Attaining efficiency in a health care system with a budget constraint involves increasing the utilization of the most cost-effective services. This can be achieved by adjustments to prices, cost curves, or demand curves. In this paper, the potential for demand curve adjustments is examined by selecting two apparently cost-effective services (prenatal care and childhood immunization against tuberculosis), and analyzing the factors explaining their utilization. Data from recent household surveys in Burkina Faso and Niger are used. A multivariate analysis of utilization employs income, price, and taste variables. Utilization is highly sensitive to the distance which must be travelled to the health facility, a price, and taste variables. Utilization is highly sensitive to the distance which must be travelled to the health facility, a price variable. Members of certain ethnic groups tend to use the services less, other things being equal. The importance of demand-side factors like ethnicity points to certain kinds of policy interventions like information, education and communication activities which could increase the utilization of cost-effective services.
PIP: Two surveys undertaken by the Health Financing and Sustainability Project in Burkina Faso and Niger in 1994 provided the data for analysis. Prenatal care information was collected in households from women who had been pregnant during the previous 12 months. Bacillus Calmette-Guerin (BCG) immunization information was available only from the Niger survey. In Burkina Faso only 48% of women received prenatal care and only 33% did in the Niger sample. A multivariate analysis of utilization of these 2 services employed income, price, and taste variables (women's age, education, and ethnicity). The low utilization of services was examined using independent variables. Regarding prenatal care the effect of income was visible in Niger, but it was absent in Burkina Faso. Ethnicity had an important effect on prenatal care. In Burkina Faso it was much less likely to get prenatal care for Fulani or Gourmantche women rather than Mossi. Also in Niger among the Fulani and Hausa low utilization was prevalent. The price variables also affected utilization, particularly the distance to the health facility. On the other hand, user charges stimulated utilization because enhanced services. Teenagers were less likely to get their babies immunized, although they were just as likely to get prenatal care. In Niger 26% of girls received BCG compared to 22% of boys. Part of the powerful effect of ethnicity was explained by French colonial rule, when Mossi and Zarma groups were incorporated into the colonial administration. This suggests the need for certain policy interventions, such as information, education, and communication activities to increase utilization of cost effective services.