This blog is also available in French. CE blog est distable en français.
Written by Matt Boxhall (Thinkwell), Sarah Straubinger (Thinkwell), Kadidia Dissa Boro (Thinkwell Burkina Faso), Pierre-Marie Metangmo (Thinkwell Burkina Faso)
Despite the many competitive challenges, the Burkina Faso government continues to prove its commitment to sexual and reproductive health rights. In July 2020, the Burkina Ministry of Health (MOH) moved to improve equality and access to family planning (FP) by expanding ‘Male” – A user’s fee exemption system for women and children under 5 years of age – to make FP services free in all public installations. Thinkwell supports MOH to undertake routine resolution of free FP data. The analysis shows that the number of claims submitted has increased rapidly during the first three months of the program, based mainly on the demand for contraceptive implants. However, the removal of user fees does not appear to have increased the overall intake of FP in Burkina Faso and it is not clear how the cost of returns for free services from MOH will be met.
Government commitment, backed by strong international support, allowed FP to be relatively high in Burkina Faso in accordance with regional standards, but there is still a lot of room for improvement. The national plan to accelerate FP is aimed at a modern 32% contraceptive rate by 2020 but Recent data indicate that this target will not be reached. The very high overall percentage of burkina fertility (5.2 Births per woman) contributes to environmental and security pressures in the area.
The Burkina government FASO adopted the Political Free Health Services Gratuité in 2016 and announced its extension to include FP in 2018. According to Gratuité, public installations at national level provide a free package of mothers, neonates and children (MNCH). Facilities replace the lost income from users’ fees through government equivalent payments. MOH’s 2018 decision to extend the plan to include FP services was informed by proof of improved access to MNCH services through Gratuité, as well as the success of the annual “FP Free Week”. A free FP pilot in Gratuité ran from June to December 2019 in Cascades and Center-Uest.
Despite the COVID-19 crisis, the hiring of FP services remained stable in Burkina Faso and in July 2020 MOH decided to develop free FP services at national level. It is intended for anyone who is sexually active, free FP benefits under Gratuité includes FP counseling and long -acting contraceptive methods, as well as for the management of side effects and complications.
Analysis of the original FP Male Data shows the increase in intake of free services driven by demand for implants. Thinkwell is working with the Ministry of Health to conduct the usual data analysis of free FP claims. Claims have increased steadily between July and September 2020, with over 80% of health areas reporting that they have offered free FP services in September. Most claims come from primary level health facilities (95% from Center de Soins et de Promotion Sociale) and farm sites (72%), suggesting that free services reach those in the most in need. Contraceptive implants are the dominant free method, creating 72% of the two years of CYPS and perhaps signaling that the removal of fees increases access to long -acting review methods.
Although the number of free services is increasing, this does not translate into an increase in FP services overall. In the first trimester of Roll-out, free services simply replace services paid out of pocket. Findings from the pilot suggest some possible reasons for this. The lack of demand for demand and awareness of the community can alleviate the impact of the plan. A limited understanding of the providers of program reference procedures can also reduce their willingness to provide free FP. Since September 2020, 20% of the areas have not yet reported FP claims in the E-Gatuité system.
An underlying issue and a long -term challenge may be the impact of the removal of user fees on provider’s motives. At Burkina Faso, the opportunity to generate immediate income for installation through user charges may have encouraged a preventive offer of family planning services. Introducing User’s remuneration programs in other African countries has reduced the motives of health workers in the health sector. A review of the Gratuité program also identified that providers regarded the reference system as a complex; Increasing administrative weight and undermine morale. Perceptions of delayed or inadequate payment by government led discontent with Gratuité among MNCH service providers; Such delays may contribute to incentives of bad providers in similar shapes.
Inadequate budget forecast for free FP is also a critical challenge for the program. The cost of free FP services increases each month and reaches 91 million CFA francs (about $ 167 thousand US) in September 2020. Gratuité is funded by the state budget, which has all immediate health care costs of covered services. Providing free MNCH services through Gratuité worked well until budget cuts in 2018 caused deficiencies in premises and debt payments at the Central Medical Store. In 2021, the Free FP will definitely cost the state over a million dollars – not a weak amount, but no additional funds have been allocated to FP. Unsure and inadequate funding is a challenge for the continued development of free FP and Free MNCH services.
Despite these challenges, the first results of Burkina Faso’s experiences that provide free FP shows that the plan has the ability to increase women’s selection and improve access to FP. In order to improve performance, the Burkina Faso government will have to take steps to build FP in communities and facilities, maintain providers’ incentives and ensuring adequate budget distribution for FP services. Moh has the opportunity to learn from these early successes and concerns to maximize value and impact, as the free FP continues to grow.
Keep in mind that blog posts are not evaluated and do not necessarily reflect SRHM’s views as an organization.
