CIHR Health System Impact Fellows: Reflections on “Driving Change” Within the Health System

Learning health systems necessitate interdependence between health and academic sectors and are critical to address the present and future needs of our health systems. This concept is being supported through the new Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship, through which postdoctoral fellows are situated within a health system-related organization to help propel evidence-informed organizational transformation and change. A voluntary working group of fellows from the inaugural cohort representing diversity in geography, host setting and personal background, collectively organized a panel at the 2018 Canadian Association for Health Services and Policy Research Conference with the purpose of describing this shared scholarship experience. Here, we present a summary of this panel reflecting on our experiential learning in a practice environment and its ability for impact

13. L’analyse spatiale

Ce chapitre présente une analyse spatiale d’une intervention qui vise à évaluer si des valeurs similaires d’un résultat sont plus susceptibles de former des grappes dans une zone d’étude. Cette méthode appelée « indicateurs locaux d’association spatiale » (local indicators of spatial association – LISA) permet d’identifier les zones où les valeurs sont spatialement dépendantes les unes des autres. LISA a été utilisé pour évaluer l’effet d’une intervention communautaire visant à contrôler le moustique responsable de la propagation de la dengue Aedes aegypti dans deux quartiers de Ouagadougou, capitale du Burkina Faso. L’évaluation finale de l’intervention à l’aide de cette méthode a montré que les groupes de larves ont disparu dans le quartier qui a reçu l’intervention alors qu’ils persistaient dans le quartier témoin.This chapter present a spatial analysis of an intervention which aims at assessing whether similar values of an outcome are more likely to form clusters in a study area. This method called local indicators of spatial association (LISA) enable to identify areas where values are spatialy dependant with one another. LISA has been used to evaluate the effect of a community-based intervention which aims at controlling the mosquito responsable for spreading Dengue, Aedes aegypti in two neighborhoods of Ouagadougou the capital city of Burkina Faso. The final evalutation of the intervention using this method showed that larva clusters disappeared in the neighborhood which received the intervention while they persisted in the control neighborhood.Este capítulo presenta un análisis espacial de una intervención para evaluar si los valores similares de un resultado tienen más probabilidades de formar grupos en un área de estudio. Este método, denominado « indicadores locales de asociación espacial » (LISA), identifica áreas en las que los valores dependen espacialmente unos de otros. LISA se utilizó para evaluar el impacto de una intervención comunitaria para controlar al mosquito responsable de la propagatión del dengue Aedes aegypti en dos barrios de Uagadugû, la capital de Burkina Faso. La evaluación final de la intervención utilizando este método mostró que los grupos de larvas desaparecieron en el área que recibió la intervención mientras persistían en el área de control

Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso

Background: A component of the performance-based financing intervention implemented in Burkina Faso was to provide free access to healthcare via the distribution of user fee exemption cards to previously identified ultra-poor. This study examines the factors that led to the receipt of user fee exemption cards, and the effect of card possession on the utilisation of healthcare services. Methods: A panel data set of 1652 randomly selected ultra-poor individuals was used. Logistic regression was applied on the end line data to identify factors associated with the receipt of user fee exemption cards. Random-effects modelling was applied to the panel data to determine the effect of the card possession on healthcare service utilisation among those who reported an illness six months before the surveys. Results: Out of the ultra-poor surveyed in 2017, 75.51% received exemption cards. Basic literacy (p = 0.03), living within 5 km from a healthcare centre (p = 0.02) and being resident in Diébougou or Gourcy (p = 0.00) were positively associated with card possession. Card possession did not increase health service utilisation (β = −0.07; 95% CI = −0.45; 0.32; p = 0.73). Conclusion: A better intervention design and implementation is required. Complementing demand-side strategies could guide the ultra-poor in overcoming all barriers to healthcare access

Breast cancer screening programmes: Challenging the coexistence with opportunistic mammography.

International audienc

Développer une culture de l’éthique en recherche interventionnelle en santé des populations

La recherche interventionnelle en santé des populations (RISP) est un champ particulier de la recherche en santé. Elle vise à produire des connaissances qui contribuent à améliorer durablement la santé à l’échelle des populations en favorisant l’implantation de solutions intersectorielles adaptées aux réalités sociales. Malgré les enjeux éthiques que suscite nécessairement son calendrier social, l’éthique de la RISP est encore très peu formalisée, ce qui pourrait avoir pour effet de limiter sa portée sur l’équité en santé. La présente contribution vise à mettre en lumière certains de ces enjeux et appelle les chercheurs du domaine à développer une culture de l’éthique en RISP. Trois avenues de réflexion complémentaires sont proposées : élaborer une conception éthique propre à ce champ, promouvoir un espace de réflexion critique qui facilite la décision éthique en RISP, et développer la compétence éthique en RISP pour laquelle un ensemble préliminaire d’éléments est avancé.Population health intervention research (PHIR) is a particular field of health research that aims to generate knowledge that contributes to the sustainable improvement of population health by enabling the implementation of cross-sectoral solutions adapted to social realities. Despite the ethical issues that necessarily raise its social agenda, the ethics of PHIR is still very little formalized. Unresolved ethical challenges may limit its focus on health equity. This contribution aims to highlight some of these issues and calls on researchers to develop a culture of ethics in PHIR. Three complementary ways are proposed: to build an ethical concept specific to this field, to promote a shared space for critical reflection on PHIRs ethics, as well as to develop the ethical competence in PHIR for which a preliminary framework is proposed

COVAX – Time to reconsider the strategy and its target

COVAX, the international initiative supporting COVID-19 vaccination campaigns globally, is budgeted to be the costliest public health initiative in low- and middle-income countries, with over 16 billion US dollars already committed. While some claim that the target of vaccinating 70% of people worldwide is justified on equity grounds, we argue that this rationale is wrong for two reasons. First, mass COVID-19 vaccination campaigns do not meet standard public health requirements for clear expected benefit, based on costs, disease burden and intervention effectiveness. Second, it constitutes a diversion of resources from more cost-effective and impactful public health programmes, thus reducing health equity. We conclude that the COVAX initiative warrants urgent review

COVID-19 epidemiological, sociological and anthropological investigation: study protocol for a multidisciplinary mixed methods research in Burkina Faso

International audienceBackground: The world has high hopes of vaccination against COVID-19 to protect the population, boost economies and return to normal life. Vaccination programmes are being rolled out in high income countries, but the pandemic continues to progress in many low-and middle-income countries (LMICs) despite implementation of strict hygiene measures. We aim to present a comprehensive research protocol that will generate epidemiological, sociological and anthropological data about the COVID-19 epidemic in Burkina Faso, a landlocked country in West Africa with scarce resources. Methods: We will perform a multidisciplinary research using mixed methods in the two main cities in Burkina Faso (Ouagadougou and Bobo-Dioulasso). Data will be collected in the general population and in COVID-19 patients, caregivers and health care professionals in reference care centers: (i) to determine cumulative incidence of SARS-CoV-2 infection in the Burkinabe population using blood samples collected from randomly selected households according to the WHO-recommended protocol; (ii) develop a score to predict severe complications of COVID-19 in persons infected with SARS-CoV-2 using retrospective and prospective data; (iii) perform semi-structured interviews and direct observation on site, to describe and analyze the healthcare pathways and experiences of patients with COVID-19 attending reference care centers, and to identify the perceptions, acceptability and application of preventive strategies among the population. Discussion: This study will generate comprehensive data that will contribute to improving COVID-19 response strategies in Burkina Faso. The lessons learned from the management of this epidemic may serve as examples to the country authorities to better design preventive strategies in the case of future epidemics or pandemics. The protocol was approved by the Ministry for Health (N° 2020-00952/MS/CAB/INSP/CM) and the Health Research Ethics Committee in Burkina Faso (N° 2020-8-140)