Ganaba Rasmané, Ilboudo Patrick G C, Cresswell Jenny A, Yaogo Maurice, Diallo Cheick Omar, Richard Fabienne, Cunden Nadia, Filippi Veronique, Witter Sophie
AFRICSanté, Bobo-Dioulasso, Burkina Faso.
London School of Hygiene and Tropical Medicine, London, UK.
BMC Pregnancy Childbirth. 2016 Apr 21;16:84. doi: 10.1186/s12884-016-0875-2.
Burkina Faso, like many low and middle income countries, has been taking a range of actions to address its poor maternal and neonatal health indicators. In 2006 the government introduced an innovative national subsidy scheme for deliveries and emergency obstetric care in public facilities. This article reports on a complex evaluation of this policy, carried out 5 years after its introduction, which examined its effects on utilisation, quality of care, equity and the health system as a whole, as well as its cost and sustainability.
The evaluation was carried out in six purposively selected districts, as well as at national level, using a case study approach. Data sources included: national and district routine and survey data, household interviews with women who had recently given birth, data extraction from hospital and medical records, and key informant and health worker interviews.
The underlying secular trend of a 1% annual increase in the facility-based delivery rate (1988-2010) was augmented by an additional 4% annual increase from 2007 onwards (after the policy was introduced), especially in rural areas and amongst women from poor households. The absence of baseline quality of care data made it difficult to assess the impact of the policy on quality of care, but hospitals with the best level of implementation of the subsidy offered higher quality of care (as measured by health care near-misses), so there is no evidence of a negative impact on quality (as is often feared). Similarly, there is little evidence of unintended negative effects on untargeted services. Household payments for facility-based deliveries have reduced significantly, compared with payments before the policy, and the policy as a whole is affordable, costing about 2% of total public health expenditure. Concerns include that the amounts paid by households are higher than the rates set by the policy, and also that 7% of households still say that they cannot afford to pay. Wealthier women have higher utilisation of services, as before, and the policy of fully exempting indigents is not being put into practice.
These findings highlight the importance of maintaining the subsidy policy, given the evidence of positive outcomes, but they also point out areas where attention is needed to ensure the poor and most vulnerable population benefit fully from the policy.
与许多低收入和中等收入国家一样，布基纳法索一直在采取一系列行动来改善其糟糕的孕产妇和新生儿健康指标。2006年，政府针对在公共机构分娩和接受急诊产科护理推出了一项创新型国家补贴计划。本文报告了该政策实施5年后对其进行的一项综合评估，该评估考察了其对利用率、护理质量、公平性以及整个卫生系统的影响，以及其成本和可持续性。
采用案例研究方法，在六个经过有目的选择的地区以及国家层面开展评估。数据来源包括：国家和地区的常规及调查数据、对近期分娩妇女的家庭访谈、从医院和医疗记录中提取的数据，以及关键信息提供者和卫生工作者访谈。
1988 - 2010年基于机构分娩率每年1%的潜在长期增长趋势，在2007年政策实施后又额外增加了每年4%，尤其是在农村地区以及贫困家庭的妇女中。由于缺乏护理质量的基线数据，难以评估该政策对护理质量的影响，但补贴实施水平最佳的医院提供了更高质量的护理（以医疗失误未遂衡量），所以没有证据表明对质量有负面影响（正如人们经常担心的那样）。同样，几乎没有证据表明对非目标服务有意外的负面影响。与政策实施前的支付情况相比，基于机构分娩的家庭支付显著减少，而且该政策总体上是可承受的，成本约占公共卫生总支出的2%。令人担忧的是，家庭支付的金额高于政策设定的费率，而且仍有7%的家庭表示他们无力支付。与以前一样，较富裕的妇女对服务的利用率更高，并且完全免除贫困者费用的政策并未得到实施。
这些发现凸显了鉴于积极成果而维持补贴政策的重要性，但它们也指出了需要关注的领域，以确保贫困和最脆弱人群能充分受益于该政策。
