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Having read with great interest the contributions of this forum, I realized that much attention is legitimately given to food security and agriculture. Tdh believes that addressing social protection in the health sector to tackle the burden of undernutrition is also of paramount importance.
Terre des hommes (Tdh), together with national and international partners steered since 2008 a strategy aiming at promoting child health and fighting acute malnutrition. Supported by the European Commission Humanitarian Office (ECHO), this strategy consist in eliminating health care user fee payment for the children under five and pregnant women.
The various phases of the implementation process, as well as Lessons Learnt & Best Practices can be found at the following link: http://www.tdh.ch/en/documents/freeing-up-healthcare-universal-access-to-health-care-for-children-under-5-and-pregnant-women.
In terms of results and impact, studies and researches (that also concern a similar project implemented by the German NGO HELP) have demonstrated that:
- Health services user-fee abolition policy have increased access to health facilities (Attendance of children under five has multiplied by 7).
- Costs of health care services have gradually decreased since the establishment of a payment exemption policy (from 1,260 FCFA to less than 800 CFA per consultation).
- Removing user fees contributes to more equity in access.
- Users fee exemption leads to an estimated 16% reduction in child mortality
- In 2 districts where Tdh is implementing user fee exemption (together with other strategies aimed at improving service quality), acute malnutrition rate are much lower than the national average (which was not the case before the intervention).
User fee exemption addresses the three main pathways through which social protection programs impact nutrition (as defined by the World Bank in ‘Improving Nutrition Through Multisectoral Approaches - Social Protection’):
- It protects households income as it prevents unforeseen extra health expenses for the most vulnerable.
- It promotes and enhance access and delivery of Health Services.
- It targets nutritionally vulnerable populations (pregnant women and U5 children).
It is worth mentioning that the same results have been obtained over the last year while Terre des hommes has handed-over most of the implementation process to District Health staff (though still funded by ECHO).
The Ministry of Health of Burkina Faso has conducted Feasibility study in order to estimate the cost of a national scaling-up of this strategy. It is now a matter of political will.