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Ridde V.,University of Montreal | Ridde V.,Institute Of Recherche En Science Of La Sante Irss Cnrst | Richard F.,Institute of Tropical Medicine | Bicaba A.,Societe dEtudes et de Recherches en Sante Publique SERSAP | And 2 more authors.
Health Policy and Planning

Introduction To reduce financial barriers to health care services presented by user fees, Burkina Faso adopted a policy to subsidize deliveries and emergency obstetric care for the period 2006-2015. Deliveries and caesarean sections are subsidized at 80; women must pay the remainder. The worst-off are fully exempted. Methods The aim of this article is to document this policy's entire process using a health policy analytical framework. Qualitative data are drawn from individual interviews (n = 113 persons) and focus groups conducted with 344 persons in central government, three rural districts and one urban district. Quantitative data are taken from the national health information system in eight districts. Results The policy was initiated in all districts concurrently, before all the technical instruments were ready. The subsidy is paid by the national budget (US$60 million, including US$10 million for the worst-off). Information activities, implementation and evaluation support have been minimal because of insufficient funding. Health workers and lay people have not always had the same information, such that the policy has not been uniformly applied. Coping strategies have been noted among health workers and the population, but there has been no attempt to impede the policy's implementation. At the time of the study, fixed-rate reimbursement for delivery (output-based) and overestimation of input costs were financially advantageous to health workers (bonuses) and management committees (hoarding). Very few of the worst-off have been exempted from payment because selection processes and criteria have not yet been defined and most health workers are unaware of this possibility. The upward trend in assisted deliveries since 2004 continued after the policy's introduction.Conclusions This ambitious policy expresses a strong political commitment but has not been adequately supported by international partners. Despite relatively tight administrative controls, health workers have figured out how to take advantage of the system. Some of the policy's instruments should be reviewed and clarified to improve its effectiveness. © The Author 2011; all rights reserved. Source

Schwartz S.R.,Center for Public Health and Human Rights | Papworth E.,Center for Public Health and Human Rights | Ky-Zerbo O.,Programme dAppui au Monde Associatif et Communautaire PAMAC | Anato S.,Arc en ciel | And 5 more authors.
Infectious Diseases in Obstetrics and Gynecology

Background. Reproductive health programming for female sex workers (FSW) may include contraceptive services but rarely addresses safer pregnancy planning.Methods. Adult FSW were enrolled into a cross-sectional study across four sites in Burkina Faso and Togo using respondent-driven sampling. Sociobehavioral questionnaires and HIV counseling and testing were administered. Sample statistics and engagement in HIV treatment were described and compared using Chi-squared statistics.Results. 1,349 reproductive-aged FSW were enrolled from January to July 2013. Overall, 267 FSW (19.8%) were currently trying to conceive. FSW trying to conceive were more likely to test positive for HIV at enrollment as compared to women not trying to become pregnant (24.5% versus 17.7%, P < 0.01); however awareness of HIV status was similar across groups. Among FSW trying to conceive, 79.0% (211/267) had previously received HIV testing, yet only 33.8% (23/68) of HIV-infected FSW reported a previous HIV diagnosis. Overall 25.0% (17/68) of HIV-infected FSW trying to conceive were on antiretroviral therapy.Conclusion. FSW frequently desire children. However engagement in the HIV prevention and treatment cascade among FSW trying to conceive is poor potentiating periconception transmission risks to partners and infants. Programs to facilitate earlier HIV diagnosis for FSW and safer conception counseling are needed as components of effective combination HIV prevention services. © 2014 Sheree R. Schwartz et al. Source

Meessen B.,Institute of Tropical Medicine | Hercot D.,Institute of Tropical Medicine | Noirhomme M.,Independent Consultant | Ridde V.,University of Montreal | And 6 more authors.
Health Policy and Planning

In recent years, governments of several low-income countries have taken decisive action by removing fully or partially user fees in the health sector. In this study, we review recent reforms in six sub-Saharan African countries: Burkina Faso, Burundi, Ghana, Liberia, Senegal and Uganda. The review describes the processes and strategies through which user fee removal reforms have been implemented and tries to assess them by referring to a good practice hypotheses framework. The analysis shows that African leaders are willing to take strong action to remove financial barriers met by vulnerable groups, especially pregnant women and children. However, due to a lack of consultation and the often unexpected timing of the decision taken by the political authorities, there was insufficient preparation for user fee removal in several countries. This lack of preparation resulted in poor design of the reform and weaknesses in the processes of policy formulation and implementation. Our assessment is that there is now a window of opportunity in many African countries for policy action to address barriers to accessing health care. Mobilizing sufficient financial resources and obtaining long-term commitment are obviously crucial requirements, but design details, the formulation process and implementation plan also need careful thought. We contend that national policy-makers and international agencies could better collaborate in this respect. © The Author 2011; all rights reserved. Source

Hercot D.,Institute of Tropical Medicine | Meessen B.,Institute of Tropical Medicine | Ridde V.,University of Montreal | Ridde V.,Institute Of Recherche En Science Of La Sante Irss Cnrst | And 2 more authors.
Health Policy and Planning

Several authors have stressed the fact that many policy reforms fail because of poor formulation or implementation. On the other hand, the health financing literature provides little guidance to policy makers in low-income countries on how to implement a health care financing reform in ways that enhance its chance of achieving policy objectives, even less so for a user fee removal reform.This paper presents the framework used for a multi-country review of the policy process of removing user fees in six sub-Saharan African countries. The review aimed at developing operational guidance for health managers involved in user fee removal reform. Drawing broadly on Walt and Gilson's 'health policy analysis triangle' (context - actor - process - content), we focused particularly on understanding the process of planning and implementing the reform led by central-level policy actors. Our core analytic strategy was the verification of a list of 'good practice hypotheses' that might be expected in a health financing policy reform against experience.This framework offers an approach for how to analyse health financing policy reform processes in low-income countries. It allows for an explicit and transparent review of multiple experiences against a set of clear hypotheses. This approach might be a step in the direction of research that supports better formulation and implementation of policies in resource-poor settings. © The Author 2011; all rights reserved. Source

Ouedraogo H.G.,Institute Of Recherche En Science Of La Sante Irss Cnrst | Kouanda S.,Institute Of Recherche En Science Of La Sante Irss Cnrst | Tiendrebeogo S.,Institute Of Recherche En Science Of La Sante Irss Cnrst | Konseimbo G.A.,Center Medical Avec Antenne Chirurgicale Of Bogodogo | And 5 more authors.
Medecine et Sante Tropicales

Introduction. The purpose of this study was to evaluate anti-HBV vaccination status and factors associated with vaccination against HBV among health care workers in Burkina Faso. Methods. In August and September 2010, we conducted a cross-sectional study on health care workers having practiced in a health facility for at least three months. Data were collected using a selfadministered questionnaire. Blood samples were collected from consenting participants to search for anti-HBs antibodies, markers of immune status. Results. A total of 452 health care workers were surveyed. Among the respondents, 47.7 % had received at least one dose of HBV vaccine. The full immunization coverage against HBV was estimated at 10.9 %. Factors associated with vaccination status were age (p = 0.005), occupation (p = 0.005), and seniority in the profession (p = 0.001). Anti-HBs was found in 61.6 % of respondents, with significant differences (p = 0.01) between subjects who received at least one dose of vaccine (76.7 %) and those who reported never having been vaccinated (50.3 %). Conclusion. Hepatitis B vaccination coverage among health care workers is low in Burkina Faso, hence the need to promote vaccination against HBV in health facilities. Source

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