Abolishing Fees at Health Centers in the Context of Community Case Management of Malaria: What Effects on Treatment-Seeking Practices for Febrile Children in Rural Burkina Faso?

• Published in: PloS one Vol. 10; no. 10; p. e0141306
• Main Authors: Druetz, Thomas, Fregonese, Federica, Bado, Aristide, Millogo, Tieba, Kouanda, Seni, Diabaté, Souleymane, Haddad, Slim
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 26.10.2015; Public Library of Science (PLoS)
• Subjects: Adolescent; Antimalarials - therapeutic use; Burkina Faso; Care and treatment; Case management; Case Management - economics; Case Management - statistics & numerical data; Child; Child, Preschool; Childhood fever; Children; Community health services; Delay; Disease transmission; Economic aspects; Fees & charges; Fees and Charges; Female; Fever; Health care; Health facilities; Health Services Accessibility - economics; Health Services Accessibility - statistics & numerical data; Hospitals; Households; Humans; Hypotheses; Malaria; Malaria - drug therapy; Male; Medical case management; Medical fees; Medical research; Methods; NGOs; Nongovernmental organizations; Polls & surveys; Primary care; Public health; Rural areas; Rural Population; Time series; User fees; Vector-borne diseases; Burkina Faso; Canada; Senegal
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0141306

Burkina Faso started nationwide community case management of malaria (CCMm) in 2010. In 2011, health center user fees for children under five were abolished in some districts. To assess the effects of concurrent implementation of CCMm and user fees abolition on treatment-seeking practices for febrile children. This is a natural experiment conducted in the districts of Kaya (CCMm plus user fees abolition) and Zorgho (CCMm only). Registry data from 2005 to 2014 on visits for malaria were collected from all eight rural health centers in the study area. Annual household surveys were administered during malaria transmission season in 2011 and 2012 in 1,035 randomly selected rural households. Interrupted time series models were fitted for registry data and Fine and Gray's competing risks models for survey data. User fees abolition in Kaya significantly increased health center use by eligible children with malaria (incidence rate ratio for intercept change = 2.1, p <0.001). In 2011, in Kaya, likelihood of health center use for febrile children was three times higher and CHW use three times lower when caregivers knew services were free. Among the 421 children with fever in 2012, the delay before visiting a health center was significantly shorter in Kaya than in Zorgho (1.46 versus 1.79 days, p <0.05). Likelihood of visiting a health center on the first day of fever among households <2.5 km or <5 km from a health center was two and three times higher in Kaya than in Zorgho, respectively (p <0.001). User fees abolition reduced visit delay for febrile children living close to health centers. It also increased demand for and use of health center for children with malaria. Concurrently, demand for CHWs' services diminished. User fees abolition and CCMm should be coordinated to maximize prompt access to treatment in rural areas.