Assisted deliveries: the share of the total consumption of each income group.

*<p>Estimates in 2006 from the national census and assumed to be stable over the observation period.</p

Comparison of the two districts studied.

<p>Source: Ministry of Health (2011); Ministry of the Economy and Finances (2009); RGPH (2006).</p

Implementation Fidelity of the National Malaria Control Program in Burkina Faso

<div><p>Background</p><p>Every year 40,000 people die of malaria in Burkina Faso. In 2010, the Burkinabè authorities implemented a national malaria control program that provides for the distribution of mosquito nets and the home-based treatment of children with fever by community health workers. The objective of this study was to measure the implementation fidelity of this program.</p><p>Methods</p><p>We conducted a case study in two comparable districts (Kaya and Zorgho). Data were collected one year after the program’s implementation through field observations (10 weeks), documentary analysis, and individual interviews with stakeholders (n = 48) working at different levels of the program. The analysis framework looked at the fidelity of (i) the intervention’s content, (ii) its coverage, and (iii) its schedule.</p><p>Results</p><p>The program’s implementation was relatively faithful to what was originally planned and was comparable in the two districts. It encountered certain obstacles in terms of the provision of supplies. Coverage fidelity was better in Kaya than in Zorgho, where many community health workers (CHW) experienced problems with the restocking of artemisinin-based combination therapy and with remuneration for periods of training. In both districts, the community was rarely involved in the process of selecting CHWs. The components affected by scheduling all experienced successive implementation delays that pushed nets distribution and the initial provision of artemisinin-based combination therapies to the CHWs past the 2010 malaria season.</p><p>Conclusions</p><p>The activities intended by the program were mostly implemented with good fidelity. However, the implementation was plagued by delays that probably postponed the expected beneficial effects.</p></div

Content implementation fidelity.

<p>Source: survey data.</p

Coverage implementation fidelity.

<p>Source: survey data.</p

Proportion of women exempted from payment for deliveries by income quintile in 2006 (n = 34) and 2010 (n = 68).

<p>Proportion of women exempted from payment for deliveries by income quintile in 2006 (n = 34) and 2010 (n = 68).</p

Distribution of medical costs (F CFA) between 2006 (Q1 and Q5 = 234) and 2010 (Q1 = 166; Q5 = 176) by household income quintiles and distance from public health centre.

<p>Distribution of medical costs (F CFA) between 2006 (Q1 and Q5 = 234) and 2010 (Q1 = 166; Q5 = 176) by household income quintiles and distance from public health centre.</p

Share of total medical expenditure by income group 2006 and 2010.

<p>Share of total medical expenditure by income group 2006 and 2010.</p

Distribution of medical costs and total costs (F CFA) for a normal delivery from 2006 (n = 1170) to 2010 (n = 905).

<p>Distribution of medical costs and total costs (F CFA) for a normal delivery from 2006 (n = 1170) to 2010 (n = 905).</p

Number of interviews carried out in the two districts.

<p>Number of interviews carried out in the two districts.</p