Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation.

Hdl Handle:
http://hdl.handle.net/10144/88051
Title:
Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation.
Authors:
Lambert-Evans, Sophie; Ponsar, Frederique; Reid, Tony; Bachy, Catherine; Van Herp, Michel; Philips, Mit
Journal:
International Journal for Equity in Health
Abstract:
ABSTRACT: BACKGROUND: In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. METHODS: An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. RESULTS: Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. CONCLUSION: The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty.
Affiliation:
Médecins Sans Frontières (Belgium), 94 rue Dupré, Brussels, Belgium. sophielambertevans@gmail.com.
Issue Date:
24-Oct-2009
URI:
http://hdl.handle.net/10144/88051
DOI:
10.1186/1475-9276-8-36
PubMed ID:
19852830
Language:
en
ISSN:
1475-9276
Appears in Collections:
Health Politics

Full metadata record

DC FieldValue Language
dc.contributor.authorLambert-Evans, Sophieen
dc.contributor.authorPonsar, Frederiqueen
dc.contributor.authorReid, Tonyen
dc.contributor.authorBachy, Catherineen
dc.contributor.authorVan Herp, Michelen
dc.contributor.authorPhilips, Miten
dc.date.accessioned2009-12-15T21:23:00Z-
dc.date.available2009-12-15T21:23:00Z-
dc.date.issued2009-10-24-
dc.identifier.citationFinancial access to health care in Karuzi, Burundi: a household-survey based performance evaluation. 2009, 8:36 Int J Equity Healthen
dc.identifier.issn1475-9276-
dc.identifier.pmid19852830-
dc.identifier.doi10.1186/1475-9276-8-36-
dc.identifier.urihttp://hdl.handle.net/10144/88051-
dc.description.abstractABSTRACT: BACKGROUND: In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. METHODS: An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. RESULTS: Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. CONCLUSION: The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty.en
dc.language.isoenen
dc.rightsArchived with thanks to International Journal for Equity in Healthen
dc.titleFinancial access to health care in Karuzi, Burundi: a household-survey based performance evaluation.en
dc.contributor.departmentMédecins Sans Frontières (Belgium), 94 rue Dupré, Brussels, Belgium. sophielambertevans@gmail.com.en
dc.identifier.journalInternational Journal for Equity in Healthen

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