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Evaluating the effects of the free healthcare policy on clinical visits and malaria among children in Burkina Faso:a modeling study of past trends and future forecasts 认领 引用
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作者 AndréLin Ouédraogo Marie-Jeanne Offosse +2 位作者 Julie Zhang Sylvain Toé Pierre Yaméogo 《Global Health Research and Policy》 CSCD 2025年第1期43-54,共12页
Background Access to primary healthcare remains a major challenge in sub-Saharan Africa.In 2016,Burkina Faso introduced the free healthcare policy,eliminating financial barriers by offering free healthcare services fo... Background Access to primary healthcare remains a major challenge in sub-Saharan Africa.In 2016,Burkina Faso introduced the free healthcare policy,eliminating financial barriers by offering free healthcare services for children under five and pregnant women.While previous studies have reported increased healthcare utilization under the policy,its effects on health outcomes remains unassessed.Here,we evaluate the free healthcare policy's effects on three key indicators:frequency of clinical visits,malaria prevalence,and severe malaria.Methods Routine health and demographic data for children under five were collected from health facilities using the government's Electronic Medical Record(EMR)platform.Generalized Linear Mixed Effects Models(GLMM)with a Differences-in-Differences design assessed changes in the three indicators between baseline(2015)and 2018 while Bayesian hierarchical models were used to forecast trends through 2020.Results Analysis of 344,935 clinical visits from 199,664 children across 192 villages showed an increase in healthcare utilization,with clinical visits rising from 1.1 to 2 per child between 2015 and 2018(p<0.001)resulting in a percentage increase of 82%.However,disparities persisted,as children living within 5 km of a health facility accessed more care than those in remote areas(2.2 vs.1.7 visits,p<0.001).Malaria prevalence decreased from 98 to 80%(p<0.001),and severe malaria declined from 6%to 2.2%(p<0.001)during the same period.Bayesian forecasts indicated continued increases in clinical visits(from 2.36 in 2019 to 2.75 in 2020)and further declines in malaria prevalence(to 64%)and severe malaria(to 1.02%)by 2020.Conclusions Our study highlights the transformative effects of the free healthcare policy in improving healthcare access and outcomes for children under five in Burkina Faso.However,inequities in access remain a challenge.Strengthening community health worker programs and expanding community health activities are critical to addressing these gaps.The findings offer valuable insights for policymakers in Burkina Faso and contribute to global efforts to leverage health reforms to improve malaria control and progress toward universal health coverage. 展开更多
关键词 Burkina Faso Free healthcare policy Primary healthcare Children under five Malaria Equity Difference-indifferences Bayesian modeling Gratuité Distance
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