In Burkina Faso, we have recently achieved important steps forward in health.

I’ve been working with advocates for women and children’s health to campaign for the removal of user fees. The coalition’s campaign, ‘Ma Voix, La Santé des Enfants’ (My Voice, Children’s Health) brought together a wide range of partners to lobby for the introduction of this policy and resulted in the passing of a law on the removal of fees.

On the 2 April this law came into effect and – as you can see from the case study below – it’s already having important effects on the health and financing for Burkina’s poorest women and children. This law means healthcare is now free for children under five, for pregnant women, for deliveries and caesareans, and for breast and uterine cancer screening. Starting in three districts and at the first two levels of the health system, the government plans to roll this out nationally and at all levels of the health system by the end of June 2016.

Save the Children warmly welcomes the removal of fees for women and children. This is a decisive step towards the goal to end maternal and child deaths in Burkina Faso.

In 2015, 60,000 children died before their fifth birthday. Almost all of these deaths could have been avoided through greater access to known interventions.  The costs of healthcare, particularly for delivery care, are associated with catastrophic expenditure, pushing people into poverty. And they are a deterrent to women seeking essential services.

Save the Children believes countries must move away from relying on regressive, out-of-pocket payments, and increase funding for health as well as ensuring it is spent equitably and efficiently. Women and children must be a priority as countries advance towards Universal Health Coverage – as outlined in our new report, A Common Cause.

The removal of user fees for women and children is a just the first step for Burkina Faso, which has also passed a law on Universal Health Coverage to guarantees access to essential health services for all.

If implemented fully, this policy could save the lives of 30,000 children each year.

Save the Children received  funding support from GSK to support ‘Ma Voix, La Santé des Enfants’, a group of maternal and child health advocates. They worked together as a movement, lobbying parliamentarians, decisions-makers, and especially candidates for the presidential election in 2015, and working with the media to achieve this important win in Burkina. We’ll continue to monitor the roll-out of the policy at the frontline and ensure its effective implementation

Much remains to be done. Too often, user fees have been removed without putting in place necessary steps to ensure that the policy is successful. Careful preparation is essential, and lessons can be learnt from neighbouring countries, such as Niger and Sierra Leone, on the removal of fees. In Burkina Faso, Save the Children’s programmes and those of other NGOs have built up a body of evidence over the past eight years on the removal of fees. This has been shared with the government as they developed their plans.

In Burkina Faso, the government has allocated 5 billion FCFA (£6 million) to kick-start the programme for children. This is great news and needs to be available over the long term. And it must be additional funding, not diverted from other parts of the health budget.

Successful outcomes of the policy will require investment in the supply of services  – recent studies show some weaknesses in services, including health workers and equipment.

Making sure the policy is well communicated will also be important. Only half of women in the country were aware of previous subsidies for delivery services. Burkina Faso must ensure that as the policy is rolled out, it is clearly and widely communicated so that people can claim their right to free care.

The government of Burkina Faso is to be congratulated on taking measures to widen access to healthcare – with immediate impacts, as Alizeta’s story shows.

What this means for Burkina’s poorest people across the country, and over the long term, will depend on what happens next.


It’s 2.35pm at the healthcare and welfare centre in Dassasgho, Secteur 28, Ouagadougou. And it’s the middle of a heatwave.

But Alizeta Tapsoaba, in her 40s, would walk anywhere under the sun to get her 17-month-old boy, Scheik, who has a worrying fever, back to good health.

When she gets to the health centre, the welcome she receives is a relief in itself. After the seeing the doctor she comes back from the pharmacy all smiles:

“I didn’t have to pay anything at all but I still received all the medicine”, she explains.

This Alizeta’s second appointment of the month, and the outcome is the same. Healthcare for children under five has been free since 2 April 2016 in this health centre, one of the first  sites for the roll-out of the policy.

Alizeta has two children and looks after them at home with her husband working in commerce. She sees this free care as reducing their struggles significantly.

“We thank God. Before, you couldn’t get all the medicines prescribed from the health centre’s pharmacy. Often, we had to try to find private pharmacies, which are expensive for us. But these last couple of times, everything has been available,” says Alizeta.

Her only concern is that this measure is rolled out throughout the country. She believes that this will have a significant positive impact for households and will definitely reduce poverty.