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

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.

journal_name

Int J Equity Health

journal_title

International journal for equity in health

authors

Lambert-Evans S,Ponsar F,Reid T,Bachy C,Van Herp M,Philips M

doi

10.1186/1475-9276-8-36

subject

Has Abstract

pub_date

2009-10-24 00:00:00

pages

issn

1475-9276

pii

1475-9276-8-36

journal_volume

pub_type

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