National user fee abolition and health insurance scheme in Burkina Faso : how can they be integrated on the road to universal health coverage without increasing health inequities?

Incorporating the free health care policy into a Universal Health Insurance (UHI) scheme was recently introduced (2019) as a solution to the debate about free health care in Burkina Faso. The article discusses options for linking free health care to an insurance plan while limiting the risk of adding to existing health inequities. In line with Universal Health Coverage and improved access to health care, the long-term ambition is for the new UHI national fund to generate surpluses that can partly contribute to sustaining the free health care policy

User fee policies and women’s empowerment : a systematic scoping review

User fee removal policies alone are not enough to improve women’s healthcare decision-making power. Comprehensive and multi-sectoral approaches are needed to bring sustainable change regarding women’s empowerment. A focus on “gender equitable access to healthcare” would serve to reconcile women’s empowerment and efforts to achieve universal health coverage. The article provides a synopsis of research that examined existing literature, with study settings in three low-income countries (Burkina Faso, Mali, Sierra Leone) and two lower-middle countries (Kenya, India). Evidence suggests that user fee removal contributes to improving women’s capacity to make health decisions, but that the impact is limited

Effects of terrorist attacks on access to maternal healthcare services : a national longitudinal study in Burkina Faso

Terrorist attacks constitute a new barrier to already fragile access to maternal healthcare in Burkina Faso. Regional insecurity needs to be recognized and investigated by global health research. The study reveals that terrorist attacks started in 2015 and have grown exponentially, reaching a total of 206 in 2018, and 411 in 2019. Problems can be compounded by the COVID-19 pandemic, which as well, could instigate an upsurge of terrorist activity with increased insecurity across the Sahel region

Monitoring the performance of the Expanded Program on Immunization: the case of Burkina Faso

<p>Abstract</p> <p>Background</p> <p>The greatest challenge facing expanded programs on immunization in general, and in Burkina Faso in particular, lies in their capacity to achieve and sustain levels of immunization coverage that will ensure effective protection of children. This article aims to demonstrate that full immunization coverage of children, which is the primary indicator for monitoring national immunization programs, is sufficient neither to evaluate their performance adequately, nor to help identify the broad strategies that must be implemented to improve their performance. Other dimensions of performance, notably adherence to the vaccination schedule and the efficacy of the approaches used to reach all the children (targeting) must also be considered.</p> <p>Methods</p> <p>The study was carried out using data from surveys carried out in Burkina Faso: the 1993, 1998 and 2003 Demographic and Health Surveys and the 2003 national Survey of Immunization Coverage. Essentially, we described levels of immunization coverage and their trends according to the indicators considered. Performance differences are illustrated by amplitudes and maximum/minimum ratios.</p> <p>Results</p> <p>The health regions' performances vary according to whether they are evaluated on the basis of full immunization coverage or vaccination status of children who have not completed their vaccinations. The health regions encompass a variety of realities, and efforts of substantially different intensity would be required to reach all the target populations.</p> <p>Conclusion</p> <p>Decision-making can be improved by integrating a tripartite view of performance that includes full immunization coverage, adherence to the vaccination schedule (timely coverage), and the status of children who are not fully vaccinated. With such an approach, interventions can be better targeted. It provides information on the quality and timeliness of vaccination and identifies the efforts required to meet the objectives of full immunization coverage.</p> <p>Abstract in French</p> <p>See the full article online for a translation of this abstract in French.</p

An exploratory analysis of the regionalization policy for the recruitment of health workers in Burkina Faso

BACKGROUND: Health personnel retention in remote areas is a key health systems issue wordwide. To deal with this issue, since 2002 the government of Burkina Faso has implemented a staff retention policy, the regionalized health personnel recruitment policy, aimed at front-line workers such as nurses, midwives, and birth attendants. This study aimed to describe the policy’s development, formulation, and implementation process for the regionalization of health worker recruitment in Burkina Faso. METHODS: We conducted a qualitative study. The unit of analysis is a single case study with several levels of analysis. This study was conducted in three remote areas in Burkina Faso for the implementation portion, and at the central level for the development portion. Indepth interviews were conducted with Ministry of Health officials in charge of human resources, regional directors, regional human resource managers, district chief medical officers, and health workers at primary health centres. In total, 46 indepth interviews were conducted (February 3 - March 16, 2011). RESULTS: Development The idea for this policy emerged after finding a highly uneven distribution of health personnel across urban and rural areas, the availability of a large number of health officers in the labour market, and the opportunity given to the Ministry of Health by the government to recruit personnel through a specific budget allocation. Formulation The formulation consisted of a call for job applications from the Ministry of Health, which indicates the number of available posts by region. The respondents interviewed unanimously acknowledged the lack of documents governing the status of this new personnel category. Implementation During the initial years of implementation (2002-2003), this policy was limited to recruiting health workers for the regions with no possibility of transfer. The possibility of job-for-job exchange was then approved for a certain time, then cancelled. Starting in 2005, a departure condition was added. Now, regionalized health workers can leave the regions after undergoing a competitive selection process. CONCLUSION: The policy was characterized by the absence of written directives and by targeting only one category of personnel. Moreover, there was no associated incentive—financial or otherwise—which poses the question of long-term viability

Politiques publiques et lutte contre l'exclusion : un réseau de chercheurs/décideurs pour l'équité en santé

En novembre 2001, une subvention du Centre de Recherche en Développement International a permis de mettre en place un réseau de recherche dont le thème central est l’équité d’accès aux soins en Afrique de l’Ouest. L’objectif était de constituer un réseau de chercheurs et de décideurs de l’Afrique de l’Ouest actif dans la promotion de politiques de santé «pro-équité» et de favoriser l’émergence d’un observatoire des systèmes de santé sous régional en renforçant les capacités locales de recherche sur les systèmes de santé. Des équipes associant chercheurs et décideurs réalisent des projets de recherche qui s’inscrivent dans les agendas nationaux de recherche et qui ont établi des évidences sur l’équité des mesures prises dans le cadre des différentes politiques nationales de santé. Des activités de valorisation et de transfert ont alimenté des processus de révision de ces mesures dans les pays. // La première phase de cette initiative a duré 3 ans (2001-2004) et concernait 3 pays (Burkina Faso, Côte d’Ivoire et Sénégal). Les projets ont touché l’évaluation des mesures d’exemption du paiement des forfaits hospitaliers pour les urgences obstétricales (BF), des mécanismes d’exemption des paiements pour les indigents (RCI) et un portrait du milieu mutualiste sénégalais, des logiques et des dynamiques de ses acteurs. Après une période transitoire de 2 ans, une troisième phase de cette initiative a démarré en 2006, visant la diversification et la consolidation du réseau. Le Bénin et le Mali se sont ajoutés aux trois pays initiateurs. Les projets de recherche sont en cours, ils concernent: l’évaluation de l’impact des mutuelles de santé au Bénin, l’analyse des conditions de mise en oeuvre des mesures gouvernementales de réduction de la mortalité maternelle au Burkina Faso, la conception d’une stratégie nationale d’exemptions pour les indigents en Côte d’Ivoire, l’analyse des effets d’un programme de réduction de la mortalité maternelle et à documenter leurs mécanismes de production au Mali et une définition de l’orientation du mouvement mutualiste sénégalais afin de maximiser son potentiel de réduction des inégalités d’accès aux soins. Des résultats préliminaires des travaux de cette phase sont disponibles

Longitudinal analysis of the capacities of community health workers mobilized for seasonal malaria chemoprevention in Burkina Faso

Results of the study confirm the capacity of community health workers, or “community-based distributors” (CBDs), under routine programme implementation of seasonal malaria chemoprevention (SMC). Mandating CBDs with targeted tasks is a successful functional model, as they achieve mastery where investments are made in training and supervision. Losing this specificity by extending CBDs’ mandates beyond SMC could have undesirable consequences. The added value of retaining committed CBDs is high. It is suggested that motivation and commitment be considered in recruitment, and that a supportive climate be created to foster retention of workers.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Analysis of the quality of seasonal malaria chemoprevention provided by community health workers in Boulsa health district, Burkina Faso

The study evaluated the level of quality of care provided by community health workers (CHW) within the framework of the Seasonal Malaria Chemoprevention (SMC) strategy. Results have shown that despite the difficulties faced by community health workers, they manage to deliver acceptable quality of care. The SMC’s administration guide proposed by WHO was the standard for CHW’s quality assessment and an important factor supporting the study. The report reviews details of methodology and outcomes of the project as well as providing background to the SMC strategy. This study was conducted in the Boulsa health district, located in the north-central region of Burkina Faso

Low coverage but few inclusion errors in Burkina Faso: a community-based targeting approach to exempt the indigent from user fees

<p>Abstract</p> <p>Background</p> <p>User fees were generalized in Burkina Faso in the 1990 s. At the time of their implementation, it was envisioned that measures would be instituted to exempt the poor from paying these fees. However, in practice, the identification of indigents is ineffective, and so they do not have access to care. Thus, a community-based process for selecting indigents for user fees exemption was tested in a district. In each of the 124 villages in the catchment areas of ten health centres, village committees proposed lists of indigents that were then validated by the health centres' management committees. The objective of this study is to evaluate the effectiveness of this community-based selection.</p> <p>Methods</p> <p>An indigent-selection process is judged effective if it minimizes inclusion biases and exclusion biases. The study compares the levels of poverty and of vulnerability of indigents selected by the management committees (n = 184) with: 1) indigents selected in the villages but not retained by these committees (n = 48); ii) indigents selected by the health centre nurses (n = 82); and iii) a sample of the rural population (n = 5,900).</p> <p>Results</p> <p>The households in which the three groups of indigents lived appeared to be more vulnerable and poorer than the reference rural households. Indigents selected by the management committees and the nurses were very comparable in terms of levels of vulnerability, but the former were more vulnerable socially. The majority of indigents proposed by the village committees who lived in extremely poor households were retained by the management committees. Only 0.36% of the population living below the poverty threshold and less than 1% of the extremely poor population were selected.</p> <p>Conclusions</p> <p>The community-based process minimized inclusion biases, as the people selected were poorer and more vulnerable than the rest of the population. However, there were significant exclusion biases; the selection was very restrictive because the exemption had to be endogenously funded.</p