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Community based prepayment and health insurance schemes in rural Burkina Faso and Ghana - an intervention study


To improve the health status of the general population in rural areas of Burkina Faso and Ghana by improving the quality of the health care system and ensuring equitable access to it through sustainable community-based prepayment and health insurance schemes.

Specific objectives:
Improve financial access to essential health services while reducing access differentials between rich and poor as well as children and adults;
Design two alternative prepayment schemes (with and without risk sharing: health insurance vs. prepayment), based on the costs of services provision and the schemes' projected revenues (depending on the amount of contribution to the schemes and their coverage);
Recover all recurrent non-salary costs of providing the essential care package;
Improve the quality of care: 75% (up from 40%) of users are satisfied and 60% (up from 20%) of providers follow locally accepted diagnostic and therapeutic algorithms;
Assess the effect of quality on participation in prepayment/insurance schemes;
Measure the impact of the intervention on the economic burden of illness;
Measure the impact of the intervention on morbidity and mortality;
Evaluate the process and outcome of partnership between the Ministry of Health and autonomous church affiliated providers in the implementation of a rural health insurance scheme (Ghana).
Expected Outcome

Continuous feed-back of concerned audiences (research community, policy makers, public health staff, local communities) will be given.
The project will consist of three phases:
Phase 1: Preparatory research (12 months), to a) design the modalities of insurance and/or prepayment scheme and b) establish the quality and the distribution of health care to be provided under the schemes. Essential care packages have to be defined, the innovative financing options (prepayment/health insurance) will be elaborated. Willingness and ability to pay studies, using contingent valuation method, will be realised, and a comprehensive tool for assessing quality of care (as perceived by the clients as well as defined by professionals) will be developed.
Phase 2: Study of the effect of prepayment and community health insurance (30 months). The following questions will be addressed: How many and which households to enrol to prepayment/insurance scheme? How does the quality of services influence households' choice to enrol? How do rate and patterns of utilisation of health services change? Does community involvement and resource generation for health services improve the quality of health care? To what extent do revenues from those enrolled cover the non-salary costs of providing the essential care package to them? Does prepayment/health insurance reduce illness-related costs of households? Does the anticipated increase in access to quality health services - especially among children - have an impact on age-specific death rates? The research tools addressing these questions are: health census, vital events registration, sequential household-surveys, analysis of routine health services information, financial analysis of providers' costs and the revenue of the prepayment/insurance scheme, comprehensive assessment of quality of care (defined by clients and professionals) through observation and exit polls, focus group discussions.
Phase 3: Finalisation of data analysis, preparing of publications.

Funding Scheme

CSC - Cost-sharing contracts


Ruprecht-Karls-Universität Heidelberg
Im Neuenheimer Feld 324
69120 Heidelberg

Participants (3)

London School of Hygiene and TropicalMedicine
United Kingdom
Keppel Street
WC1E 7HT London
Ministère de la Santé Publique & Action Sociale
Burkina Faso

01 Ouagadougou
Regional Health Administration of Eastern Region - Ministry of Health

10 Accra