Impact of fee subsidy policy on perinatal health in a low-resource setting: A quasi-experimental study

BACKGROUND: A national subsidy policy was introduced in 2007 in Burkina Faso to improve financial accessibility to facility-based delivery. In this article, we estimated the effects of reducing user fees on institutional delivery and neonatal mortality, immediately and three years after the introduction of the policy. METHODS: The study was based on a quasi-experimental design. We used data obtained from the 2010 Demographic and Health Survey, including survival information for 32,102 live-born infants born to 12,474 women. We used a multilevel Poisson regression model with robust variances to control for secular trends in outcomes between the period before the introduction of the policy (1 January, 2007) and the period after. In sensitivity analyses, we used two different models according to the different definitions of the period “before” and the period “after”. RESULTS: Immediately following its introduction, the subsidy policy was associated with increases in institutional deliveries by 4% (RR = 1.04, 95% CI: 0.98–1.10) in urban areas and by 12% (RR = 1.12, 95% CI: 1.04–1.20) in rural areas. The results showed similar patterns in sensitivity analyses. This effect was particularly marked among rural clusters with low institutional delivery rates at baseline (RR = 1.44, 95% CI: 1.33–1.55). It was persistent for 42 months after the introduction of the policy but these increases were not statistically significant. At 42 months, the delivery rates had increased by 26% in rural areas (RR = 1.26; 95% CI: 0.86–1.86) and 13% (RR = 1.13; 95% CI: 0.88–1.46) in urban areas. There was no evidence of a significant decrease in neonatal mortality rates. CONCLUSION: The delivery subsidy implemented in Burkina Faso is associated with short-term increases in health facility deliveries. This policy has been particularly beneficial for rural households.