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.

Public Financial Management as an Enabler for Health Financing Reform: Evidence from Free Health Care Policies Implemented in Burkina Faso, Burundi, and Niger.

In Burkina Faso, Burundi and Niger, the policy to remove user fees for primary care was carried out through significant adjustments in public financial management (PFM). The paper analyzes the PFM adjustments by stage of the budget cycle and describes their importance for health financing. The three countries shifted from input-based to program-based allocation for primary care facility compensation, allowed service providers autonomy to access and manage the funds, and established budget performance monitoring frameworks related to outputs. These PFM changes, in turn, enabled key improvements in health financing, namely, more direct funding of primary care facilities from general budget revenue, and payments to those service providers based on outputs and drawn from noncontributory entitlements. The paper draws on these experiences to provide key lessons on the PFM enabling conditions needed to expand health coverage through public financing mechanisms.

[Moodle, a credible alternative pedagogy for teaching medicine in a tropical environment to address large numbers and pandemic situations?] / Moodle, une pédagogie alternative crédible d'enseignement de la médecine en milieu tropical pour répondre aux grands nombres et aux situations de pandémie?

Introduction: Moodle is an interactive online education platform, a true virtual amphitheater, breaking down geographical and space barriers, capable of offering continuous education even in times of war or pandemic. Aim: To show the possible contribution of Moodle in the teaching of medicine in tropical environments to respond to large numbers and pandemic situations. Methodology: It was a cross-sectional and descriptive survey. It was conducted in June 2019 at Joseph KI-ZERBO University of Ouagadougou in Burkina Faso. It consisted of a questionnaire submitted to Master 1 students of medicine and to their teachers. The survey focused on the solutions that students would propose to improve their learning conditions, the role that Moodle could play in improving their learning, as well as the prerequisites to be resolved before adopting Moodle. The respondent rate was 75.6% of the entire promotion. Results: For students Moodle is a good alternative to conventional education. However, prerequisites must be fulfilled such as the donation of computer to each student (90.3%), the availability of a good connection for all (96%), their training prior to the use of Moodle. Students found no harm in their online assessment via Moodle provided it was reliable and verifiable when needed. Teachers in 38% wanted teaching to remain traditional, face to face against 62% who advocated its abandonment in favor of new teaching methods like Moodle provided that the right conditions are in place. Conclusion: Moodle is a credible e-learning that can facilitate the management of large numbers and ensure the continuity of lessons learned in a pandemic situation despite the need for containment. However, it must be a mastered technique, applied on prepared ground.

[Oncoplasty by the Thorek technique for lower quadrant cancers in a condition of gigantomastia]. / Oncoplastie selon la technique de Thorek pour cancers des quadrants inférieurs en situation de gigantomastie.

OBJECTIVE: Describe our experience of Oncoplasty according to Thorek in gigantomastia with hard and less plastic breasts and a major ptosis. METHODOLOGY: Thirteen cases of breast carcinoma on gigantomastia operated using the Thorek technique between 2014 and 2019 in Burkina Faso were analyzed retrospectively. The operative indications, technique and results were considered. Breast Q was used to assess patient satisfaction. RESULTS: The indication of oncoplasty by the Thorek's technique was breast lower quadrants carcinoma, associated with a major ptosis, gigantomastia. There was a consequence on the spine in 9 over 13 cases. The breasts were hard and less plastic, making the other breast reduction techniques difficult. This technique helped remove the carcinoma, reduce the volume of the breast and address the ptosis. The patients were satisfied with the volume of the remaining breasts and their aesthetic look. The resection margins were safe. Two cases of aerolar dyschromia were noticed. CONCLUSION: The Thorek technique remains an alternative concerning tumours on gigantomastia, with hard and less plastic breasts and a major ptosis. The results combine carcinological and aesthetic requirements.

Factors limiting the use of modern contraceptive methods in mothers with children aged 12-23 months at the Yalgado Ouedraogo University Hospital in Ouagadougou, Burkina Faso.

Knowledge of the factors of non-use of modern contraceptive methods should help to reduce the number of infants born after short interpregnancy intervals, which are associated with adverse effects for mothers, children, and families. For this reason, this study aimed to determine the factors associated with this non-use among mothers of infants aged 12 to 23 months. This case-control study included a sample of mothers of children aged 12 to 23 months. The case mothers were users of modern contraceptive methods and the control mothers were non-users. Data were collected from January 1 through March 31, 2018. Six factors were significantly associated with the use of modern contraceptive methods: age younger than 25 years, lack of gainful activity, desire for a family size ≥ 4 children, BMI greater than 25, opposition by husband, and failure to attend the 45-day postnatal consultation. Modifiable socio-economic factors were significantly associated with the non-use of modern contraceptive methods by mothers of children aged 12 to 23 months.

24-Month adherence, tolerance and efficacy of once-a-day antiretroviral therapy with didanosine, lamivudine, and efavirenz in African HIV-1 infected children: ANRS 12103/12167.

BACKGROUND: There is no data on long-term benefit of once-a-day antiretroviral therapy (ART) with combination of DDI, 3TC and EFV to allow its use in future therapeutic strategies. OBJECTIVES: To assess 24-month immuno-virological, adherence, tolerance, and effectiveness of a once-a-day ART with DDI, 3TC and EFV. METHODS: A phase 2 open trial including 51 children aged from 30 months to 15 years, monitored a once-a-day regimen for 24 months from 2006 to 2008 in the Departement de Pediatrie du CHUSS, at Bobo-Dioulasso in Burkina Faso. We tested immunological and virological response, adherence, tolerance and resistance of the treatment. RESULTS: Children with CD4 >25% at 24 months were 67.4% (33/49) CI 95% [54%, 80%]. The proportion of children with viral plasma RNA <300 cp / ml at 24 months of treatment was 81.6 % (40/49) CI [68.0% 91.2%]. Good adherence was obtained with more than 88% adherence > 95% over the 24 months. Drugs were well tolerated. CONCLUSIONS: Given the limited number of antiretroviral drugs available in Africa and the inadequacy of laboratory monitoring in support program, once-a-day treatment and especially the DDI-based combination strategies could be an attractive operational option.

[Arthropathic and degenerative pathology in rheumatology patients in Burkina Faso]. / Pathologie mécanique et dégénérative en consultation de rhumatologie au Burkina Faso.

OBJECTIVE: The purpose of this report is to describe epidemiologic features of arthrosic and degenerative disorders observed during the first two years of rheumatologic practice in Ouagadougou, Burkina Faso. PATIENTS AND METHODS: The files of all patients examined between March 2006 to February 2008 were reviewed. All patients presenting arthrosic or degenerative disorders were included. RESULTS: Out of 1,439 patients examined during the study period, 1,078 (74.91%) were included. Spine pain accounted for 33.7% of cases, i.e., 485 patients including 306 with lumbago. The mean age in this group was 47.8 +/- 15.19 years and the M/F sex ratio was 0,75. Osteoarthritis represented 20.43% of cases including osteoarthritis of the knee in 18%. The mean age in this group was 54.66 +/- 12.29 years and the M/F sex ratio was 0.23. Aseptic osteonecrosis (AON) of the femoral head was observed in 1.11% of cases, i.e. 16 patients including 8 with sickle cell disease (SC) The mean age in this group was 40.75 years. Abarticular rheumatism accounted for 15.98% of cases, i.e. 230 patients including 118 cases with tendinitis of the shoulder. The mean age in this group was 48.48 years. CONCLUSION: Arthrosic and degenerative disorders observed in this series from Ouagadougou presented the same semiological features as in other African series. Primary osteoarthritis of the hip was uncommon.

[Salmonella meningitis in Ouagadougou, Burkina Faso, from 2000 to 2004]. / Méningites dues à Salmonella au CHU de Ouagadougou, Burkina Faso (2000-2004).

56 strains of Salmonella were isolated from the cerebro-spinal fluids (CSF) from meningitis suspected patients at the Yalgado-Ouédraogo University hospital center in Burkina Faso, from January 2000 to December 2004. 75% of the patients were less than 3 years old; 71.4% of the CSF were purulent, with an average of 523 leucocytes/mm3 and 78% of neutrophile polynuclears. The strains identified belonged mostly to Salmonella O: 4.5 group (51.8%). In vitro, 92.7% of the strains were resistant to ampicillin and this resistance was partially restored with amoxicillin/clavulanic acid; however no strain was resistant to ceftriaxone. For the overall 56 patients, 20 different antibiotherapy regimes were used and they were successful in only 27% cases while 71% of patients died and 2% escaped from the hospital. Neurologic sequels were found in a patient treated with both ceftriaxone and chloramphenicol. These results showed that the illness occurred mainly in infants and was associated with high mortality rate. Most of the Salmonella strains were multi-drug resistant. In spite of strains multi-antibiotics resistance, adequate definition of therapeutic lines and early treatment including ceftriaxone could lead to higher cure rates and may improve the outcome.

Ethnoveterinary medicine and indigenous pharmacopoeia of Passoré Province in Burkina Faso.

A study of traditional animal health care practices in Passoré province of Burkina Faso led to the characterization of 24 diseases, together with their local names, causes of their appearance, and their treatment. Most (95%) of the medicinal recipes used to treat affected animals were based on plants.