Landscape analysis of healthcare workforce and resilience actions in the Sahelian context of high security challenge areas: The case of Burkina Faso.

INTRODUCTION: Access to health services is a major challenge in developing countries in general, particularly those affected by insecurity. The availability of sufficient quantity and quality of equitably distributed healthcare workforce is a major obstacle, yet it is an essential pillar of an effective and efficient national health system. Burkina Faso, similar to other countries in the Sahel, has been affected by an unprecedented security crisis that has severely tested the functionality of health facilities and the availability of healthcare workforce. OBJECTIVE: To describe the landscape of healthcare workforce and to analyse the actions taken by the government and other stakeholders to improve the resilience of the system and the retention of healthcare workers in the context of major security challenges. METHODS: This is a transversal, descriptive and analytical study carried out in Burkina Faso in 2023 through a documentary review, analyses of databases collected from health districts and regional directorates, focus groups and a national triangulation workshop with key informants. RESULTS: The study shows that, with the closure and minimal functioning of certain health facilities in security-challenged areas, healthcare workforceare concentrated in the urban areas of regional and district capitals, to the detriment of rural areas. Some staff become in an irregular situation regarding the administration. To strengthen resilience to the crisis, the main solutions have been implemented: (i) enhancing the community platform with the recruitment of 15,000 community-based health volunteers, (ii) delegating tasks to community health agents, (iii) simplified approaches, (iv) advanced health posts and mobile clinics, (v) redeployment to the most stable structures, (vi) thinking about legislation in crisis situations. CONCLUSION: Community resilience through the delegation of tasks to community-based health workers and strengthening of the community health platform has helped ensure the continuity of care in insecure areas. However, the optimization of innovative and attractive strategies will further improve the retention and return of healthcare workers in rural areas affected.

Task-Shifting Immunization Activities to Community Health Workers: A Mixed-Method Cross-Sectional Study in Sahel Region, Burkina Faso.

INTRODUCTION: Faced with the frequent disruptions to the health care system and provision of immunization services caused by terrorist attacks that began in 2015, the Sahel region in Burkina Faso initiated resilience strategies, including the task-shifting of immunization activities to community health workers (CHWs). This strategy was designed to involve more CHWs in the vaccination delivery process and ultimately to improve the performance of the health care system. STRATEGY DEVELOPMENT AND IMPLEMENTATION: The task-shifting strategy began as a pilot in Djibo health district in 2019 and then extended to all 4 districts of the Sahel region. CHWs included both personnel recruited through the Ministry of Health and Public Hygiene processes at the national level and other community members who support the operation of health facilities. They were trained on standardized immunization modules and provided with vaccines by functional health facilities teams. Implementation initiated with the administration of oral antigens by CHWs. Subsequently, their service delivery was expanded to include injectable vaccines in the context of the worsening terrorist attacks and the urgent need to protect the health of local populations affected by the security and humanitarian crisis. STRATEGY EVALUATION: The intervention was evaluated through an internal programmatic review conducted as a descriptive cross-sectional study implemented from August 1 to October 28, 2022, in the Sahel region, including a survey in Dori health district. CHWs involved in implementing the strategy were considered for interviews. Performance indicators for all antigens have shown an upward trend since the strategy's inception in 2019. CONCLUSION: The task-shifting of immunization activities to CHWs has been implemented successfully in a region seriously affected by terrorism-related insecurity. It holds the promise of maintaining or even improving performance if institutionalized and scaled up while improving the monitoring of adverse events following immunization by the CHWs.

Development and Implementation of a Cloud-Based Meningitis Surveillance and Specimen Tracking System in Burkina Faso, 2018.

Nationwide case-based meningitis surveillance was established in Burkina Faso following the introduction of meningococcal serogroup A conjugate vaccine in 2010. However, timely tracking and arrival of cerebrospinal fluid specimens for confirmation at national reference laboratories remained suboptimal. To better understand this gap and identify bottlenecks, the Burkina Faso Ministry of Health, along with key partners, developed and implemented a cloud-based System for Tracking Epidemiological Data and Laboratory Specimens (STELAB), allowing for timely nationwide data reporting and specimen tracking using barcodes. STELAB was adapted to Burkina Faso's infrastructure to ensure suitability, functionality, flexibility, and sustainability. We describe the design, development, and implementation of STELAB. In addition, we discuss strategies used to promote sustainability, lessons learned during the first year of implementation, and future directions. STELAB's novel design and country-driven approach has the potential to achieve sustainable real-time data reporting and specimen tracking for the first time in sub-Saharan Africa.