Health Insurance and the challenges of public response to Pandemics in Burkina Faso: Exploring the role of the informal economy

Volume 6, Issue 5, October 2022     |     PP. 347-365      |     PDF (232 K)    |     Pub. Date: October 23, 2022
DOI: 10.54647/sociology84916    80 Downloads     2157 Views  


Natéwindé Sawadogo, Institut Universitaire de Formations Initiale et Continue, Université Thomas SANKARA, Ouagadougou, Burkina Faso

Economic barriers remain the main challenge facing households regarding healthcare access in Burkina Faso. Universal health coverage is yet to be extended to the majority of the population, especially the most vulnerable. Furthermore, access to community based health insurance has been so far impeded by the financial challenges facing household to contribute. Yet, public health policy performances depend on the quantity and quality of health information. In case of epidemic outbreak, apart from mass testing, the standard sources of health information for decision-making are based on populations’ demand for healthcare services. This paper explores the state of the economic determinants of this demand. The results of these analyses provide the basis for the evaluation of the impact of the economic situation of households on the government of Burkina Faso’s response to the covid-19. The data used for the analysis come from two main sources. Firstly, a systematic documentary review of macro macroeconomic policy and social security regimes in the country has been conducted. Secondly, a survey of the economic living conditions of 503 households in Ouagadougou is conducted. The analysis uses a conceptual lens drawn from classical sociological analysis of public problems, which provided the framework for the qualitative analysis. The paper argued that the dependence of public policy process on information constituted some constraints for government effective response to the pandemic to the extent that the macroeconomic context and the households’ economic circumstances stand as barriers to households’ access to health services - through which further information on the population could have been gained, in the absence of mass systematic testing. The results show that households have been resilient to the chock caused by the pandemic. From 2014 health policy measures started to reverse the trend in government’s interventions in healthcare access that mitigated the negative impacts of several decades of privatization of healthcare services. Recent policy measures facilitated healthcare access for children aged less than five years and pregnant women, thus reducing households’ health expenditures. Furthermore, the households in the informal sector suffered less from the restrictions due to the covid-19, as they benefited from the increase in domestic demand for goods and services in some of the branches of the economy.

health insurance; covid-19; Burkina Faso; public pandemic response; challenges

Cite this paper
Natéwindé Sawadogo, Health Insurance and the challenges of public response to Pandemics in Burkina Faso: Exploring the role of the informal economy , SCIREA Journal of Sociology. Volume 6, Issue 5, October 2022 | PP. 347-365. 10.54647/sociology84916


[ 1 ] Akuoko, P.B., Aggrey, V., Amoako-Arhen, A. “Ghana’s informal economic sector in the face of a pandemic”, Social Sciences & Humanities Open 3. 2021; 100094
[ 2 ] Meagher, K. Crisis, Informalization and the Urban Informal Sector in Sub-Saharan Africa. Development and Change, 26. 259-284; 1997
[ 3 ] Xaba et al. 2001
[ 4 ] Hussmanns, R. Measuring the informal economy: From employment in the informal sector to informal employment, Working Paper No. 53. 2004
[ 5 ] IMF “Measuring the informal economy”, IMF policy paper, February 2021
[ 6 ] Bennett, J., Rablen, M. “Self‐Employment, Wage Employment and Informality in a Developing Economy”, Working Paper No. 12‐02. Centre for Economic Development & Institutions Brunel University, 2012
[ 7 ] Onyebueke, V., Geyer, M. “The informal sector in urban Nigeria: Reflections from almost four decades of Research”, SSB/TRP/MDM 2011 59. 2011
[ 8 ] Yusuff, O. S., A. “Theoretical Analysis of the Concept of Informal Economy and Informality in Developing Countries, European”, Journal of Social Sciences, 20(4). 624-636
[ 9 ] Hughes, C. E. The Sociological eye. Selected papers, New Brunswick, Transaction, Inc, 1984
[ 10 ] Anselm L Strauss, L. A, Baszange, E. (éd.), La Trame de la Négociation, Sociologie qualitative et interactionnisme, L’Harmattan, Paris, 1992
[ 11 ] Becker, S.H. Outsiders: Studies in the Sociology of Deviance, New York: The Free Press, 1963
[ 12 ] Freidson, E., Professionalism. The third logic, Cambridge, Polity Press, 2001
[ 13 ] Dingwall, R. Aspects of Illness. Aldershot,Ashgate Publishing Limited, 2001
[ 14 ] Knill, C. and Tuson, J., Public policy. A new introduction, Palgrave Macmillan, Hampshire, 2012
[ 15 ] Parsons, W., Public policy. An introduction to the theory and practice of policy analysis, Cheltenham, Edward Elgar, 1995
[ 16 ] Mills, C. W. The sociological imagination, Oxford, Oxford University Press
[ 17 ] Kremer and Miguel (2007), 1967
[ 18 ] Cohen, J. and Dupas, P. “Free Distribution or Cost-Sharing? Evidence from a randomized malaria experiment.” Quarterly Journal of Economics 125.1-45; 2010
[ 19 ] Subramanian, V. S., Belli, P., and Kawachi, I. “The macroeconomic determinants of health”, Annu. Rev. Public Health 23.287–302; 2002.
[ 20 ] Swain, R., G. “How does economic and social disadvantage affect health?”, Focus, 33 (1). 1-6; 2016
[ 21 ] Barreto, L.M. “Health inequalities: a global perspective”, Ciência & Saúde Coletiva, 22(7):2097-2108; 2017
[ 22 ] Katikireddi (2016)
[ 23 ] Tekabe, L. F. Health and Long Run Economic Growth in Selected Low Income Countries of Africa South of the Sahara. Cross country panel data analysis, Master Thesis, Södertörns University, 2012
[ 24 ] Deaton, A. “Health, Inequality, and Economic Development”, Journal of Economic Literature (XLI). 113–158; 2003
[ 25 ] Strojkoski, V., Utkovski, Z., Jolakoski, P., Tevdovski, D. and Kocarev, L. “The socio-economic determinants of the coronavirusdi sease (COVID-19) pandemic” medR xiv preprint doi:; 2020
[ 26 ] Clay, K., Lewis, J., Severnini, R.E., Wang, X“The Value of Health Insurance during a Crisis: Effects of Medicaid Implementation on Pandemic Influenza Mortality”, IZA Institute of Labor Economic Discussion Paper No. 13200. 2020
[ 27 ] Woolhandler, S. and Himmelstein, U.D. “Intersecting U.S. Epidemics: COVID-19 and Lack of Health Insurance”, Annals of Internal Medicine, Ideas and Opinions, 2020
[ 28 ] World Bank World Development report 1990, Oxford, Oxford University Press, 1990
[ 29 ] Kaboré, B. Histoire politique du Burkina Faso 1919-2000, Paris, L’Harmattan, 2002
[ 30 ] Sawadogo, N. Dynamique et enjeux de la planification sanitaire au Burkina Faso: cas du district de Pissy/Ouagadougou, Mémoire Cycle PRAT, IPD/West Africa-Sahel, Ouagadougou, 2005
[ 31 ] Bognounou, O., Guinko, S. Ethnobotanique-médecine traditionnelle, Rapport, Ouagadougou, 2005
[ 32 ] Soubeiga, A. « Quête de guérison, conversion, évangélisation. » in  Otayek, R., Dieu dans la cité, Bordeaux, Centre d’Etude D’Afrique Noire, pp.111-128 ; 1999
[ 33 ] Ouédraogo, J-B. « L’émergence du secteur privé et les perspectives d’avenir », Communication Conférence sectorielle sur la santé dans le cadre du cinquantenaire, Ouagadougou, Décembre 2010,
[ 34 ] Elias, N. What is sociology?, London, Hutchinson, 1978 
[ 35 ] Bationo, B.F. et Ouédraogo, L-M “Solidarity in the extension of micro health insurance –the problem of enrolment in mutual health organisations in Burkina Faso” In Hans Jurgen Rosner, Gerald Leppert, Philipp Degens, Lisa-Marie Ouédraogo, éds. 2012. Handbook of Micro health insurance in Africa. Zurich, Lit Verlag, 415-427 ; 2012
[ 36 ] Zagré, P. Les politiques économiques du Burkina Faso. Une tradition d’ajustement structurel, Paris, Éditions Karthala, 1994
[ 37 ] Ouédraogo, L-M. ‘Access for all’ and ‘reaching the poor’? Integrating of mutual health insurance units into public social security arrangements-benefits and risks for mutual schemes’, in Rosner, H.J., Leppert, G., Degens, P., Lisa-Marie Ouédraogo, L-M., eds., 2012, Handbook of Micro health insurance in Africa, Zurich, Lit Verlag, 2012