towards universal health care in Burkina Faso

When only 1% of your population has health insurance, the road to universal coverage is a long one. Burkina Faso is beginning this journey, but is off on a rocky start.

In 2012 an initiative was launched to provide healthcare for the “poorest of the poor”. The International Social Security Review, a journal published for the International Social Security Association under the under the auspices of the International Labour Organization, has an article on this in the latest issue. Unfortunately, it is available to subscribers only. I do not have a subscription, so could only read the abstract, which I reproduce below.

The initiative was not successful, as might have been predicted, as the poor were required to make co-payments, no doubt on top of their insurance contribution, and were limited to three visits to a doctor or hospital per year. It is not clear from the abstract if this limitation was per family or per family member.

To enable mutual health funds to extend coverage to poor people, the Mutual Health Support Network (Réseau d’appui aux mutuelles de santé – RAMS) in 2012 launched an initiative in collaboration with the Ministry of Social Action and Solidarity (ministère de l’Action sociale et de la Solidarité nationale – MASSN) in Burkina Faso. This article reveals difficulties in the initiative’s implementation, which resulted in the continued exclusion of poor people from health services. Poor people were required not only to make co-payments, but also to accept a limitation of coverage to three episodes of illness per year.

True universal health care, reaching the poorest of the poor, must be funded by taxation – by general government revenue – not by social security contributions paid by rich and poor alike. Apparently the government has no intention of moving toward a truly universal system, as the abstract continues (and concludes) with the following information:

Additional challenges to service takeup were the geographical distance of the homes of some beneficiaries covered by a mutual fund agreement from a health centre and the failure by some health workers and managers of pharmacies to recognize the mutual membership card. A formal framework was lacking that brought together all the actors involved in planning and implementing the initiative. Those involved did not all have the same information. Each structure performed the tasks within its scope, according to its own interests, but without consulting the other parties, and there was no platform for discussing implementation difficulties.

Kadio Kadidiatou, Kafando Yamba, Ouédraogo Aboubacar and Valéry Ridde, “Analysis of the implementation of a social protection initiative to admit the poorest of the poor to mutual health funds in Burkina Faso”, International Social Security Review 71:1 (January/March 2018, gated paywall).

With help from google, I was able to locate another study of this initiative, funded by the Canadian Institutes of Health Research (CIHR) through the project “Community research studies and interventions for health equity in Burkina Faso” (Grant number ROH-115213). Importantly, the article is not gated! For me, the most important information was that only a tiny proportion of the population of Burkina Faso has health insurance (0.5% of women and 1.5% of men), and the intitiative as of 2016 was still a “pilot program”. Most likely, this is also true in 2018.

Here are brief excerpts from the article. Two of the authors are also co-authors of the recent International Social Security Review article that I cited above.

UHC [Universal Health Care] in Burkina Faso is representative of francophone West Africa in general. In 2010, only 0.5% of women and 1.5% of men were covered by health insurance. Current health system funding … does not allow for cross-subsidization among population segments. ….

A parliamentary workshop held in September 2014 finalized a bill concerning UHC strategies. This bill, scheduled for parliamentary debate in October 2014, … stipulates that coverage will be conditional on an (eventually mandatory) contribution, to be set according to each household’s capacity. Operational issues such as the healthcare package and third-party payment will be set by decrees. A three-year pilot program will be conducted to evaluate different funding models and care packages.

Isabelle Agier, Antarou Ly, Kadidiatou Kadio, Seni Kouanda, and Valéry Ridde, “Endorsement of universal health coverage financial principles in Burkina Faso“, Social Science & Medicine 151 (February 2016), pp. 157-166. Free access.

According to Pension Watch (HelpAge International), only 2.7% of the 65+ population of Burkina Faso have a pension, and there is no social pension. So, the elderly of Burkina Faso not only have no access to healthcare, they also have no pension income!


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