Examining out-of-pocket expenditure on health care in Nouna, Burkina Faso: implications for health policy


Frederick Mugisha Department of Tropical Hygiene and Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. Fax: +49 6221 56 5948; E-mail: frederick.mugisha@urz.uni-heidelberg.de


OBJECTIVE To examine household out-of-pocket expenditure on health care, particularly malaria treatment, in rural Burkina Faso.

METHOD Comprehensive analysis of out-of-pocket expenditure on health care through a descriptive analysis and a second, multivariate analysis using the Tobit model with emphasis on malaria, based on 800 urban and rural households in Nouna health district.

RESULTS Households will spend less on malaria, either in or outside the health facility, if given the choice to do so, because they feel confident to self-treat malaria. Seeking health care from a qualified health worker incurs more out-of-pocket expenditure than self-treatment and traditional healers, and if necessary, households sell off assets to offset the expenditure. More than 80% of household out-of-pocket expenditure is allocated to drugs.

CONCLUSION This has policy implications for malaria control and the Roll Back Malaria Initiative. Communities need to be educated on the risks of malaria complications and the potential risk of inappropriate diagnosis and treatment. Drug or health services pricing policy needs to create an incentive to use the health services. In the fight against malaria, building alliances between households, traditional healers and health workers is essential.