@article{fdi:010072004,
  title = {{S}treet-level workers' inadequate knowledge and application of exemption policies in {B}urkina {F}aso jeopardize the achievement of universal health coverage: evidence from a cross-sectional survey},
  author = {{R}idde, {V}al{\'e}ry and {L}eppert, {G}. and {H}ien, {H}. and {R}obyn, {P}. {J}. and {D}e {A}llegri, {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {S}treet-level workers play a key role in public health policies in {A}frica, as they are often the ones to ensure their implementation. {I}n {B}urkina {F}aso, the {S}tate formulated two different user-fee exemption policies for indigents, one for deliveries (2007), and one for primary healthcare (2009). {T}he objective of this study was to measure and understand the determinants of street-level workers' knowledge and application of these exemption measures. {M}ethods: {W}e used cross-sectional data collected between {O}ctober 2013 and {M}arch 2014. {T}he survey targeted 1521 health workers distributed in 498 first-line centres, 18 district hospitals, 5 regional hospitals, and 11 private or other facilities across 24 districts. {W}e used four different random effects models to identify factors associated with knowledge and application of each of the above-mentioned exemption policies. {R}esults: {O}nly 9.2% of workers surveyed knew of the directive exempting the worst-off, and only 5% implemented it. {K}nowledge and application of the delivery exemption were higher, with 27% of all health workers being aware of the delivery exemption directive and 24.2% applying it. {M}obile health workers were found to be consistently more likely to apply both exemptions. {H}ealth workers who were facility heads were significantly more likely to know about the indigent exemption for primary health care and to apply it. {H}ealth workers in districts with higher proportions of very poor people were significantly more likely to know about and apply the delivery exemption. {N}early 60% of respondents indicated either 5% or 10% as the percentage of people they would deem adequate to target for exemption. {C}onclusion: {T}his quantitative study confirmed earlier qualitative results on the importance of training and informing health workers and monitoring the measures targeting equity, to ensure compliance with government directives. {T}he local context (e.g., hierarchy, health system, interventions) and the ideas that street-level workers have about the policy instruments can influence their effective implementation. {M}ethods for remunerating health workers and health centres also need to be adapted to ensure equity measures are applied to achieve universal healthcare.},
  keywords = {{S}treet-level workers ; {P}ublic policy ; {H}ealth policy ; {I}mplementation gap ; {E}xemption ; {F}ree care ; {U}niversal health coverage ; {B}urkina {F}aso ; {BURKINA} {FASO}},
  booktitle = {},
  journal = {{I}nternational {J}ournal for {E}quity in {H}ealth},
  volume = {17},
  numero = {},
  pages = {art. 5 [13 ]},
  ISSN = {1475-9276},
  year = {2018},
  DOI = {10.1186/s12939-017-0717-5},
  URL = {https://www.documentation.ird.fr/hor/fdi:010072004},
}