Relevance of a Toll-Free Call Service Using an Interactive Voice Server to Strengthen Health System Governance and Responsiveness in Burkina Faso.

BACKGROUND: In Africa, health systems are poorly accessible, inequitable, and unresponsive. People rarely have either the confidence or the opportunity to express their opinions. In Burkina Faso, there is a political will to improve governance and responsiveness to create a more relevant and equitable health system. Given their development in Africa, information and communication technologies (ICTs) offer opportunities in this area. METHODS: This article presents the results of an evaluation of a toll-free call service coupled with an interactive voice server (TF-IVS) tested in Ouagadougou, Burkina Faso, to assess its relevance for improving health systems governance. The approach consisted of a 2-phased action research project to test 2 technologies: recorded messages and touch keypad. Using a concurrent mixed approach, we assessed the technological, social, and instrumental relevance of the service. RESULTS: The call service is available everywhere, 24 hours per day, seven days per week. The equipment and its physical location were not adequately protected against technological hazards. Of the 278 days of operation, 49 were non-functional. In 8 months, there were 13 877 calls, which demonstrated the popularity of ICTs and the ease of access to telephone networks and mobile technologies. The TF-IVS was free, anonymous, and multilingual, which fostered the expression of public opinion. However, cultural context (religion, ethnic culture) and fear of reprisals may have had a negative influence. In the end, questions remained regarding people's capacity to use this innovative service. In the first trial, 49% of callers recorded their message and in the second, 48%. Touch key technology appeared more relevant for automated and real-time data collection and analysis, but there was no comprehensive strategy for translating the information collected into a response from healthcare actors or the government. CONCLUSION: This study showed the relevance and feasibility of implementing a TF-IVS to strengthen health system responsiveness in one of the world's poorest countries. Public opinion expressed through data collected in real-time is helpful for improving system responsiveness to meet care needs and enhance equity. However, the strategy for developing this tool must take into account the implementation context and the activities needed to influence the mechanisms of social responsibility (eg, information provision, citizen action, and state response).

[Evaluation of social inequalites in health of road accident victims in Ouagadougou, Burkina Faso]. / Évaluation des inégalités sociales de santé des traumatisés de la route à Ouagadougou au Burkina Faso.

INTRODUCTION: Each year, more than 1.2 million deaths in the world are due to road accidents. It is the leading cause of mortality in young people between the ages of 15 and 29 years. Road accidents and associated injuries have a major impact on health and development. Many international reports have evaluated the mortality and morbidity related to road accidents, but these studies are based on limited data, often with limited robustness. Based on a study conducted in Ouagadougou, the capital of Burkina Faso, to estimate the mortality and morbidity of road accident victims, the objective of this article was to evaluate social, spatial and health inequalities of populations killed or injured as a result of a road accident. METHODS: Between February and July 2015, all road accidents were recorded by policemen using a mobile telephone data collection system, including geolocation of accidents. Three quantitative and prospective survey phases were then performed on injured patients admitted to Yalgado Ouedraogo hospital, the reference centre for these patients. RESULTS: A total of 1,867 emergency department admissions were reported. The majority (95%) of road accident victims were vulnerable users. More than 30% of accidents occurred in one central quarter and two peripheral quarters. The mean management time as 1 hour 3 minutes for victims rescued by firemen and 3 hours 10 minutes for those who attended the emergency department on their own. The mean total cost of management was 126,799 CFA francs (€193) [400-2,000,000 CFA francs]. DISCUSSION: These results identify possible actions designed to reduce road accident injuries and their consequences. They demonstrate that the creation of surveillance systems common to police forces, rescue and health care services are essential to produce convincing data.

What interventions are required to reduce road traffic injuries in Africa? A scoping review of the literature.

Road traffic accidents are the major cause of mortality among people aged 15-29 years in Africa. World Health Organisation (WHO) and the World Bank launched a Decade of Action for Road Safety in 2011 with the goal of halving the number of injuries and deaths on the roads. No progress has been reported in Low and Middle Income Countries (LMICs) and the number of deaths remains very high. To reach the target set, there is a need for interventions in several areas. This scoping review proposes to produce a synthesis by identifying the kinds of interventions and outcomes which have been carried out on the African continent. Using the scoping studies method, 23 articles were selected and analysed. The study shows that interventions were developed in four fields: road safety policy, health education, safety equipment and data collection. It shows also that there were records of interventions in only twelve countries, mostly in Eastern and Southern Africa. The main conclusion of this study reveals both a lack of road safety interventions and shortcomings in the assessment of those performed and selected for our study.

Terrorist attack of 15 January 2016 in Ouagadougou: how resilient was Burkina Faso's health system?

In Africa, health systems are often not very responsive. Their resilience is often tested by health or geopolitical crises. The Ebola epidemic, for instance, exposed the fragility of health systems, and recent terrorist attacks have required countries to respond to urgent situations. Up until 2014, Burkina Faso's health system strongly resisted these pressures and reforms had always been minor. However, since late 2014, Burkina Faso has had to contend with several unprecedented crises. In October 2014, there was a popular insurrection. Then, in September 2015, the Security Regiment of the deposed president attempted a coup d'état. Finally, on 15 January 2016, a terrorist attack occurred in the capital, Ouagadougou. These events involved significant human injury and casualties. In these crises, the Burkinabè health system was sorely tried, testing its responsiveness, resiliency and adaptability. We describe the management of the recent terrorist attack from the standpoint of health system resilience. It would appear that the multiple crises that had occurred within the previous 2 years led to appropriate management of that terrorist attack thanks to the rapid mobilisation of personnel and good communication between centres. For example, the health system had put in place a committee and an emergency response plan, adapted blood bank services and psychology services, and made healthcare free for victims. Nevertheless, the system encountered several challenges, including the development of framework documents for resources (financial, material and human) and their use and coordination in crisis situations.

[Equity and social determinants of road traffic injuries in Ouagadougou, Burkina Faso]. / Équité et déterminants sociaux des accidents de la circulation à Ouagadougou, Burkina Faso.

This pilot study shows that it is possible to create an effective framework to obtain data concerning the social determinants of health for road traffic injuries, and that actions in favour of equity must be initiated..