Barriers to the implementation of quality maternal death reviews in health districts in Burkina Faso.

OBJECTIVE: To identify barriers to the implementation of maternal death reviews in health districts in Burkina Faso. METHODS: We conducted a multiple case study in seven health facilities chosen by contrasted purposive sampling. Sampling criteria were based on intrahospital maternal mortality rates and the location of the health facility. Data collection was conducted from April 27 to May 30, 2015, using structured and semistructured interviews and data extraction from source documents. Data were analyzed using a thematic approach. RESULTS: Barriers to quality maternal death reviews identified were primarily implementation conditions, including poor skills and motivation of healthcare personnel, low interest in quality of care, lack of suitable equipment, insufficient coordination and collaboration between health services, insufficient monitoring, and weakness in programming and conducting the reviews. CONCLUSION: Barriers to achieving quality maternal death reviews remain numerous at the operational level of the health system. Taking steps to remove these barriers is key to improving the quality of maternal death reviews and childbirth outcomes in Burkina Faso.

Assessment of the maternal death surveillance and response implementation process in Burkina Faso.

OBJECTIVE: To evaluate the maternal death surveillance and response (MDSR) implementation process in two health districts in Burkina Faso and identify factors that have affected implementation. METHODS: We conducted a case study in two health districts selected by purposive sampling according to location (rural or urban) during the period 2015-2016. Data gathering consisted of semi-structured interviews with several health personnel involved in the implementation process. RESULTS: Identification and notification of deaths varied depending on the facility. Maternal death review sessions were irregular, and the completion rate was lower in urban areas The community component has not yet been implemented and review of newborn deaths is not yet standard practice. Follow-up and implementation of the review recommendations were inadequate. CONCLUSION: Implementation of the MDSR system in Burkina Faso remains in progress. Improvements are needed in notification of deaths occurring at community level, monitoring and evaluation, and integration of newborn deaths into the process.

Local initiatives to access emergency obstetric and neonatal care in Burkina Faso.

OBJECTIVE: To describe the various local initiatives to access emergency obstetric and neonatal care in Burkina Faso. METHODS: An existing framework was used to review the three processes for local initiatives: emergence, formulation, and implementation. Multiple case studies were conducted, followed by literature review and semi-structured interviews with key informants. RESULTS: Sixteen districts had implemented local initiatives, including cost sharing, free care for women and children, and free care for delivery and cesareans. Most districts (n=10) had implemented the cost-sharing intervention. These initiatives were initiated by local actors as well as nongovernmental organizations. The profile of those involved led to different ways of handling the emergence and formulation processes. At implementation, these initiatives faced many issues including late payment of contributions, low involvement of local governments, and equity in participation. CONCLUSION: There are some issues in the implementation and sustainability of the local initiatives. Although many initiatives exist, these are unable to fully address the financial barriers to care. However, these initiatives highlight context-based financial barriers that must be taken into account to accelerate universal access to health care.