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Dar Es Salaam

SP4PHC in Burkina Faso

Health financing reforms in Burkina Faso are taking place in a challenging environment, as the country struggles with security concerns and labor unrest. SP4PHC is working with the Ministry of Health 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 services free of charge. SP4PHC is working to gather evidence on the gratuité scheme, including its extension to include family planning, to build consensus about ways to improve its performance, and to develop and test policy changes. SP4PHC is working to facilitate 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, one pager, and factsheet.

Our Strategies

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

Strategy 1: Supporting the development and effectiveness of the gratuité scheme

SP4PHC is working with government stakeholders and development partners to review the performance of the gratuité scheme, build consensus around the challenges and opportunities to improve the scheme, and to establish a working group on purchasing primary health care. Together we will explore opportunities to simplify and harmonize various purchasing mechanisms, including gratuité, performance-based financing and line-item budgets. SP4PHC will build from this to support the design and testing of modifications to gratuité, and towards the transition of gratuité management to the national health insurance agency, Caisse Nationale d’Assurance Maladie Universelle (CNAMU).

Strategy 2: Expanding gratuité to include free family planning

The Ministry of Health is piloting the integration of family planning into the gratuité scheme. SP4PHC supported the ministry to assess this pilot, including by conducting a field survey of family planning data in pilot districts. This evidence and our ongoing support to the ministry team will inform the evolution and scale-up of free family planning.

Strategy 3: Facilitating policy dialogue around strategic purchasing to improve quality

Health facility quality assessment is resource intensive, and multiple parallel quality measurement systems can be inefficient. SP4PHC is reviewing the range of quality tools used by the Ministry of Health – including the national guide under development – with an emphasis on cost savings and alignment. Building from this review, SP4PHC will facilitate discussions to improve quality measurement, with the goal of using purchasing to strengthen incentives for quality of care.

Strategy 4: Building a sustainable platform for technical policy support

Capacity in health financing is essential for the long-term success of health reforms, and technical policy support must be associated with deep contextual understanding, delivered through local leadership. SP4PHC is supporting the development of a local organization specializing in health financing to provide sustainable technical policy support to Burkina Faso and francophone West Africa.

Featured Learning Products

An Overview of the User Fee Exemption Policy (Gratuité) in Burkina Faso

In 2016 the Government of Burkina Faso introduced Gratuité, a user fee replacement policy, to increase access and utilization of healthcare services for women and children under 5 years of age. Burkina Faso’s Gratuité policy represents a valiant effort to remove financial barriers for key health services and so to improve health care access in one of the world’s poorest countries. A comprehensive review of the policy, conducted by ThinkWell and Recherche pour la Santé et le Développement (RESADE), explains how Gratuité works, analyzes its performance, and identifies areas for potential improvement. Our analysis reveals that Gratuité has been successful when sufficient funding has been available, but has faltered when budget constraints interrupted payments and undermined providers’ confidence in the Gratuité system. Our report, published in September 2020, provides a key reference and is already promoting constructive discussion and debate in Burkina Faso. The report is available in both English and French.

Removing User Fees for Family Planning Services in Burkina Faso: A Review of a Pilot Program

At the request of the Ministry of Health (MOH), ThinkWell completed a rapid assessment in April 2020 of a pilot program to integrate family planning (FP) into the ‘gratuité’ scheme for maternal, neonatal, and child health (MNCH).  The goals of this rapid assessment were to identify trends in FP uptake, document perceptions of health workers, and to verify that FP user fees had been removed. The assessment reveals that introduction of the FP gratuité has resulted in at best modest improvement in the number of FP consultations and in couple-years protection (CYP) in the pilot regions. Findings point to challenges that inhibit improvement of FP service utilization, which include absence of training around implementation of the FP gratuité and a lack of community sensitization to the scheme, as well as a limited underlying demand for FP services. The assessment findings present an opportunity for course correction, which will inform the evolution and scale-up of the FP gratuité. ThinkWell’s review is available in both English and French.

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.

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