Abstract

In the 1980s, as recommended by the international organizations, almost all African countries adopted direct payment for healthcare services as the principal means of financing their health systems. African patients therefore had to pay whenever they used the health services. During the 1990s, however, research demonstrated the negative effects of this choice of financing on health services utilization, particularly by women and the poorest. In a general context of poverty, a particularly precarious state of health, and the avowed intention to attain the Millennium Development Goals, access to health services is a major determinant. One after another, African countries decided to subsidize or suppress direct payment for certain services and population categories, again on new international recommendations. While some of these experiences have been documented in East Africa this is not the case in West Africa. This project will therefore examine the forms of suppression or subsidization of direct payment in Burkina Faso, Mali and Niger as strategies for improving equity and access to the health system, notably for women and children.

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