Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2019

Open Access 01-12-2019 | Care | Research

Assessing changes in costs of maternal postpartum services between 2013 and 2014 in Burkina Faso

Authors: Danielle Yugbaré Belemsaga, Anne Goujon, Olivier Degomme, Tchichihouenichidah Nassa, Els Duysburgh, Seni Kouanda, Marleen Temmerman

Published in: International Journal for Equity in Health | Issue 1/2019

Login to get access

Abstract

Introduction

In Africa, a majority of women bring their infant to health services for immunization, but few are checked in the postpartum (PP) period. The Missed opportunities for maternal and infant health (MOMI) EU-funded project has implemented a package of interventions at community and facility levels to uptake maternal and infant postpartum care (PPC). One of these interventions is the integration of maternal PPC in child clinics and infant immunization services, which proved to be successful for improving maternal and infant PPC.

Aim

Taking stock of the progress achieved in terms of PPC with the implementation of the interventions, this paper assesses the economic cost of maternal PPC services, for health services and households, before and after the project start in Kaya health district (Burkina Faso).

Methods

PPC costs to health services are estimated using secondary data on personnel and infrastructure and primary data on time allocation. Data from two household surveys collected before and after one year intervention among mothers within one year PP are used to estimate the household cost of maternal PPC visits. We also compare PPC costs for households and health services with or without integration. We focus on the costs of the PPC intervention at days 6–10 that was most successful.

Results

The average unit cost of health services for days 6–10 maternal PPC decreased from 4.6 USD before the intervention in 2013 (Jan-June) to 3.5 USD after the intervention implementation in 2014. Maternal PPC utilization increased with the implementation of the interventions but so did days 6–10 household mean costs. Similarly, the household costs increased with the integration of maternal PPC to BCG immunization.

Conclusion

In the context of growing reproductive health expenditures from many funding sources in Burkina Faso, the uptake of maternal PPC led to a cost reduction, as shown for days 6–10, at health services level. Further research should determine whether the increase in costs for households would be deterrent to the use of integrated maternal and infant PPC.
Appendix
Available only for authorised users
Footnotes
1
We have considered the real time occupancy of the room corresponding to 100% of time allocated to services for health prevention and promotion delivered during the morning.
 
Literature
1.
2.
Ministère de la santé, COMPTES DE LA SANTE 2015 Comptes globaux & Dépenses de santé du Paludisme, du VIH/Sida, de la Tuberculose et de la Santé de la Reproduction. Ministère de la santé. Burkina Faso: Ouagadougou; 2016.
3.
Ridde V, Olivier de Sardan JP, Brouillet P. Abolishing user fees for patients in West Africa: lessons for public policy. Paris: AFD Agence Francaise de Developpement; 2013.
4.
Ministère de la santé, Gratuité des soins au Burkina Faso: liste de reference des pathologies et des prestations par niveau de soin dans les districts sanitaires. 2016, Ministère de la santé, Burkina Faso: Ouagadougou.
5.
Ministère de la santé, Guide de mise en œuvre du financement base sur les resultats dans le secteur de la sante. 2013, Ministère de la santé, Burkina faso: Ouagadougou.
6.
Steenland M, Robyn PJ, Compaore P, Kabore M, Tapsoba B, Zongo A, et al. Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso. SSM Popul Health. 2017;3:179–84.CrossRef
7.
World Health Organisation. WHO recommendations on postnatal care of the mother and new born. WHO Geneva; Switzerland. 2013;72.
8.
Duysburgh E, Kerstens B, Kouanda S, Kabore CP, Belemsaga YD, Gichangi P, Masache G, et al. Opportunities to improve postpartum care for mothers and infants: design of context-specific packages of postpartum interventions in rural districts in four sub-Saharan African countries. BMC Pregnancy and Childbirth. 2015;131(15).
9.
World Health Organization. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD MM. Geneva: World Health Organization; 2012.
10.
Djellouli N, Mann S, Nambiar B, Meireles P, Miranda D, Barros H, Colbourn T. Final evaluation of the MOMI Project in Burkina!Faso, Kenya, Malawi and Mozambique M. project, editor. 2016, Institute for Global Health, University College London (UCL), London, UK, and Faculdade de Medicina da Universidade do Porto (FMUP): Porto. Portugal. .
11.
Yugbaré Belemsaga D, Goujon A, Kouanda S, Bado A, Duysburgh E, Temmerman M, Degomme O. Integration of postpartum care into child health and immunization services in Burkina Faso: findings from a cross-sectional study. Reprod Health. 2018;15(1):171.
12.
Mangham-Jefferies L, Pitt C, Cousens S, Mills A, Schellenberg J. Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review. BMC Pregnancy and Childbirth. 2014;14:243.
13.
Nolte E, Pitchforth E. What is the evidence on the economic impacts of integrated care? World Health Organization: Copenhagen; 2014.
14.
Yugbaré Belemsaga D, Goujon A, Tougri H, Coulibaly A, Degomme O, Duysburgh E, et al. Integration of maternal postpartum services in maternal and child health services in Kaya health district (Burkina Faso): an intervention time trend analysis. BMC Health Serv Res. 2018;18(1):298.
15.
Ministère de la santé, Annuaire statistique 2015. Ministère de la santé, Burkina Faso: Ouagadougou; 2016.
16.
17.
Newlands D, Yugbare-Belemsaga D, Ternent L, Hounton S, Chapman G. Assessing the costs and cost effectiveness of a skilled care initiative in rural Burkina Faso. Tropical Med Int Health. 2008;13(SUPPL):61–7.CrossRef
18.
Direction des Infrastructures des Equipements et de la Maintenance (DIEM), Normes et standards en infrastructures et en equipements du Centre de Santé et de Promotion Sociale. du Centre Médical avec Antenne Chirurgical et du Centre Hospitalier Régional, Ministère de la Santé, Burkina Faso. 2004.
19.
Hounton SH, Newlands D, Meda N, De Brouwere V. A cost-effectiveness study of caesarean-section deliveries by clinical officers, general practitioners and obstetricians in Burkina Faso. Hum Resour Health. 2009;7:34.CrossRef
20.
Drummond M.F.; O'Brien B.; and Stoddart G.W., Ed. Methods for the economic evaluation of health care programmes 2nd ed. 2004, Oxford university press: Oxford and New york.
21.
Andrea S. Sensitivity analysis for importance assessment. Risk Anal. 2002;22(3):579–90.CrossRef
22.
Pannell DJ. Sensitivity analysis: strategies, methods, concepts, examples. Agric Econ. 1997;16:139–52.CrossRef
23.
Briggs A, Sculpher M, Buxton M. Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ. 1994;3(2):95–104.CrossRef
24.
Ly A, Kouanda S, Ridde V. Nursing and midwife staffing needs in maternity wards in Burkina Faso referral hospitals. Human resources for health. 2014;12(Suppl 1):S8.CrossRef
25.
LY A., Effets de la gratuité des soins sur la charge de travail du personnel soignant dans quatre CSPS du district sanitaire de Dori- Burkina Faso in Faculté de Médecine de Marseille. 2011, Université de la Méditerranée AIX-Marseille II: Marseille p 57.
26.
Djellouli N, Mann S, Nambiar B, Meireles P, Miranda D, Barros H, et al. Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project. BMJ global health. 2017;2(4):e000408.CrossRef
27.
Kouanda S, Bado A, Yameogo M, Nitiema J, Yameogo G, Bocoum F, et al. The Kaya HDSS, Burkina Faso: a platform for epidemiological studies and health programme evaluation. Int J Epidemiol. 2013;42(3):741–9.CrossRef
28.
Yugbaré BD, Bado A, Anne GA, Els DE, Degomme O, Kouanda S, Temmerman M. A cross-sectional mixed study of the opportunity to improve maternal postpartum care in reproductive, maternal, newborn, and child health services in the Kaya health district of Burkina Faso. International Journal of Gynecology and Obstetrics. 2016;135(Supplement 1):S20–6.CrossRef
29.
Sculpher M. and Drummond M.F., The role and estimation of productivity costs in economic evaluation, in Economic evaluation in health care: Merging theory with practice, Drummond M.F. and McGuire A., Editor. 2001, Oxford University Press. p. 94–112.
30.
Yugbaré Belemsaga D, Goujon A, Tougri H, Coulibaly A, Degomme O, Duysburgh E, Temmerman M, Seni Kouanda S. Integration of maternal postpartum services in maternal and child health services in Kaya health district (Burkina Faso): an intervention time trend analysis. BMC Health Serv Res. 2018;18:298. https://​doi.​org/​10.​1186/​s12913-018-3098-6.
31.
Horton S. and Levin C., Cost-Effectiveness of Interventions for Reproductive, Maternal, Neonatal, and Child Health., in Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2), L.R. Black R.E., Temmerman M. and Walker N., Editor. 2016 The International Bank for Reconstruction and Development / The World Bank: Washington (DC).
32.
Lassi ZS, Majeed A, Rashid S, Yakoob MY, Bhutta ZA. The interconnections between maternal and newborn health – evidence and implications for policy. J Matern Fetal Neonatal Med. 2013;26(Suppl 1):3–53.CrossRef
33.
Black R.E.; Walker N.; Laxminarayan R.; and Temmerman M., Reproductive, Maternal, Newborn, and Child Health: Key Messages of This Volume, in Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2), Black R.E; Laxminarayan R.;Temmerman. M. and Walker N., Editor. 2016, The International Bank for Reconstruction and Development / The World Bank: Washington, DC.
34.
Van der Klauw D, Molema H, Grooten L, Vrijhoef H. Identification of mechanisms enabling integrated care for patients with chronic diseases: a literature review. Int J Integr Care. 2014;14(3):10.
35.
Institut national de la statistique et de la démographie (INSD). Rapport Enquête multisectorielle continue (EMC) 2014 Profil de pauvreté et d’inégalités. Ouagadougou: INSD; 2015.
36.
Hargreaves JR, Goodman C, Davey C, Willey BA, Avan BI, Schellenberg JR. Measuring implementation strength: lessons from the evaluation of public health strategies in low- and middle-income settings. Health Policy Plan. 2016;31(7):860–7.CrossRef
37.
Sibeudu FT, Uzochukwu Benjamin SC, Onwujekwe OE. Investigating socio-economic inequity in access to and expenditures on routine immunization services in Anambra state. BMC Research Notes. 2017;10(1):78.CrossRef
38.
Sacks E, Langlois EV. Postnatal care: increasing coverage, equity, and quality. Lancet Glob Health. 2016;4(7):e442–3.CrossRef
39.
Kinney MV, Boldosser-Boesch A, McCallon B. Quality, equity, and dignity for women and babies. Lancet. 2016;388(10056):2066–8.CrossRef
40.
Barros A.J.D.; Ronsmans C.; Axelson H.; Loaiza E.; Bertoldi A.D.; França G. V. A. and al, Equity in maternal, newborn, and child health interventions in Countdown to 2015: A retrospective review of survey data from 54 countries. The Lancet, 2012 379(9822): p. 1225–1233.
41.
Torbica A, De Allegri M, Belemsaga D, Medina-Lara A, Ridde V. What criteria guide national entrepreneurs' policy decisions on user fee removal for maternal healthcare services? Use of a best-worst. Scaling choice experiment in West Africa. Journal of Health Services Research & Policy. 2014;19(4):208–15.CrossRef
42.
Meessen B, Hercot D, Noirhomme M, Ridde V, Tibouti A, Tashobya CK, et al. Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries. Health Policy Plan. 2011;26(Suppl 2):ii16–29.PubMed
43.
Leone T, Cetorelli V, Neal S, Matthews Z. Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis. BMJ Open. 2016;6(1):e009692.CrossRef
44.
Borghi J, Ensor T, Somanathan A, Lissner C, Mills A. Mobilising financial resources for maternal health. Lancet. 2006;368(9545):1457–65.CrossRef
45.
Witter S, Boukhalfa C, Cresswell JA, Daou Z, Filippi V, Ganaba R, et al. Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco. International journal for equity in health. 2016;15(1):123.CrossRef
46.
Richard F, Hercot D, Ouédraogo C, Delvaux T, van Olmen SS, J. And al, Sub-Saharan Africa and the health MDGs: the need to move beyond the “quick impact” model. Reproductive Health Matters. 2011;19(38):42–55.CrossRef
47.
Ministère de la santé, Stratégie nationale de subvention des accouchements et des soins obstétricaux et néonataux d’urgence au Burkina Faso. Direction de la santé de la Famille. Burkina Faso: Ouagadougou; 2006.
48.
Temmerman M, Khosla R, Bhutta ZA, Bustreo F. Towards a new global strategy for Women’s, Children’s and Adolescents’ Health. BMJ. 2015;351(suppl. 1):h4414.CrossRef
49.
50.
Ly A, Ridde V, Kouanda S, Queuille L. Health staff workload in a context of user fees exemption policy for health care in Burkina Faso and Niger. Bull Soc Pathol Exot. 2013;106(4):264–71.CrossRef
Metadata
Title
Assessing changes in costs of maternal postpartum services between 2013 and 2014 in Burkina Faso
Authors
Danielle Yugbaré Belemsaga
Anne Goujon
Olivier Degomme
Tchichihouenichidah Nassa
Els Duysburgh
Seni Kouanda
Marleen Temmerman
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
International Journal for Equity in Health / Issue 1/2019
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-019-1064-5

Other articles of this Issue 1/2019

International Journal for Equity in Health 1/2019 Go to the issue

Research

Socioeconomic inequalities in survival of children with acute lymphoblastic leukemia insured by social security in Mexico: a study of the 2007–2009 cohorts

Research

Health needs, health care seeking behaviour, and utilization of health services among lesbians, gays and bisexuals in Addis Ababa, Ethiopia

Research

Healthcare-seeking behavior among pregnant women in the Chinese hierarchical medical system: a cross-sectional study

Research

Vulnerable populations and the right to health: lessons from the Peruvian Amazon around tuberculosis control

Research

The impact of perceived discrimination on depressive symptoms and the role of differentiated social support among immigrant populations in South Korea

Research

Widespread and widely widening? Examining absolute socioeconomic health inequalities in northern Sweden across twelve health indicators