SP4PHC in Burkina Faso

Health financing reforms in Burkina Faso take place in a challenging environment, as the country struggles with security concerns and labor unrest. SP4PHC works with the Ministry of Health (MoH) to support reforms through pragmatic steps to enhance strategic purchasing of family planning and maternal, newborn, and child health services. A key focus is the Gratuité scheme that uses government funds to replace out-of-pocket payments and allows public health facilities to provide a defined package of maternal, newborn, and child health (MNCH) services free of charge. SP4PHC gathers evidence on the Gratuité scheme, including its extension to include family planning (FP), to build consensus about ways to improve its performance, and to develop and test policy changes. SP4PHC facilitates the harmonization of the Gratuité scheme and other schemes under the Caisse Nationale d’Assurance Maladie Universelle (CNAMU), the national health insurance agency. For more information, view our Burkina Faso overview presentation and one pager. To see how our SP4PHC team in Burkina Faso has helped its government respond to Covid-19, view our Covid-19 response page.

Our Strategies

SP4PHC has three key strategies to strengthen primary health care in Burkina Faso.

Strategy 1: Support the development and effectiveness of the Gratuité scheme, and prepare for transfer to CNAMU

SP4PHC is working with government stakeholders and development partners to build consensus around the challenges and opportunities of the Gratuité scheme and to establish a working group on purchasing primary health care. Together we will explore opportunities to increase efficiency by simplifying and harmonizing systems. SP4PHC will build from this to support the design and testing of modifications to Gratuité, and towards the transition of Gratuité management to CNAMU.

Strategy 2: Supporting MoH’s effort to expand Gratuité to include free family planning

The MoH, through the technical secretary for the demographic dividend (ST/ATD), has launched integration of FP services into the Gratuité scheme. SP4PHC is supporting the ST/ATD to facilitate dialogue and generate evidence to guide policy and implementation of free FP services nationally.

Strategy 3: Support incorporation of incentives for quality into Gratuité

Health facility quality assessment is resource intensive, and a coherent approach to quality measurement can help to maximize efficiency. SP4PHC is reviewing the range of quality tools used by the MoH – including the national guide under development – with an emphasis on costs and alignment. Building from this review, SP4PHC will facilitate discussions to improve quality measurement, with the goal of strengthening incentives for quality of care through purchasing.


These three factsheets below serve as a reference and aim to visualize the latest data and trends on purchasing family planning, maternal & newborn health services, and a broader overview of purchasing in Burkina Faso.  Each factsheet also highlights some of the activities the SP4PHC country team is working on with local stakeholders within that topic area.  These factsheets are updated annually (latest in May 2021).

Health Purchasing Factsheet                     Maternal, Newborn and Child Health Factsheet                  Family Planning Factsheet

Featured Learning Products

A Review of the Control Mechanism for Burkina Faso’s Gratuité Policy

This brief describes how Burkina Faso’s Ministry of Health controls the implementation of its Gratuité program to ensure free access to family planning and maternal and child health services. ThinkWell worked with the Ministry’s Technical Secretariat for Universal Health Coverage to review the control mechanism’s design and implementation, analyze data, and develop recommendations in order to further strengthen Gratuité.

Gratuité scheme’s routine feedback bulletin

ThinkWell successfully supported the Technical Secretariat for UHC to produce the second publication of the Gratuité program’s routine feedback bulletin. Using data from the e-Gratuité platform and reports from contracted non-governmental organizations (NGOs) that carry out control and evaluation functions, this sixth edition provide an updated overview of the implementation of Gratuité program in 2021. Satisfaction of health facilities needs in essential medicines fluctuated throughout the year and was generally below the national target of 80 except in September and November 2021. Beneficiary satisfaction for Gratuité services remains high nationally (above 88% for all satisfaction indicators). No significant changes were recorded on beneficiary perception of quality of services the Centre-East and South-West regions. Satisfaction rates on confidentiality, waiting time and hygiene remain lower than the national average.

Rolling Out Free Family Planning in Burkina Faso is Improving Choice, But Who Will Pay?

In July 2020, Burkina Faso’s Ministry of Health moved to improve access to family planning (FP) by extending ‘Gratuité’ – a user fee exemption scheme for women and children – to make FP services free of charge in all public facilities. ThinkWell has been supporting the MOH to undertake routine analysis of free FP data to understand how it’s worked so far, what the red flags are, and what can be done to improve it. This blog post originally appeared on Sexual and Reproductive Health Matters here and it is available in French here.

Analysis of Demand and Costs of Family Planning, October-December 2020 (Analyse des demandes et des coûts de planification familiale, octobre à décembre 2020)

ThinkWell completed an analysis of FP claims from the national roll-out of free FP services through to the end of 2020. The data show continued increase in free FP claims nationwide, with nearly 90% of health districts claiming for free services by the end of 2020. The costs of free FP services have also continued to increase, with a spike in costs in October 2020 associated with the National FP week. This factsheet published in March 2021 is the second in a series of quarterly updates to summarize key findings of the national roll-out of free FP services, showing method mix, geographical distribution, and costs.

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.