Street-level workers' criteria for identifying indigents to be exempted from user fees in Burkina Faso

Trop Med Int Health. 2012 Jun;17(6):782-91. doi: 10.1111/j.1365-3156.2012.02991.x. Epub 2012 Apr 19.


Objectives: Universal healthcare coverage cannot be achieved in Africa as long as the indigent, the poorest, are unable to access healthcare systems. This study was carried out in Burkina Faso to obtain street-level workers' perspectives on what criteria should be used to select indigents to be exempted from user fees.

Methods: Two group consensus techniques were used (Delphi and Concept Mapping). The participants were nurses (CM; n = 24), midwives (CM; n = 23) from a rural district and Social Action agents (CM; n = 31) and healthcare workers (Delphi n = 23) in training at two national schools.

Results: Altogether, 446 criteria were proposed. The nurses put forward criteria related to being ill without support and being a victim of society. The midwives focused more on the disabled poor and those who were ill and unsupported. The healthcare workers in training mentioned disabled persons and the elderly with no family support. The Social Action agents spoke about vulnerability related to illness or disability and the fact of being excluded or being a disaster victim.

Conclusions: These criteria proposed by street-level workers add to other studies conducted in Burkina Faso and should help the State to improve indigents' access to care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Burkina Faso
  • Community Health Services / economics
  • Community Health Services / statistics & numerical data
  • Community Health Workers / statistics & numerical data
  • Disabled Persons / statistics & numerical data
  • Fees and Charges / statistics & numerical data*
  • Health Personnel / statistics & numerical data*
  • Health Promotion / economics
  • Health Promotion / methods*
  • Health Services Accessibility / economics*
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Middle Aged
  • Midwifery / statistics & numerical data
  • Nurses / statistics & numerical data
  • Population Dynamics
  • Poverty / economics*
  • Poverty / statistics & numerical data
  • Rural Population / statistics & numerical data
  • Social Work / statistics & numerical data
  • Young Adult