ArticleBulletin of the World Health Organization2013
Removal of user fees no guarantee of universal health coverage: observations from Burkina Faso.
Article in Bulletin of the World Health Organization, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed.
- Household costs of care in children under five attending primary care in Burkina Faso, Guinea, Mali and Niger: a cross-sectional study nested in the AIRE project.BMJ global health · 2025Article
- Assessment of Household Catastrophic Total Cost of Tuberculosis and Its Determinants in Cairo: Prospective Cohort Study.Tuberculosis and respiratory diseases · 2022Article
- Economic burden of tuberculosis in Tanzania: a national survey of costs faced by tuberculosis-affected households.BMC public health · 2022Article
- Engagement of non-governmental organisations in moving towards universal health coverage: a scoping review.Globalization and health · 2021Article
- Factors associated with the use of maternal health services by mothers in a post-conflict area of western Côte d'Ivoire in 2016.BMC health services research · 2020Article
- The impact of increased reimbursement rates under the new cooperative medical scheme on the financial burden of tuberculosis patients.Infectious diseases of poverty · 2019Article
- Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia.PloS one · 2019Article
- Assessing out-of-pocket expenditures for primary health care: how responsive is the Democratic Republic of Congo health system to providing financial risk protection?BMC health services research · 2018Article
- Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India.Health economics review · 2018Article
- Comparison of two cash transfer strategies to prevent catastrophic costs for poor tuberculosis-affected households in low- and middle-income countries: An economic modelling study.PLoS medicine · 2017Article
- Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya.International journal for equity in health · 2017Article
- Collaborative Approaches and Policy Opportunities for Accelerated Progress toward Effective Disease Prevention, Care, and Control: Using the Case of Poverty Diseases to Explore Universal Access to Affordable Health Care.Frontiers in medicine · 2017Article
- Determinants of Healthcare Utilisation and Out-of-Pocket Payments in the Context of Free Public Primary Healthcare in Zambia.International journal of health policy and management · 2016Article
- Beyond pills and tests: addressing the social determinants of tuberculosis.Clinical medicine (London, England) · 2016Article
- The economic effects of supporting tuberculosis-affected households in Peru.The European respiratory journal · 2016Article
- Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China.Infectious diseases of poverty · 2016Article
- Mitigating Financial Burden of Tuberculosis through Active Case Finding Targeting Household and Neighbourhood Contacts in Cambodia.PloS one · 2016Article
- What can dissaving tell us about catastrophic costs? Linear and logistic regression analysis of the relationship between patient costs and financial coping strategies adopted by tuberculosis patients in Bangladesh, Tanzania and Bangalore, India.BMC health services research · 2015Article
- Defining catastrophic costs and comparing their importance for adverse tuberculosis outcome with multi-drug resistance: a prospective cohort study, Peru.PLoS medicine · 2014Article
- No effect of user fee exemption on perceived quality of delivery care in Burkina Faso: a case-control study.BMC health services research · 2014Article
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6 authors.
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Abstract
In theory, the removal of user fees puts health services within reach of everyone, including the very poor. When Burkina Faso adopted the DOTS strategy for the control of tuberculosis, the intention was to provide free tuberculosis care. In 2007-2008, interviews were used to collect information from 242 smear-positive patients with pulmonary tuberculosis who were enrolled in the national tuberculosis control programme in six rural districts. The median direct costs associated with tuberculosis were estimated at 101 United States dollars (US$) per patient. These costs represented 23% of the mean annual income of a patient's household. During the course of their care, three quarters of the interviewed patients apparently faced "catastrophic" health expenditure. Inadequacies in the health system and policies appeared to be responsible for nearly half of the direct costs (US$ 45 per patient). Although the households of patients developed coping strategies, these had far-reaching, adverse effects on the quality of lives of the households' members and the socioeconomic stability of the households. Each tuberculosis patient lost a median of 45 days of work as a result of the illness. For a population living on or below the poverty line, every failure in health-care delivery increases the risk of "catastrophic" health expenditure, exacerbates socioeconomic inequalities, and reduces the probability of adequate treatment and cure. In Burkina Faso, a policy of "free" care for tuberculosis patients has not met with complete success. These observations should help define post-2015 global strategies for tuberculosis care, prevention and control.
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