The cost of clinic visits for children under 5 years of age, in a context of free malaria treatment in four cercles in Mali

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1 The cos of clinic visis for children under 5 years of age, in a conex of free malaria reamen in four cercles in Mali Georges KONE, Docoral suden in healh economics a IRD/UMR 151 and a UCAD Geneviève Mák, Docoral suden, PhD in public healh, Universiy of Monreal Slim Haddad, Professor, Universiy of Monreal Valery Ridde, Professor, Universiy of Monreal and IRSS/CNRST Burkina

2 Inroducion and objecives of he sudy

3 Free healhcare for vulnerable populaions in developing counries(ghana, Niger,...). En 2007, Mali adoped a policy of free drugs o rea cases of mild malaria in children under he age of 5 years. MSF projec in Kangaba cercle: parial exempion in 2005 and full exempion in Observaoire de la grauié April Very few sudies exis on he coss suppored by he healhcare sysem and on he social coss aribuable o hese inervenions.

4 Objecives (2): Esimae he economic impac on communiy healh cenres (CHC) of he MSF inervenion and he governmen measure Analyze he impac of full exempion on he cos of a clinic visi for children under age 5 in Kangaba cercle. Idenify he impac of he governmen measure on he cos of a clinic visi for children under age 5 in he hree oher cercles of he observaory. Idenify he variaion in each cos iem subsequen o he increase in demand beween 2006 and 2009 in Kangaba cercle.

5 Esimae he cos for Mali of scaling up he implemenaion, for children under age 5, of: parial exempion (free drugs, for all pahologies combined) oal exempion (free drugs and free clinic visis, for all pahologies combined)

6 METHODOLOGY

7 Daa sources: Daa from he healh informaion sysems (HIS) of each cercle in he observaory. Daa from communiy healh associaions (CHA) and CHCs Sampling: four CHCs in each cercle of he observaory (Commune V, Kangaba, Kayes and Sikasso) were visied. Daa was colleced beween November 8 and December 8, 2010, using a sandardized quesionnaire.

8 Analysis of cos per clinic visi A) Invesmens Coss Vehicles Equipmen Buildings (surface area) Suboal B) Operaing coss Personnel Drugs and consumables Vehicles operaion and mainenance Buildings operaion and mainenance Coninuing educaion Miscellaneous Suboal Toal cos of producion Adaped from Creese and Parker, 1995 Average cos per visi CM CC Enf Coû _ CC Consulaion _ Enfan( 5 ans) Incremenal cos per visi Cm Cc C P Cc Cc

9 Esimae for scaling up in Esimae of he populaion under 5 years of age Pop 1 Pop Enf ( 5 ans) 1, 03 hen Pop - Esimae of he number of curaive care visis Nbre CC Pop Tx CC Enf ( 5 ans) Enf ( 5 ans) _. wih Tx. CC Pop 0, 20 Nbre _ CC Enf ( 5 ans) Enf ( 5 ans) Pop - Esimae of he cos of parial exempion for hree scenarios Coû _ oal _ C C Nbre _ C C CM med Enf ( 5 ans) med max max wih CM med Coû _ médicamen Nbre _ CC Enf ( 5 ans) Esimae of he cos of oal exempion for hree scenarios Coû _ oal _ CC Nbre _ CC CM Enf Enf ( 5 ans) CC

10 RESULTS

11 Economic impac of exempion policies on average cos per consulaion Cercles Average cos in F CFA Incremenal cos Kangaba Commune V Kayes Sikasso Exisence of economies of scale in Kangaba cercle

12 Variaion in cos iems subsequen o he implemenaion of full exempion in Kangaba cercle Toal coû invesisssemen Coû Personnel Coû Médicamens Aure coû de foncionnemen % 27% 66% 4% % 30% 46% 15% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

13 Growh (in %) in oal cos and in cos iems beween 2006 and 2009 in Kangaba cercle Toal coû CC enfan 179 Toal coû foncionnemen 187 Aure coû de foncion 16 Coû médicamen 259 Coû personnel 127 oal coû invesissemen

14 Esimae for scaling up in 2012 Parial exempion (drugs and consumables, for all pahologies) Toal exempion (clinic visis and drugs, for all pahologies) Coss in billions of F CFA: Exempion Minimum Average Maximum Parial Toal

15 DISCUSSION

16 Limiaions of he sudy Lack of documenaion o suppor he coss quoed by he managers Homogeneous disribuion approach Sample no represenaive for scaling up No sensiiviy esing on cos iems

17 Toal exempion in Kangaba: increased service uilizaion and reducion in cos of clinic visis (Idem, Burkina Faso) Governmen policy had limied impac because of: Problems wih resocking drugs (Ghana, Madagascar and Kenya) Scaling up appears o be realisic. The cos in 2012 is:

18 CONCLUSION AND RECOMMENDATION

19 Impacs of he governmen policy are barely percepible Projeced coss of scaling up are achievable. To ensure beer implemenaion of he scaling up, resources will be needed o: Conduc informaion campaigns Srenghen and resrucure he workforce Se up a monioring sysem, ec.

20 Thank you for your aenion