Realistic Evaluation of the Integrated Electronic Diagnosis Approach (IeDA) for the Management of Childhood Illnesses at Primary Health Facilities in Burkina Faso

Background: In 2014, Terre des Hommes (Tdh) together with the Ministry of Health (MoH) launched the Integrated electronic Diagnosis Approach (IeDA) intervention in two regions of Burkina Faso consisting of supplying every health centre with a digital algorithm. A realistic evaluation was conducted to understand the implementation process, the mechanisms by which the IeDA intervention lead to change. Methods: Data collection took place between January 2016 and October 2017. Direct observation in health centres were conducted. In-depth interviews were conducted with 154 individuals including 92 healthcare workers (HCW) from health centres, 16 officers from district health authorities, 6 members of health centre management committees. In addition, 5 focus groups were organised with carers. The initial coding was based on a preliminary list of codes inspired by the Middle Range Theory. Results: Our results showed that the adoption of the electronic protocol depended on a multiplicity of management practices including role distribution, team work, problem solving approach,task monitoring,training, supervision, support and recognition. Such changes lead to reorganising the health team and redistributing roles before and during consultation, and positive atmosphere that included recognition of each team member, organisational commitment and sense of belonging. Conditions for such management changes to be effective included open dialog at all levels of the system, a minimum of resources to cover the support services and supervision and regular discussions focusing on solving problems faced by health centre teams. Conclusion: This project reinforces the point that in a successful diffusion of IeDA, it is necessary to combine the introduction of technology with support and management mechanisms. It also important to highlight that managers’ attitude plays a great place in the success of the intervention: open dialog and respect are crucial dimensions. This is aligned with the findings from other studies

Socio-Economic Perspectives of Transition in Inland Fisheries and Fish Farming in a Least Developed Country

Small-scale inland fisheries are essential for livelihoods and food security in developing countries such as Burkina Faso. However, there is a gap in research on the ongoing transformation of the sector toward sustainability. This article analyzes the transition in inland fisheries and aquaculture in Burkina Faso and its implications in terms of natural resources management, food security, and livelihoods. We used the Multi-Level Perspective (MLP) method as a reference transition framework and sampled using a mixed approach including 63 qualitative interviews, with fisheries experts and stakeholders, as well as quantitative data gathered through a representative survey with 204 fishermen’s households. We examined open access, concession, and co-management fisheries systems. Our results show that technical and institutional changes in fisheries over the last decades deeply shaped and transformed fisheries governance. Technological changes improved the sector’s productivity and its contribution to households’ livelihoods. Fishermen’s households consume up to 25% of fishermen’s catches. The share of the catches consumed is typically higher when commercial fishing is “not important”, but it remains typically low when it is “very important”. The income is higher for fishermen who allocate more time to or gain more income from animals breeding. The establishment of state-based management affects the balance between the coexisting traditional and newer “republican” institutions. Concession and co-management niches can contribute to the empowerment of the stakeholders and establishment of more effective management. However, they are still dominated by the traditional and centralized state regimes and governance. The support of the socio-technical landscape is paramount for the scaling-up of the fish farming niche, which has the potential to improve food security and sustain rural livelihoods in the least developed country, Burkina Faso