Cost sharing scheme for emergency obstetric care in Secteur 30 health district, Ouagadougou, Burkina Faso.

In January 2005, a cost-sharing system was introduced into Secteur 30 health district, an urban district of the city of Ouagadougou, with the aim of improving access to emergency obstetric care for pregnant women in the district. The cost-sharing covers emergency transport and caesarean deliveries. The direct costs are shared between four parties: 1) the management committees of health centres and confessional health facilities, 2) the woman and her family, 3) the local authorities and 4) the health district. These different contributions reduce the family’s share and generate a surplus for treating the poorest inhabitants of the district. Three years after implementation, the results have been measured in terms of service utilisation, quality of care, financial viability and perception of the system by the different parties involved. Data were collected from several sources: routine data from the health information system, individual prescription forms, an Unmet Obstetrical Needs (UON) study and individual interviews with the different parties. The coverage of assisted deliveries in the district rose from 66.2% in 2003 to 86.5% in 2007 and the rate of caesarean deliveries from 2.5 to 3.7%, with 1% of interventions for absolute maternal indications. The cost-sharing system is financially viable and managed to adapt itself to the introduction of a new national subsidy for emergency obstetric care. It now provides complete case management for a caesarean delivery for only 6,000 CFA francs (9.1 €). Nevertheless, the sustainability of such a system, based on an annual commitment from each party, requires monitoring and evaluation within Burkina’s fast changing context (decentralisation, reforms).