The fiscal sustainability of Burkina Faso's free health care policy for maternal and child health: an analysis using the fiscal space diamond.

backgroundIn April 2016, Burkina Faso implemented a free maternal and child health care program. Program monitoring after the policy’s introduction showed increased stock-outs of essential drugs and supplies. The program’s outcomes could differ from those expected if financing and resources were insufficient.

objectiveThis study investigated the program’s fiscal sustainability by examining ways to finance its implementation effectively.

methodsA slightly modified four-dimension definition of fiscal space was used to examine whether Burkina Faso had sufficient financial capacity to support its free health care program. Secondary data from various sources covering the years 1970–2018, 2008–2018, and 2009–2021, were used to estimate the optimal tax rate, analyze the efficiency of health care service delivery, and examine official development assistance, respectively. 2008–2018, 2009–2021, and 1970–2018 were used to estimate the optimal tax rate, analyze official development assistance, and the efficiency of the delivery of health care services, respectively. Furthermore, the fiscal burden of the free care program was evaluated through a desk review.

resultsUnder scenario 1, the free health care program will consume 14.60% and 16.00% of the MoH budget in 2018 and 2023, respectively, equaling 0.40% and 0.50% of the overall GDP in those years. The burden of the program will be substantially lower under scenarios 2 and 3, ranging from 11.70% to 14.60% and 9.70% to 14.60% of the MoH’s budget, respectively. Furthermore, the estimated optimal tax rate for expanding the fiscal space was 24.00%, in contrast to the current tax rate of 17.30%. This indicates that a slight increase in total tax revenues would be sufficient to fund the program, as the 6.70% margin for increasing tax revenues (24.00%-17.30%) will suffice to cover the policy, whose burden was estimated at 2.50% of the total tax revenues. The findings also reported an average technical efficiency score of 0.73 from 2008 to 2018, suggesting there may be room for additional savings.

conclusionsTo efficiently meet the policy’s financial requirements, it is imperative to strengthen domestic resource mobilization through taxation, reduce health care inefficiency, and improve the coordination of joint financing arrangements. These must go together with a strong commitment from the government to pursue program implementation.