Achieving universal health coverage is the cornerstone of the Sustainable Development Program in health domain. This strategy aims to improve the quality and access to health services of the most vulnerable populations, while minimizing their financial risk. While several interventions are currently being deployed to achieve universal health coverage, their effectiveness (under natural implementation conditions) remains to be demonstrated. In particular, the effects on service utilization and health indicators have rarely been studied by rigorous evaluation designs.
The purpose of this research is to produce scientific evidence on the practical effectiveness of two particular interventions, the first one being the introduction of free healthcare for mothers and children in Burkina Faso and the second one being the establishment of community health centers with a university affiliation in Mali. These horizontal interventions are innovative in order to increase universal health coverage, as they specifically aim to strengthen health systems, rather than deploying vertical actions targeting specific conditions.
The objectives of this research are to: (1) measure the effects on utilization, coverage and quality of services, as well as on healthcare-seeking practices; (2) understand the dynamics of implementation and change in consultation practices; (3) assess the impact on maternal and child health indicators and; (4) analyze costs and cost-effectiveness. The effect assessment is based on several robust quasi-experimental designs, i.e. pre-post comparisons and interrupted time series (both with control group), and uses different strategies to increase our capacity to attribute the effects to the intervention. This interventional research requires using mixed methods (qualitative and quantitative) and brings together researchers with varied expertise in an interdisciplinary effort.