Facteurs individuels associés à l'usage irrationnel des médicaments essentiels génériques, Burkina Faso.

INTRODUCTION: Assessing the quality of drug prescriptions in a region is undoubtedly important. However, understanding the factors that may influence this quality would be of more interest. OBJECTIVE: The objective of this study is to analyze the influence of individual factors on the rationality of the prescription of generic essential medicines (MEG) in the Bogodogo health district, Ouagadougou. METHOD: A descriptive and analytical cross-sectional study was conducted in May 2016 in 15 Health facilities in the Bogodogo Health District. A mixed methodology was adopted: prescription indicators were calculated on the basis of a sample of 764 medical prescriptions; observation techniques and semi-directed interviews with 15 nurses made it possible to collect qualitative data, which were analyzed thematically. The Chi2 test followed by logistic regression made it possible to assess the relationships between the variables studied at the 5% threshold. RESULTS: The medical prescription was found to be non-rational in the Bogodogo health district. Seniority, qualification, gender, use of the Diagnosis and Treatment Guide, perception of MEG, and personal experience with MEG influenced the rationality of prescribing. CONCLUSION: This study has thus highlighted the influence of certain individual factors on the rationality of MEG prescribing and may make it possible to define new strategies for improving the supply of primary health care.

Analysis of the impact of healthcare support initiatives for physically disabled people on their access to care in the city of Saint-Louis, Senegal.

BACKGROUND: People with disabilities represent approximately 6% of the Senegalese population. They face significant barriers to accessing health care. Although several initiatives have been implemented to improve access to health care for this vulnerable population, few studies have examined the effects of these initiatives. We conducted a mixed methods study in three neighborhoods in Saint-Louis City (Senegal) to assess the impact of health systems and social assistance programs aimed at improving access to health care for people with disabilities. METHODS: Data were collected from 105 people living with disabilities aged 1-49 years (or their caregivers). Interviews were also conducted with key stakeholders in the health and welfare sectors. Global Positioning System (GPS) coordinates of all the health and social services within the city were obtained. We also conducted observations in the main regional hospital, the district health center and three level-one health facilities to assess physical accessibility as well as interactions between patients living with disabilities and health and social workers. Descriptive and multivariate analyses were performed using Sphinx software. Spatial data were used to make cartographic representations of the proximity to basic social services using Arc GIS software. RESULTS: Seventy-nine percent of survey respondents reported difficulty obtaining treatment. Key barriers to care included the high cost of care, as well as ill-treatment by health workers. Limited human resources and low levels of financial support, combined with logistical challenges were reported to hamper the success of social welfare initiatives that aim to facilitate access to health care for people with disabilities. CONCLUSION: Our results suggest that initiatives to increase access to health care among people with disability in Saint-Louis have had limited impact. Study findings underscore the importance of strengthening social assistance schemes within the health system and the need for social workers and health workers to collaborate to improve access to health care for people with disabilities.

[Local perceptions of community participation in health in Burkina Faso]. / Les perceptions locales de la participation communautaire à la santé au Burkina Faso.

OBJECTIVE: Burkina Faso has been implementing a strategy of community participation in the health system for several years.The main objective of this strategy is to involve people in the decision-making process in order to improve the use of health services and to encourage massive support of communities for health promotion activities. Empirical data indicate a low involvement of communities in activities designed to promote participation. This article aims to identify the perceptions of local people in relation to community participation in health. METHODS: The study was conducted in the Tenkodo go health district, located in the administrative region of East-Center, about 190 km from the capital. This exclusively qualitative study used two data collection methods: individual interviews and focus groups. Data were collected in two health areas. RESULTS: The results show that communities have negative perceptions on the community participation in health strategy,which is perceived by the majority as a mechanism of exploitation of the population by health workers and members of health center management committees. CONCLUSIONS: These negatives perceptions of the participation strategy have a negative impact on the behaviour of communities,reflected by the very low participation rate in community activities.Urgent action is needed to revitalize the existing participation mechanisms.

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 in depth interviews were conducted (February 3 - March 16, 2011). 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.

Stories of change in nutrition in Burkina Faso 1992-2018: a macro-level perspective.

Looking back at the development of successful enabling environments for nutrition may inform policymakers on how to accelerate progress to end all forms of malnutrition by 2030. As under-five stunting declined substantially in Burkina Faso, from a peak at 45% in 1998/99 to 25% in 2018, we analyzed through a stories of change approach the actors, ideas, initiatives, policies and capacities which enabled wide-scale nutrition progress. We triangulated findings from policy analysis, stakeholder mapping, and national-level semi-structured interviews (n = 20). We found that since 2002, nutrition has been anchored in the Ministry of Health, where leadership advocated for the creation of coordination bodies, enabling a coherent defining of nutrition and laying groundwork for better integration of nutrition into and prioritization of nutrition by the health and tangential ministries. Under the leadership of the Ministry of Health and its partners, horizontal and vertical coherence in nutrition action increased, through effective cooperation between nutrition actors; increasing intersectoral collaboration, particularly with the influential agriculture sector; and increasing funding to support nutrition-sensitive programming and build the capacity of nutrition staff. Nevertheless, sustainably organizing funding and human resources at the decentralized level remained challenging, in a context of emerging threats such as climate change and insecurity. Burkina Faso's health sector's success in creating an enabling environment for nutrition may have contributed to improvements in child nutrition alongside other sectoral improvements. Enhancing accountability of the Health, Agriculture, WASH, Education and Social Protection sectors and empowering decentralized bodies to take nutrition-relevant decisions may help accelerating progress in nutrition.

Stories of change in nutrition in Burkina Faso 1992-2018: a micro-level perspective.

Looking back at what has effectively improved nutrition may inform policy makers on how to accelerate progress to end all forms of malnutrition by 2030. As under-five stunting declined substantially in Burkina Faso, we analyzed its nutrition story at the micro-level. We conducted a regression-decomposition analysis to identify demographic and health drivers associated with change in height-for-age using longitudinal, secondary, nationally-representative data. We triangulated results with findings from semi-structured community interviews (n = 91) in two "model communities" with a history of large stunting reduction. We found that improvement in immunization coverage, assets accumulation and reduction in open defecation were associated with 23%, 10% and 6.1% of the improvement in height-for-age, respectively. Associations were also found with other education, family planning, health and WASH indicators. Model communities acknowledged progress in the coverage and quality of nutrition-specific and nutrition-sensitive sectoral programs co-located at the community level, especially those delivered through the health and food security sectors, though delivery challenges remained in a context of systemic poverty and persistent food insecurity. Burkina Faso's health sector's success in improving coverage of nutrition and healthcare programs may have contributed to improvements in child nutrition alongside other programmatic improvements in the food security, WASH and education sectors. Burkina Faso should continue to operationalize sectoral nutrition-sensitive policies into higher-quality programs at scale, building on its success stories such as vaccination. Community leverage gaps and data gaps need to be filled urgently to pressure for and monitor high coverage, quality delivery, and nutrition impact of agriculture, education, and WASH interventions. Supplementary Information: The online version contains supplementary material available at 10.1007/s12571-022-01274-z.

Analysis of the implementation of a community-based intervention to control dengue fever in Burkina Faso.

BACKGROUND: A community-based dengue fever intervention was implemented in Burkina Faso in 2017. The results achieved vary from one area to another. The objective of this article is to analyze the implementation of this intervention, to better understand the process, and to explain the contextual elements of performance variations in implementation. METHODOLOGY: The research was conducted in the former sector 22 of the city of Ouagadougou. We adapted the Consolidated Framework for Implementation Research (CFIR) to take into account the realities of the context and the intervention. The data collected from the participants directly involved in the implementation using three techniques: document consultation, individual interview, and focus group. RESULTS: Two dimensions of CFIR emerge from the results as having had a positive influence on the implementation: (i) the characteristics of the intervention and (ii) the processes of the intervention implementation. The majority of the CFIR constructions were considered to have had a positive effect on implementation. The quality and strength of the evidence received the highest score. The dimension of the external context had a negative influence on the implementation of the intervention. CONCLUSION: The objective of the study was to analyze the influence of contextual elements on the implementation process of a community-based dengue fever intervention. We used the CFIR framework already used by many studies for implementation analysis. Although it was not possible to test this framework in its entirety, it is useful for the analysis of the implementation. Its use is simple and does not require any special skills from users. Usability is indeed an essential criterion for the relevance of using an analytical framework in implementation science.

Comprendre l'influence des facteurs contextuels sur la participation communautaire à la santé : une étude de cas dans le district sanitaire de Tenkodogo, au Burkina Faso.

Le Burkina Faso met en œuvre depuis plusieurs années la stratégie de la participation communautaire. Des comités de gestion (CoGes) ont été mis en place dans les centres de santé de la première ligne et doivent participer aux prises de décisions. L'objectif principal de cette stratégie est de favoriser l'utilisation des services de santé et une adhésion massive des communautés aux activités de promotion de la santé. Seulement, on constate que les résultats escomptés par les autorités sanitaires tardent à se réaliser. Le présent article convoque les facteurs liés au contexte socioculturel du district sanitaire, pour analyser le phénomène de la participation communautaire. L'étude s'est déroulée dans le district sanitaire de Tenkodogo, situé dans la région administrative du Centre-est, à environ 190 km de la capitale. Cette étude exclusivement qualitative, a utilisé deux méthodes de collecte : les entretiens individuels et les focus groups. Les participants à l'étude sont les chefs de ménage ( n = 48), les membres des CoGes ( n = 10), les agents de santé ( n = 8) et les agents de santé communautaire ( n = 24). La méthode de l'analyse de contenu a été utilisée pour l'analyse des données. Les résultats de l'étude montrent que plusieurs facteurs socioculturels influencent la dynamique de la participation communautaire dans le district. Ce sont les conditions économiques, la perception négative des services de santé, les inégalités sociales de sexe et d'âge, le faible ancrage social des organisations communautaires, les rivalités inter-villages et les conflits coutumiers. L'étude relève également que les communautés ne perçoivent pas leur implication dans le processus décisionnel des services de santé comme une priorité. Leurs principales attentes s'orientent vers la disponibilité de soins de qualité et à coût réduit.