Effect of the free healthcare policy on the health services' utilisation by children under five years in Burkina Faso

Objectives: This study aimed to analyse, at national level, the effects of
the free healthcare policy for children on the use of health services by
children under five in Burkina Faso. We hypothesized that this policy has
led to an immediate and sustained increase in the use of health services
for these children in the country. Setting: We conducted a controlled
interrupted time series. Monthly data at district level, spanning from
January 2013 to December 2018 and corresponding to 72 monthly data points
(39 before and 33 after), were extracted from the Burkina Faso National
Health Information System. The analysed dataset included data from all the
70 health districts of the country. Participants: The study consisted of
aggregated data from children under five as the target for the policy with
children aged between 5-14 years old as control group. Intervention: The
intervention was the introduction of the free healthcare policy for women
and children under five years from April 2016. Outcome: The primary
outcome was the mean monthly rate of health services visits by children
Results: Among the children under five, the rate of visits increased of
57% (IRR= 1.57; 95% CI=1.2 to 2.0) in the month immediately following the
launching of the free healthcare policy. An increase in the rate of health
facility visits of 1% (IRR=1.01; 95% CI=1.0 to 1.1) per month was also
noted during post-intervention. Compared to the control group, we observed
an increase of the rate of visits of 2.5% (IRR=1.025; 95%CI= 1.023 to
1.026) per month. Conclusion: Findings suggest that the free healthcare
policy increased the use of health facilities for care in Burkina Faso
immediately after the implementation of the policy with a small increase
in the rate overtime. Strategies to maintain the policy effect over time
are necessary.