The Landscape of Strategic Health Purchasing for Universal Health Coverage in Burkina Faso: Insights from Five Major Health Financing Schemes.

Strategic health purchasing is a key strategy in Burkina Faso to spur progress toward universal health coverage (UHC). However, a comprehensive analysis of existing health financing arrangements and their purchasing functions has not been undertaken to date. This article provides an in-depth analysis of five key health financing schemes in Burkina Faso: Gratuité (a national free health care program for women and children under age 5), crédits délégués (delegated credits), crédits transférés (transfers to municipalities), community-based health insurance, and occupation-based health insurance. This study involved a document review and complementary key informant interviews using the Strategic Health Purchasing Progress Tracking Framework developed by the Strategic Purchasing Africa Resource Center (SPARC). Data were collected using the framework's accompanying Microsoft Excel-based tool. We analyzed the data manually to examine and identify the strengths and weaknesses of governance arrangements and purchasing functions and capacities. The study provides insight into areas that are working well from a strategic purchasing perspective and, more importantly, areas that need more attention. Areas for improvement include low financial and managerial autonomy for some schemes, weak accountability measures, lack of explicit quality standards for contracting and for service delivery, budget overruns and late provider payment, provider payment that is not linked to provider performance, fragmented health information systems, and information generated is not linked to purchasing decisions. Improvements in purchasing functions are required to address shortcomings while consolidating achievements. This study will inform next steps for Burkina Faso to improve purchasing and advance progress toward UHC.

Collaborative Learning to Advance Knowledge and Implementation of Strategic Health Purchasing in Sub-Saharan Africa.

Strategic purchasing means deliberately directing health funds to priority populations, interventions, and services. This is done by actively creating incentives so funding is used equitably and efficiently and is aligned with population health needs. Strategic purchasing is a complex policy area fraught with challenging technical, institutional, and political issues. Policy makers and practitioners are an important source of tacit knowledge-experiential knowledge that is context specific and gained over time. Collaborative learning, through which a group of peers jointly problem-solves and generates lessons and solutions that can be adapted to different country contexts, is an important way to advance collective understanding of how to make progress on strategic purchasing within the unique health financing systems of sub-Saharan Africa. The Strategic Purchasing Africa Resource Center (SPARC), a resource hub hosted by AMREF Health Africa with technical support from Results for Development, is facilitating a collaborative learning agenda among 11 technical partners in 10 countries. SPARC and the technical partners are generating new insights and practical lessons to inform country policy and regional discourse on how to better use strategic purchasing to advance progress toward universal health coverage (UHC). This paper summarizes lessons and best practices from SPARC's collaborative learning approach that can benefit others who are seeking to apply a similar approach to share tacit learning on strategic purchasing and UHC.

Antibiotic Prescription Patterns among Children Younger than 5 Years in Nouna District, Burkina Faso.

Understanding antibiotic use may help predict emergence of antimicrobial resistance. We evaluated antibiotic prescription trends in rural Burkina Faso, where little is known about antibiotic consumption. Antibiotic prescription data for 20 communities were extracted through record review in six primary health-care facilities serving the communities. The number of antibiotic prescriptions per child-year was calculated using population-based census data from the communities. A total of 1,444 antibiotic prescriptions were made from March to June 2017 among 3,401 children in the communities. The frequency of antibiotic prescription was 1.70 prescriptions per child-year (95% CI: 1.61-1.79). Penicillins were the most common (1.04 prescriptions per child-year, 95% CI: 1.01-1.06), followed by sulfonamides (0.69 prescriptions per child-year, 95% CI: 0.67-0.71) and macrolides (0.38 prescriptions per child-year, 95% CI: 0.37-0.40). Continued monitoring of antibiotic consumption in diverse settings will be important to understand the potential for emergence of antibiotic resistance.