ArticlePloS one2015
Abolishing Fees at Health Centers in the Context of Community Case Management of Malaria: What Effects on Treatment-Seeking Practices for Febrile Children in Rural Burkina Faso?
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Place of death, care-seeking and care pathway progression in the final illnesses of children under five years of age in sub-Saharan Africa: a systematic review.Journal of global health · 2019Pooled it
- Pooled it
- Trial
- Seasonal malaria chemoprevention in an area of extended seasonal transmission in Ashanti, Ghana: an individually randomised clinical trial.Tropical medicine & international health : TM & IH · 2016Trial
- Article
- The fiscal sustainability of Burkina Faso's free health care policy for maternal and child health: an analysis using the fiscal space diamond.BMC health services research · 2026Article
- Evaluating the effects of the free healthcare policy on clinical visits and malaria among children in Burkina Faso: a modeling study of past trends and future forecasts.Global health research and policy · 2025Article
- The evolution of facility-based deliveries at primary healthcare centres during an insecurity and conflict crisis in Burkina Faso: a geospatial analysis.Conflict and health · 2025Article
- Examining the effect of nearby armed conflict on access to maternal and child health services in Burkina Faso's primary healthcare facilities.BMJ global health · 2025Article
- Impact of the free healthcare policies in Burkina Faso: underscoring important nuances.Health policy and planning · 2025Article
- Effects of the free healthcare policy on maternal and child health in Burkina Faso: a nationwide evaluation using interrupted time-series analysis.Health economics review · 2023Article
- To What Extent Do Free Healthcare Policies and Performance-Based Financing Reduce Out-of-Pocket Expenditures for Outpatient services? Evidence From a Quasi-experimental Study in Burkina Faso.International journal of health policy and management · 2023Article
- Individual and Contextual Factors Associated With Malaria Among Children 6-59 Months in Burkina Faso.International journal of public health · 2023Article
- Does abolishing user fees for family planning increase contraception use? An impact evaluation of the national policy in Burkina Faso.Journal of global health · 2022Article
- Observational
- Using experience to create evidence: a mixed methods process evaluation of the new free family planning policy in Burkina Faso.Reproductive health · 2022Article
- Socioeconomic inequalities in curative healthcare-seeking for children under five before and after the free healthcare initiative in Sierra Leone: analysis of population-based survey data.International journal for equity in health · 2021Article
- Free healthcare for some, fee-paying for the rest: adaptive practices and ethical issues in rural communities in the district of Boulsa, Burkina Faso.Global bioethics = Problemi di bioetica · 2021Article
- User fee policies and women's empowerment: a systematic scoping review.BMC health services research · 2020Article
- Effects of terrorist attacks on access to maternal healthcare services: a national longitudinal study in Burkina Faso.BMJ global health · 2020Article
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
Abstract
introductionBurkina Faso started nationwide community case management of malaria (CCMm) in 2010. In 2011, health center user fees for children under five were abolished in some districts.
objectiveTo assess the effects of concurrent implementation of CCMm and user fees abolition on treatment-seeking practices for febrile children.
methodsThis is a natural experiment conducted in the districts of Kaya (CCMm plus user fees abolition) and Zorgho (CCMm only). Registry data from 2005 to 2014 on visits for malaria were collected from all eight rural health centers in the study area. Annual household surveys were administered during malaria transmission season in 2011 and 2012 in 1,035 randomly selected rural households. Interrupted time series models were fitted for registry data and Fine and Gray's competing risks models for survey data.
resultsUser fees abolition in Kaya significantly increased health center use by eligible children with malaria (incidence rate ratio for intercept change = 2.1, p <0.001). In 2011, in Kaya, likelihood of health center use for febrile children was three times higher and CHW use three times lower when caregivers knew services were free. Among the 421 children with fever in 2012, the delay before visiting a health center was significantly shorter in Kaya than in Zorgho (1.46 versus 1.79 days, p <0.05). Likelihood of visiting a health center on the first day of fever among households <2.5 km or <5 km from a health center was two and three times higher in Kaya than in Zorgho, respectively (p <0.001).
conclusionsUser fees abolition reduced visit delay for febrile children living close to health centers. It also increased demand for and use of health center for children with malaria. Concurrently, demand for CHWs' services diminished. User fees abolition and CCMm should be coordinated to maximize prompt access to treatment in rural areas.
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