Effect of a free healthcare policy on health services utilization for non-malarial febrile illness by children under five years in Burkina Faso: an interrupted time series analysis.

Sia, D; Dondbzanga, B D G; Carabali, M; Bonnet, E; Enok Bonong, P R; Ridde, V

OBJECTIVE To assess the effect of a free healthcare policy for children under five years old implemented in Burkina Faso since April 2016, on the use of healthcare of non-malarial febrile illnesses (NMFI). METHODS To assess the immediate and long-term effect of the free healthcare policy in place, we conducted an interrupted time series analysis of routinely collected data on febrile illnesses from three urban primary health centers of Ouagadougou between January 1, 2015 and December 31, 2016. RESULTS Of the 39,046 febrile cases reported in the study period, 17,017 NMFI were included in the study. Compared to the period before the intervention, we observed an immediate, non-statistically significant increase of 7% in the number of NMFI (IRR=1.07; 95% CI= 0.75, 1.51). Compared to the trend that would have been expected in absence of the intervention, the results showed a small but sustained increase of 6% in the trend of monthly number of NMFI during the intervention period (IRR= 1.06; 95%CI= 1.01, 1.12). CONCLUSION Our study highlighted an increase in the uptake of health care services, specifically for NMFI by children under five years of age, after the implementation of a free care policy. This analysis contributes to informing decision-makers on the need to strengthen the capacities of health care centers and to anticipate the challenges of the sustainability of this policy.