Paying for health and schooling services in rural Mali

Martha Ainsworth , Nancy Birdsall , Punam Chuhan , François Orivel (1, 2)

1 IREDU - Institut de recherche sur l'éducation : Sociologie et Economie de l'Education
2 CNRS - Centre National de la Recherche Scientifique

This study reports on analyses of household demand for health, schooling and water supply services in an impoverished region of the African Sahel. The ability and willingness of rouseholds to pay user fees for these services is assessed. The effect of introduction of such charges on demand among low-income groups most in need of the services is analyzed. Data for the analyses come from surveys conducted in the Kayes region of the Republic of Mali, an area typical of the least-developed rural areas of the Sahel, including a survey of households, surveys of health posts, schools, and drug outlets, and village group surveys. The analyses presented highlight tre importance of service-related variables in influencing the use of schooling, health, and water supply services: • Distance to the service is a consistently significant determinant of use. Greater distance is associated with lower use of schooling and health care, lower drug expenditure, and higher willingness to pay for village wells and health workers. • The quality of services is also an important correlate of use. School quality - as measured by class size and the number of textbooks - is associated with higher enrollments. Households with access to higher quality drug outlets are more likely to choose modern care or self-treatment over traditional treatment, and are less willing to pay for a real the worker. • The effect of user fees on demand - which could only be measured for schooling - is negative, as expected, but small in magnitude. Households in the majority of villages are willing to finance well maintenance, but not clearly willing to finance community health care provision. Private expenditures on drugs are substantial. The experienoe of villages and public facilities in the region studied in collecting and managing fees is extremely limited, institutional development would be a necessary prerequisite for success of any local cost recovery schemes.

Mots clés: Famille; Financement de la santé; Financement privé; Participation financière; Pays en développement

Domaines: Education

Martha Ainsworth, Nancy Birdsall, Punam Chuhan, François Orivel. Paying for health and schooling services in rural Mali. [Research Report] PHN Technical Note 86-15, Banque mondiale. 1986, pp.102. ⟨halshs-03192753⟩