Exploring decision makers' knowledge, attitudes and practices about decentralisation and health resources transfer to local governments in Burkina Faso.

In the health sector, decentralisation mainly consists of the devolution of administrative functions to local governments. Since 2009, Burkina Faso has engaged in a process to transfer health resources to local governments. This study examines the decision-makers' knowledge, attitudes and practices (KAP) about the decentralisation and health resources transfer to local governments in Burkina Faso. We used a qualitative research method. In-depth semi-structured interviews were conducted with key decision-makers. The data collected went through a directed qualitative content analysis. Findings suggest that all respondents are aware of the rationale of the decentralisation and resources transfer to local governments. The vast majority of respondents have a positive opinion towards decentralisation and the main elements that appear to be motivating their attitude, are the expected outcomes from decentralisation. The practical experience was limited to awareness raising, training, supervision, technical assistance and resources mobilisation. Poor collaboration between health districts and local governments, the control of certain resources by the state and the health districts constrain the implementation of health resources and skills transfer policy at grassroots level. Careful attention should be given to the country's political context and institutional design.

Factors associated with access to healthcare in Burkina Faso: evidence from a national household survey.

BACKGROUND: Burkina Faso has undertaken major reforms, the cornerstone of which has been the decentralization of the health system to increase access to primary healthcare and to increase the effectiveness, efficiency, financial viability and equity of health services. This study aims to analyze the socio-demographic determinants of households' access to healthcare in Burkina Faso. METHODS: We used data from a national household survey conducted in 2014 in Burkina Faso. We carried out binary logistic and linear regression analysis using data from a national household survey. The statistical analysis explored the associations between socio-demographic characteristics on the one side, and the use of health services, satisfaction with health services and expenditures on health services, on the other side. RESULTS: The findings indicate an association between age, education, income and use of services (p < 0.0005). The results show that healthcare users' satisfaction is influenced by age, the association is stronger with the age group under 24 (p < 0.0005) than the age group of 25-39 (p < 0.005). An association was found between the age group under 15 (p < 0.005), the type of health facility used (p < 0.0005), the distance traveled to health facilities (p < 0.005) and households' individuals' health expenditure. CONCLUSION: Specific policies are needed to enhance geographical access to healthcare, financial access to and satisfaction with healthcare in moving towards universal health coverage (UHC).

RéSUMé: INTRODUCTION: Le Burkina Faso a entrepris des réformes majeures dans le domaine de la santé dont l'une des pierres angulaires a été la décentralisation du système de santé en vue d'accroître l'accès aux soins de santé primaire et d'améliorer l'efficience, l'efficacité, la viabilité financière et l'équité des services de santé. La présente étude vise à analyser les déterminants de l'accès des ménages aux services de santé au Burkina Faso. MéTHODE: Pour notre analyse, nous avons utilisé les données secondaires d'une enquête nationale réalisée en 2014 au Burkina Faso sur le profil de pauvreté et d'inégalités des ménages. Une régression logistique binaire et linéaire a été réalisée pour analyser l'association entre les caractéristiques sociodémographiques et l'utilisation des services de santé d'une part, le niveau de satisfaction des utilisateurs envers les services de santé et les dépenses de santé d'autre part. RéSULTATS: Les résultats indiquent une association entre l'âge, l'éducation, le revenu et l'utilisation des services de santé (p < 0.0005). Les résultats montrent que la satisfaction des utilisateurs des services de santé est. influencée par l'âge, la corrélation est. plus forte avec le groupe d'âge de moins de 24 ans (p < 0.0005) que le groupe d'âge de 25­39 (p < 0.005). Une corrélation a été mise en évidence entre le groupe d'âge de moins de 15 ans (p < 0.005), le type de structure de santé utilisé (p < 0.0005), la distance parcourue pour le recours aux soins (p < 0.005) et les dépenses de santé des ménages. CONCLUSION: Des politiques spécifiques sont nécessaires pour améliorer l'accès géographique et financier des populations aux services de santé, ainsi que le niveau de satisfaction des utilisateurs des services de santé dans la perspective de la couverture sanitaire universelle.

Regional health disparities in Burkina Faso during the period of health care decentralization. Results of a macro-level analysis.

BACKGROUND: Burkina Faso has undertaken decentralization reforms in the health care sector to improve the performance of the health system. This study aimed to analyze the differences in health outcomes by health district's demographic and economic status, and the distribution of health resources during the period of health care decentralization. METHODS: A bivariate correlation analysis was conducted using data at the health districts and regions level. Data from the health management information system (HMIS) and national households' surveys were used. RESULTS: The results indicate a strong correlation between district's population size and the availability of health resources (P ≤ .05). The health visits per capita and skilled birth attendance are correlated with the economic status of the health district (P ≤ .05). Malnutrition among under-five and maternal mortality was associated with the availability of health personnel and health infrastructures (P ≤ .05). No correlation was found between financial resources and health outcomes. CONCLUSION: The results indicated disparities in health among the health districts in Burkina Faso. The ways to address this inequality include more transparent resource allocation, as well as policies to address the socio-economic disparities and financial barriers to health services. Further research is needed to collect relevant data and investigate the effects of decentralization, which was not possible in our study.

Decentralization and health resources transfer to local governments in Burkina Faso: A SWOT analysis among health care decision makers.

BACKGROUND AND AIMS: In line with the decentralization policy, in 2009, the central government of Burkina Faso issued a decree to transfer health resources to local governments for fulfilling their new responsibilities in health care provision. The first stage of this health care decentralization process involved the basic health care facilities, composed of primary health care facilities, maternities, dispensaries, maternal and child health centers, and essential drugs depots.This study seeks to explore the strengths, weaknesses, opportunities, and threats (SWOT) associated with the health resources transfer in Burkina Faso, from the perspective of decision makers. METHODS: We used a qualitative research approach. We conducted 17 semistructured interviews with 17 representatives of key decision-making groups, in August to December 2017 in Burkina Faso. The participants included mayors of municipalities, health district managers, policy decision makers, and donors/partners. The data collected were subjected to a directed qualitative content analysis, and the SWOT framework was used to select themes and codes for the analysis. RESULTS: The most cited strength was the improvement of local governance, which also creates the opportunity for an enhanced partnership and decentralized cooperation. As expected, however, the limited financial capacity of local governments is an important weakness. Furthermore, misuse of financial resources threatens the resources transfer. Recommendations to improve decentralization and health resources transfer included effective enforcement of decentralization's laws and policies, strengthening local governments' capacities, adequate funding, and evaluation of the resources transfer process. CONCLUSIONS: An analysis of the preconditions for a successful resources transfer is needed to provide guidance to policy.

Municipal health services provision by local governments: a systematic review of experiences in decentralized Sub-Saharan African countries.

'Four' types of decentralization are distinguished in health care: deconcentration when the shift in authority is to regional or district offices; devolution when the shift is to state, provincial or municipal governments; delegation when semi-autonomous agencies are granted new powers; and privatization when ownership is granted to private entities. This article systematically reviews the experiences of local governments of Sub-Saharan African countries with the provision of health services during and after decentralization reforms. The article highlights the achievements, challenges and issues associated with decentralization. The review shows that most countries have mainly focused on the process by enacting numerous policies, regulations and standards with mixed outcomes for health services delivery. Decentralization in general, and resource transfer from the central to local governments in particular, are a highly political issue that influences the health reform strategy on decentralization. The literature shows the complexity of implementing decentralization schemes which strongly impact the health service organization and delivery. The theory of decision space applied in a comparative analysis found that some functions, particularly financing, remain under the control of the central state. Despite the numerous challenges, this review identifies some good practices in resources transfer, key determinants being the type of decentralization and the government's will to make legislative and administrative changes required for the effectiveness of decentralization. The literature search, even though systematic, resulted in a limited number of relevant publications with evidence on the link between decentralization and health services delivery. This is a largely unexplored research area, especially the use of financial resources by local governments, the factors that drive local decision-making processes and the effects of decentralization on health care sector performance.