevant OOPE could only be observed for those who had sought care in the first place., Results: Our sample included a total of 2740 illness episodes. Among the 1884 (68.75%) that had made use of curative healthcare services, 494 (26.22%) had incurred a positive healthcare expenditure, whose mean amounted to 678.45 MWK (equivalent to 2.72 USD). Our analysis revealed a significant positive association between the magnitude of OOPE and age 15-39 years (p = 0.022), household head (p = 0.037), suffering from a chronic illness (p = 0.019), illness duration (p = 0.014), hospitalization (p = 0.002), number of accompanying persons (p = 0.019), wealth quartiles (p 2  = 0.018; p 3  = 0.001; p 4  = 0.002), and urban residency (p = 0.001)., Conclusion: Our findings indicate that a formal policy commitment to providing free healthcare services is not sufficient to guarantee widespread financial protection and that additional measures are needed to protect particularly vulnerable population groups.

Introduction: Overwhelming evidence suggests that out-of-pocket expenditures (OOPEs) hamper access to care and impose a heavy economic burden across sub-Saharan Africa (SSA). Still, current user fee reduction and removal policies often target specific groups and services, leaving large sections of the population exposed to OOPE., Methods: To estimate the magnitude and the determinants of OOPE for curative services in Burkina Faso, we used data from a household survey conducted in 24 districts between October 2013 and March 2014 (n = 7844). Given a context of medical pluralism, we purposely focused on total OOPE irrespective of type of care sought. We used a two-part regression model to estimate determinants of OOPE., Results: Nearly 60% of those who reported an illness episode incurred a positive expenditure, with an average amount of 9362.52 FRS CFA per episode (1 USD = 577.94 FRS CFA). The first model revealed that the probability of incurring a positive OOPE was positively associated with perceived illness severity (P < .001), hospitalization (P < .001), and negatively associated with age (P = .026), distance (P = .060), and poorest wealth quintile (P = .054). The second model revealed that the magnitude of OOPE was positively associated with age (P = .087), education (P = .025), being household head (P = .015), having a chronic comorbidity (P = .025), perceived illness severity (P = .029), and hospitalization (P < .001) and negatively associated with symptoms unlikely to lead to adverse outcomes if not attended to in time (P = .056)., Conclusion: Our findings indicate that OOPEs remain a problem in Burkina Faso and that broader spectrum policy reforms are urgently needed to ensure adequate financial protection., (© 2019 John Wiley & Sons, Ltd.)