Politique publique de protection sociale au Burkina Faso : vers une compréhension des logiques des acteurs de la mise en forme et de la mise en œuvre

La réalisation des politiques de protection sociale en Afrique soulève des questions complexes, notamment leur raison d’être et le choix des contenus (Merrien, 2013). L’originalité de cette thèse tient au fait qu’elle soit la première du genre à analyser l’élaboration des politiques de protection sociale au Burkina Faso autre que celles dans le domaine de la santé. À travers une analyse de la politique nationale de protection sociale et programme pilote de protection sociale en santé des personnes démunies, la thèse répond aux questions suivantes : pourquoi et comment la protection sociale est devenue une priorité gouvernementale et quels sont les facteurs qui ont influencé la mise en forme de ces deux politiques publiques et la mise en œuvre du programme de solidarité ? À partir de cadres d’analyse issue de diverses perspectives disciplinaires (science politique, sociologie, anthropologie), la réalisation des politiques publiques de protection sociale est considérée comme le fruit de l’interaction d’une multitude d’acteurs et de leurs intérêts divers : organisations internationales, coopération bilatérale, structure étatique, associations et ONG locales. La méthodologie est essentiellement qualitative. L’entrevue semi-dirigée approfondie, l’analyse documentaire et l’entrevue informelle ont été utilisées pour collecter les données. Les résultats sont structurés en cinq articles scientifiques. La décision de formuler ces deux politiques était principalement motivée par la recherche d’une cohésion sociale pour maintenir la paix et l’ordre social (article 1 et 4). Le processus de la formulation n’a pas permis de conduire une réflexion sur le problème à résoudre, d’identifier les besoins spécifiques des bénéficiaires, d’évaluer la capacité des solutions pour choisir celles appropriées. Les logiques des acteurs nationaux étaient de maintenir leurs acquis financiers et de mobiliser des ressources supplémentaires. Les acteurs internationaux ont été guidés par la logique de promotion d’instrument de protection sociale en adéquation avec leurs valeurs, leurs idées, leurs missions, et ce pour la mise en œuvre de leur mandat institutionnel. Cela a donné lieu au constat empirique de « non-design » ou de non-formulation (article 2 et 4), a révélé l’influence des idées et des intérêts des acteurs dans le choix des solutions, mais a aussi montré qu’une volonté politique est importante pour que les choix puissent répondre aux besoins des populations pauvres et vulnérables. Par ailleurs, les connaissances issues de la recherche scientifique ont été très peu utilisées pour éclairer les choix comparativement aux connaissances issues de la littérature grise (article 3). Les gains politiques, c’est-à-dire la perception des conséquences sociales et politiques associées à une recommandation fondée sur des connaissances scientifiques, influencent la prise en compte de cette dernière. L’analyse de la mise en œuvre montre que des lacunes de formulation influencent l’efficacité d’une politique. Aussi, la mise en œuvre offre des circonstances opportunes d’adaptation et de reformulation pour intégrer les spécificités du contexte et les besoins des bénéficiaires en vue d’améliorer l’efficacité (article5).The development of social protection policies in Africa raises complex issues, including its rationale and choice of content (Merrien, 2013). This thesis is the first of its kind to analyze the development of social protection policies in Burkina Faso other than those in the field of health. Through an analysis of the National Social Protection Policy and pilot program of Social Protection in the Health of the Poor, this thesis answers the following questions: why and how social protection has become a government priority; and what factors have influenced the shaping of these two public policies and the implementation of the solidarity program? Based on analytical frameworks from various disciplinary perspectives (political science, sociology, anthropology), the process of developing public social protection policies is the result of the interaction of a multitude of actors and their diverse interests: international organizations, bilateral cooperation, state structure, associations, and local NGOs. The methodology is essentially qualitative. This thesis collects data thorough semi-structured interviews, literature review, and informal interviews. The results are structured in five scientific articles. The desire for social cohesion to maintain peace and social order motivated the decision to formulate these two policies (Articles 1 and 4). The formulation process did not lead to a reflection on the problem to be solved, to identify the specific needs of the beneficiaries, to evaluate the capacity of the solutions to choose the appropriate ones. The motive of the national actors was to maintain their financial assets and to mobilize additional resources. International actors have been guided by the logic of promoting a social protection instrument in line with their values, their ideas, and their missions, for the implementation of their institutional mandate. This implementation gave rise to the empirical observation of "non-design" or non-formulation (Article 2 and 4), revealed the influence of the ideas and interests of the actors in the choice of solutions, but also showed that it is important for choices to meet the needs of the poor and vulnerable. In addition, knowledge derived from research data was used very little compared to knowledge from gray literature (Article 3). Political gains, that is, the perception of social and political consequences associated with a recommendation based on scientific knowledge, influence the latter's consideration. The iv analysis of the implementation of the solidarity program shows that formulation gaps influence the effectiveness of a policy. Thus, the implementation offers opportune circumstances for adaptations and reformulations to integrate the specificities of the context and the needs of the beneficiaries with an aim of improving efficiency (Article 5). However, these opportunities have not been utilized by program implementers, helping to keep those who are impoverished excluded from health services

From the Formulation of a National Policy to the Compilation of Social Protection Actions: A Case of ‘Non-design’ in Burkina Faso

To improve the social protection of its population, Burkina Faso adopted a national policy in 2012. This paper analyses the process whereby this policy was formulated, looking at the issue from the standpoint of ‘policy design’ (Howlett and Mukherjee, 2014). Conducted in accordance with an inductive qualitative approach, the collection and analysis of the data show that this process of formulation has led neither to reflecting on the problem to be solved nor to identifying the specific needs of the beneficiaries. Nor has it led to evaluating the potential outcomes of the proposed solutions in order to choose the most appropriate ones. The authors are thus led to an empirical observation of ‘non-design’. This policy boils down to a document whose all-encompassing content brings together every conceivable action of social protection, without any arbitration. Three factors have contributed to this non-formulation: (1) the lack of clear government direction to guide discussions; (2) a weakness of support and of political will, resulting in a low degree of involvement in the process on the part of high-level decision makers; and (3) conceptual and technical misunderstandings on the part of national stakeholders in social protection—so much so that they have simply relied on the advice of international bodies. The government announced its intention of playing a leading role in the process of formulating this policy, but this was a purely rhetorical declaration. The study shows that leadership and political will have been lacking, particularly when it has come to channelling the respective interests of the stakeholders and managing the contradictions that hinder the formulation of a coherent policy adapted to the needs of the population

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

Connaissances et perceptions de la maladie à coronavirus (COVID-19) dans la commune de Ouagadougou

The COVID-19 disease has spread throughout the world. This has led health and political authorities from Burkina Faso to take measures to fight against this disease. Perceptions of the population about the disease are a hindrance to the fight against the pandemic. The objective of this study is to analyze and describe the general population's perception of the COVID-19 pandemic.  A qualitative study was conducted in Ouagadougou. 65 in-depth individual interviews were conducted in 2020. A thematic content analysis was conducted using NVIVO software. The results indicate a diverse community perception of coronavirus disease. Three periods of awareness of the disease were identified.  People identified physical contact and the respiratory tract as the main routes of contraction of the disease. As for the treatment, most of the participants indicate that a medical treatment is necessary to cure the coronavirus, while others believe in the effectiveness of the traditional treatment. Finally, to stop the spread of the virus, participants suggest the implementation of awareness in public places. In view of the diversity and importance of the popular perception of the coronavirus disease, the results of this study could contribute to the implementation of communication strategies by the government and the actors of the response.La COVID-19 s’est propagée à travers le monde entier. Ce qui a amené les autorités sanitaires et politiques du Burkina Faso à prendre des mesures pour lutter contre cette maladie. Certaines perceptions de la population sur la maladie constituent un frein à la lutte contre la pandémie. L’objectif de cette étude vise à analyser et à décrire la perception de la population générale face à la pandémie de COVID-19. Une étude qualitative a été réalisée à Ouagadougou. 65 entretiens individuels approfondis ont été menés en 2020. Une analyse thématique de contenu a été faite à l’aide du logiciel NVIVO. Les résultats indiquent une perception communautaire diversifiée de la maladie à coronavirus. Trois périodes de prise de connaissance de l’existence de la maladie ont été évoquées.  Pour les populations, les contacts physiques et les voies respiratoires constituent les principales voies de contractions de la maladie. Quant au traitement, la plupart des participants indiquent qu’un traitement médical est nécessaire pour guérir du coronavirus, d’autres en revanche croient à l’efficacité du traitement traditionnel. Enfin, pour arrêter la propagation du virus, les participants suggèrent la mise en œuvre de la sensibilisation dans les lieux publics. Au regard de la diversité et de l’importance de la perception populaire face à la maladie à coronavirus, les résultats de cette étude pourraient contribuer à la mise en œuvre de stratégies de communication par le gouvernement et les acteurs de la riposte

Connaissances et perceptions de la maladie à coronavirus (COVID-19) dans la commune de Ouagadougou

The COVID-19 disease has spread throughout the world. This has led health and political authorities from Burkina Faso to take measures to fight against this disease. Perceptions of the population about the disease are a hindrance to the fight against the pandemic. The objective of this study is to analyze and describe the general population's perception of the COVID-19 pandemic.  A qualitative study was conducted in Ouagadougou. 65 in-depth individual interviews were conducted in 2020. A thematic content analysis was conducted using NVIVO software. The results indicate a diverse community perception of coronavirus disease. Three periods of awareness of the disease were identified.  People identified physical contact and the respiratory tract as the main routes of contraction of the disease. As for the treatment, most of the participants indicate that a medical treatment is necessary to cure the coronavirus, while others believe in the effectiveness of the traditional treatment. Finally, to stop the spread of the virus, participants suggest the implementation of awareness in public places. In view of the diversity and importance of the popular perception of the coronavirus disease, the results of this study could contribute to the implementation of communication strategies by the government and the actors of the response.La COVID-19 s’est propagée à travers le monde entier. Ce qui a amené les autorités sanitaires et politiques du Burkina Faso à prendre des mesures pour lutter contre cette maladie. Certaines perceptions de la population sur la maladie constituent un frein à la lutte contre la pandémie. L’objectif de cette étude vise à analyser et à décrire la perception de la population générale face à la pandémie de COVID-19. Une étude qualitative a été réalisée à Ouagadougou. 65 entretiens individuels approfondis ont été menés en 2020. Une analyse thématique de contenu a été faite à l’aide du logiciel NVIVO. Les résultats indiquent une perception communautaire diversifiée de la maladie à coronavirus. Trois périodes de prise de connaissance de l’existence de la maladie ont été évoquées.  Pour les populations, les contacts physiques et les voies respiratoires constituent les principales voies de contractions de la maladie. Quant au traitement, la plupart des participants indiquent qu’un traitement médical est nécessaire pour guérir du coronavirus, d’autres en revanche croient à l’efficacité du traitement traditionnel. Enfin, pour arrêter la propagation du virus, les participants suggèrent la mise en œuvre de la sensibilisation dans les lieux publics. Au regard de la diversité et de l’importance de la perception populaire face à la maladie à coronavirus, les résultats de cette étude pourraient contribuer à la mise en œuvre de stratégies de communication par le gouvernement et les acteurs de la riposte

When the messenger is more important than the message: an experimental study of evidence use in francophone Africa

BackgroundEpistemic injustices are increasingly decried in global health. This study aims to investigate whether the source of knowledge influences the perception of that knowledge and the willingness to use it in francophone African health policy-making context. Methods The study followed a randomized experimental design in which participants were randomly assigned to one of seven policy briefs that were designed with the same scientific content but with different organizations presented as authors. Each organization was representative of financial, scientific or moral authority. For each type of authority, two organizations were proposed: one North American or European, and the other African. ResultsThe initial models showed that there was no significant association between the type of authority or the location of the authoring organization and the two outcomes (perceived quality and reported instrumental use). Stratified analyses highlighted that policy briefs signed by the African donor organization (financial authority) were perceived to be of higher quality than policy briefs signed by the North American/European donor organization. For both perceived quality and reported instrumental use, these analyses found that policy briefs signed by the African university (scientific authority) were associated with lower scores than policy briefs signed by the North American/European university. ConclusionsThe results confirm the significant influence of sources on perceived global health knowledge and the intersectionality of sources of influence. This analysis allows us to learn more about organizations in global health leadership, and to reflect on the implications for knowledge translation practices.</p

Too hot to thrive: a qualitative inquiry of community perspectives on the effect of high ambient temperature on postpartum women and neonates in Kilifi, Kenya

Objective: To understand community perspectives on the effects of high ambient temperature on the health and wellbeing of neonates, and impacts on post-partum women and infant care in Kilifi. Design: Qualitative study using key informant interviews, in-depth interviews and focus group discussions with pregnant and postpartum women (n = 22), mothers-in-law (n = 19), male spouses (n = 20), community health volunteers (CHVs) (n = 22) and stakeholders from health and government ministries (n = 16). Settings: We conducted our research in Kilifi County in Kenya’s Coast Province. The area is largely rural and during summer, air temperatures can reach 37˚C and rarely go below 23˚C. Data analysis: Data were analyzed in NVivo 12, using both inductive and deductive approaches. Results: High ambient temperature is perceived by community members to have direct and indirect health pathways in pregnancy and postpartum periods, including on the neonates. The direct impacts include injuries on the neonate’s skin and in the mouth, leading to discomfort and affecting breastfeeding and sleeping. Participants described babies as “having no peace”. Heat effects were perceived to be amplified by indoor air pollution and heat from indoor cooking fires. Community members believed that exclusive breastfeeding was not practical in conditions of extreme heat because it lowered breast milk production, which was, in turn, linked to a low scarcity of food and time spend by mothers away from their neonates performing household chores. Kangaroo Mother Care (KMC) was also negatively affected. Participants reported that postpartum women took longer to heal in the heat, were exhausted most of the time and tended not to attend postnatal care. Conclusions: High ambient temperatures affect postpartum women and their neonates through direct and indirect pathways. Discomfort makes it difficult for the mother to care for the baby. Multi-sectoral policies and programs are required to mitigate the negative impacts of high ambient temperatures on maternal and neonatal health in rural Kilifi and similar settings

Challenges of scaling up and of knowledge transfer in an action research project in Burkina Faso to exempt the worst-off from health care user fees

<p>Abstract</p> <p>Background</p> <p>Systems to exempt the indigent from user fees have been put in place to prevent the worst-off from being excluded from health care services for lack of funds. Yet the implementation of these mechanisms is as rare as the operational research on this topic. This article analyzes an action research project aimed at finding an appropriate solution to make health care accessible to the indigent in a rural district of Burkina Faso.</p> <p>Research</p> <p>This action research project was initiated in 2007 to study the feasibility and effectiveness of a community-based, participative and financially sustainable process for exempting the indigent from user fees. A interdisciplinary team of researchers from Burkina Faso and Canada was mobilized to document this action research project.</p> <p>Results and knowledge sharing</p> <p>The action process was very well received. Indigent selection was effective and strengthened local solidarity, but coverage was reduced by the lack of local financial resources. Furthermore, the indigent have many other needs that cannot be addressed by exemption from user fees. Several knowledge transfer strategies were implemented to share research findings with residents and with local and national decision-makers.</p> <p>Partnership achievements and difficulties</p> <p>Using a mixed and interdisciplinary research approach was critical to grasping the complexity of this community-based process. The adoption of the process and the partnership with local decision-makers were very effective. Therefore, at the instigation of an NGO, four other districts in Burkina Faso and Niger reproduced this experiment. However, national decision-makers showed no interest in this action and still seem unconcerned about finding solutions that promote access to health care for the indigent.</p> <p>Lessons learned</p> <p>The lessons learned with regard to knowledge transfer and partnerships between researchers and associated decision-makers are: i) involve potential users of the research results from the research planning stage; ii) establish an ongoing partnership between researchers and users; iii) ensure that users can participate in certain research activities; iv) use a variety of strategies to disseminate results; and v) involve users in dissemination activities.</p

De la formulation d’une politique nationale à la compilation d’actions de protection sociale : un cas de « non-design » au Burkina Faso

Pour améliorer la protection sociale de sa population, le Burkina Faso a adopté une politique nationale en 2012. Cet article analyse le processus de formulation de cette politique en s’appuyant sur la perspective du « policy design » (Howlett et Mukherjee, 2014). Menées conformément à la démarche qualitative inductive, la collecte et l’analyse des données montrent que ce processus de formulation n’a permis ni de mener une réflexion sur le problème à résoudre, ni d’identifier les besoins spécifiques des bénéficiaires, ni d’évaluer les résultats potentiels des solutions proposées dans le but de choisir les plus appropriées. Les auteurs aboutissent donc à un constat empirique de « non-design ». Cette politique se résume à un document dont le contenu tous azimuts rassemble toutes les actions envisageables de protection sociale, sans aucun arbitrage. Trois facteurs ont favorisé cette non-formulation : (1) le manque d’orientations gouvernementales claires pour guider les discussions ; (2) la faiblesse du soutien et de volonté politique – se traduisant par la faible implication des décideurs de haut niveau dans le processus ; et (3) les méconnaissances conceptuelle et technique des acteurs nationaux en matière de protection sociale – si bien qu’ils se sont contentés d’avoir recours aux conseils des organismes internationaux. Le gouvernement a annoncé son intention de jouer un rôle prépondérant dans le processus de formulation de cette politique mais il s’est agit d’une déclaration rhétorique. L’étude a en effet montré que le leadership et la volonté politique ont manqué, notamment pour canaliser les intérêts respectifs des acteurs et gérer les contradictions qui font obstacle à la formulation d’une politique cohérente et adaptée aux besoins de la population