SP4PHC in Burkina Faso

The Government of Burkina Faso is driving health financing reforms amidst significant security challenges. Through the SP4PHC project, ThinkWell supports the implementation of these reforms, specifically Gratuité, a policy to eliminate out-of-pocket payments for reproductive, maternal, newborn, and child health services. ThinkWell partners with the Technical Secretariat for Health Financing Reforms (ST-RFS) of the Ministry of Health to tackle emerging challenges, fortify financial control and validation mechanisms, and ensure sustainability of the Gratuité scheme for women and children under five. Additionally, ThinkWell is supporting the government to establish a minimum digital ecosystem to provide policymakers and health managers with better access to data to support decision-making.

ThinkWell’s accomplishments in Burkina Faso

  • Supported the Ministry of Health to improve implementation of the Gratuité policy. Our support has contributed to continued growth in the use of free family planning (FP) and maternal, newborn, and child health services nationwide, improving access and equity across regions and poverty levels. Early work was based on the learning generated from our overview of the Gratuité policy and review of control mechanisms for the user fee exemption policy (Gratuité) in Burkina Faso, conducted together with RESADE and the Ministry of Health.
  • Provided analytical and technical support to the Ministry of Health, enabling them to introduce harmonized tariffs for Gratuité claims for key services, throughout the public sector.
  • Strengthened the control and validation systems for Gratuité, which increased the efficiency of the scheme and improved quality of services.
  • Revitalized the Gratuité program’s routine feedback bulletin after a three-year hiatus, facilitating transparency and enabling a swift response to implementation challenges.
  • Undertook an assessment of the FP Gratuité pilot, which became a key advocacy resource and informed the national rollout of free FP in July 2020.

Current workstreams and activities

Workstream One: Support effective Gratuité implementation and coherence with NHI

  • Assist the MOH in designing and implementing reforms to strengthen Gratuité.
  • Contribute to developing a ‘road map’ for the transition of Gratuité from the Ministry of Health to CNAMU (Caisse Nationale d’Assurance Maladie Universelle – the National Health Insurance Fund).
  • Work with the MOH to identify and develop opportunities to strengthen purchasing arrangements for priority services that are integrated into maternal and newborn services.

Workstream Two: Support knowledge production and strengthen data utilization to enhance PHC purchasing

  • Support designing and implementing a Minimum Digital Ecosystem to enable improved provider and health system performance management.
  • Decentralize Gratuité data management by empowering frontline health workers to enter, analyze, and monitor Gratuité data independently.
  • Support public access to Gratuité data to strengthen accountability.
  • Support regional learning initiatives on user fee exemption (including for family planning).

Workstream Three: Increase financing for purchasing arrangements targeting PHC services

  • Increase and improve local government resource allocation to PHC (including working with select communes to identify ways to allocate funds to PHC, increasing local ownership
  • Explore policy options for sustainable resource mobilization for PHC

More information about the project can be found in this one-pager and in this slide deck.

Featured learning products

Has the Gratuité policy reduced inequities in geographic access to antenatal care in Burkina Faso? Evidence from facility-based data from 2014 to 2022

March 21, 2024

This paper builds on our earlier work that showed that the Gratuité policy has increased the utilization of maternal, newborn, and child health services. Here we demonstrate the extent to which the policy improves equity in access to services. We show that Gratuité has had a particularly beneficial impact for women seeking antenatal care services who live farthest (more that 10 km) from a health facility.

Effectiveness of the Gratuité user fee exemption policy on utilization and outcomes of maternal, newborn, and child health services in conflict-affected districts of Burkina Faso from 2013 to 2018: A pre-post analysis

This research paper, published in July 2023, investigates the impact of Burkina Faso’s Gratuité policy, a user fee exemption initiative for maternal, newborn, and child health (MNCH) services. Conducted in conflict-affected districts of Burkina Faso, we found that the policy significantly boosted the use of MNCH services. Notably, there were significant increases in sixth day postnatal care visits for women, new consultations for children under one year and children aged 1-4 years, and treatment of uncomplicated malaria cases in children under five years. The findings highlight the crucial need for sustained funding for such policies, especially in conflict-affected areas, to prevent the reversal of these health gains.

Devolution of the Health Sector to Communes: A Misfit in the National Health System Governance Framework and Management Shortfalls in Burkina Faso

Over the past five decades, subnational government units around the world have assumed some extent of decision-making authority. This often occurs through devolution, a reform that typically involves the transfer of different government functions related to sectors, such as health, from the central government to subnational units. Devolution often entails changes to public financial management (PFM) rules, systems, and processes. Public funds lie at the heart of sustainable health financing policy for achieving UHC. The World Health Organization (WHO) and ThinkWell jointly developed a series of case studies to explore the implications of devolution for health financing, with a deep dive into PFM issues. This case study, published in April 2022, details health financing and health-related PFM processes in Burkina Faso, a country where decentralized governance was introduced 30 years ago when the country established a democratic government.

Review of control mechanisms for the user fee exemption policy, Gratuité, in Burkina Faso

In Burkina Faso, SP4PHC works closely with the government on its user fee exemption scheme, known as Gratuité, which provides a defined package of FP and MNCH services free of charge to pregnant women and children under five years old. ThinkWell activities in Burkina Faso include providing technical support to the Technical Secretariat for Universal Health Coverage (ST-CSU) to increase the efficiency and effectiveness of control and verification procedures for Gratuité. The control mechanism of the Gratuité program, instituted to ensure that high-quality services are delivered free of charge, is run by the Ministry of Health (MOH) ST-CSU. A review of the Gratuité program’s control mechanism was conducted by the ST-CSU and ThinkWell. The purpose of this brief, published in January 2022, is to document the Gratuité control mechanism and capture lessons for its improvement.

Other learning products



SP4PHC aims to improve how governments purchase primary health care services, with a focus on family planning and maternal, newborn, and child health. SP4PHC is supported by a grant from the Bill & Melinda Gates Foundation.