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

  • International Journal of Health Planning and Management, Volume 35, No. 4, Year 2020

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Study Justification:
– The 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 in Burkina Faso.
– The study aimed to assess the relationship between health districts’ demographic and economic status and health outcomes.
– The study aimed to identify disparities in health among the health districts in Burkina Faso.
Study Highlights:
– The study found a strong correlation between district’s population size and the availability of health resources.
– Health visits per capita and skilled birth attendance were correlated with the economic status of the health district.
– Malnutrition among under-five and maternal mortality were associated with the availability of health personnel and health infrastructures.
– No correlation was found between financial resources and health outcomes.
Study Recommendations for Lay Reader and Policy Maker:
– Implement more transparent resource allocation to address disparities in health outcomes among health districts.
– Develop policies to address socio-economic disparities and financial barriers to health services.
– Conduct further research to collect relevant data and investigate the effects of decentralization on health outcomes.
Key Role Players Needed to Address Recommendations:
– Ministry of Health in Burkina Faso
– Health district administrators
– Health care providers
– Community leaders and organizations
– Non-governmental organizations (NGOs) working in the health sector
Cost Items to Include in Planning the Recommendations:
– Funding for resource allocation and distribution
– Budget for implementing policies to address socio-economic disparities and financial barriers
– Research funding for data collection and analysis
– Funding for capacity building and training programs for health care providers and administrators

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study conducted a bivariate correlation analysis using data from the health management information system (HMIS) and national households’ surveys, which are representative and standardized sources. The study also provides a clear description of the data collection process and the rationale for selecting the years 2010 and 2014. However, the abstract does not mention the sample size or provide specific details about the statistical analysis conducted. To improve the evidence, the authors could include information about the sample size and provide more details about the statistical methods used. Additionally, it would be helpful to mention any limitations or potential biases in the data sources or 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.

To assess the relationship between health districts’ demographic and economic status and health outcomes, we created our own database using district and region level data in Burkina Faso. The data sources are the health management information systems and national households’ surveys. These two sources provided the main representative, standardized and updated quantitative data on household’s health, demographic and economic status in Burkina Faso. The data sources are described below. The HMIS reports are published yearly by the Ministry of Health to release key information and data on the health system functioning and services organization, the health services resources available and the distribution, access, utilization and coverage of health care, as well as health outcomes and health status. These reports are used to evaluate health system performances and health planning. In this study, HMIS reports were reviewed to gather the secondary data by health districts, namely demographic, health sources, health use, and outcomes data. Two reports published by the National Statistics and Demographic Institute were used to gather secondary data on the economic profile of the 13 administrative regions which also correspond to the territorial breakdown of the 13 health regions covering the 63 health districts. These surveys are representative of the country and they involve large samples of households. The data collection points from all sources were 2010 and 2014 to allow for the changes in the socio‐economic status, health services access, and health outcomes in health districts during the decentralization period, which started in 2009. The number of health districts was 63 during the period covered in the study. Another rationale for selecting the years 2010 and 2014 was the availability of data on economic characteristics collected through the national household surveys during the same periods. The following main macro indicators were extracted from the sources described above and were used in the study: These indicators were selected because they are suitable for assessing health disparities/inequities. Previous studies have discussed the relevance of these indicators in measuring the geographical difference in health resources, health expenditures, utilization of health services, and health outcomes.18, 19, 20 Specifically, these indicators provide insight into various dimensions of health inequalities. These were also the only data available in Burkina Faso for a comparison across the regions. Data on 1512 observations were compiled using Excel spreadsheets and analyzed with statistical package SPSS version 25 to assess the correlation between the following variables: Specifically, we carried out a bivariate correlation analysis to determine, on the one hand, the extent to which health districts’ demographic and economic characteristics are associated with the availability of resources, as well as with health outcomes, and, on the other hand, to determine the association between the availability of resources and health outcomes. The Pearson Test was applied and the correlation between the variables investigated was found to be significant when P‐value was smaller than .05 (95% CI).

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Based on the information provided, here are some potential innovations that could be recommended to improve access to maternal health in Burkina Faso:

1. Mobile Health (mHealth) Solutions: Implementing mobile health technologies, such as SMS reminders for prenatal care appointments and health education messages, can help improve access to maternal health information and services, especially in remote areas.

2. Telemedicine: Introducing telemedicine services can enable pregnant women in underserved areas to consult with healthcare professionals remotely, reducing the need for travel and improving access to specialized care.

3. Community Health Workers (CHWs): Expanding the role of CHWs can help bridge the gap between healthcare facilities and communities. CHWs can provide essential maternal health services, including prenatal care, health education, and referrals, particularly in areas with limited access to healthcare facilities.

4. Maternal Waiting Homes: Establishing maternal waiting homes near healthcare facilities can provide a safe and comfortable place for pregnant women to stay before delivery, especially for those who live far away. This can help ensure timely access to skilled birth attendance and emergency obstetric care.

5. Financial Incentives: Introducing financial incentives, such as conditional cash transfers or vouchers, can encourage pregnant women to seek and utilize maternal health services. This can help address financial barriers and improve access to care.

6. Strengthening Health Infrastructure: Investing in the improvement and expansion of healthcare facilities, including maternity wards and delivery rooms, can enhance access to quality maternal health services, particularly in underserved areas.

7. Training and Capacity Building: Providing comprehensive training and capacity building programs for healthcare providers, including midwives and nurses, can enhance their skills and knowledge in providing quality maternal health services. This can contribute to improved access and outcomes.

It is important to note that these recommendations are based on general innovations in maternal health and may need to be tailored to the specific context and needs of Burkina Faso. Further research and evaluation are necessary to determine the feasibility and effectiveness of these innovations in improving access to maternal health in the country.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health in Burkina Faso would be to implement targeted interventions that address the identified disparities in health outcomes among health districts. This could include:

1. Transparent resource allocation: Ensure that health resources, such as health personnel and infrastructure, are allocated based on the population size and needs of each health district. This will help address the correlation between population size and resource availability.

2. Address socio-economic disparities: Implement policies and interventions that specifically target the socio-economic factors influencing health outcomes. This could involve providing financial support or incentives to households in economically disadvantaged districts to improve access to maternal health services.

3. Reduce financial barriers: Implement strategies to reduce financial barriers to accessing maternal health services, such as providing subsidies or waivers for services related to skilled birth attendance. This will help address the correlation between economic status and health visits per capita and skilled birth attendance.

4. Collect relevant data: Conduct further research to collect relevant data on the effects of decentralization on health outcomes. This will help inform future policy decisions and interventions aimed at improving access to maternal health.

By implementing these recommendations, it is expected that access to maternal health services will be improved, leading to a reduction in maternal mortality and improved health outcomes for mothers and their children in Burkina Faso.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations to improve access to maternal health in Burkina Faso:

1. Increase resource allocation: Allocate more resources, such as health personnel and infrastructures, to health districts with lower health outcomes and higher maternal mortality rates. This can help address the disparities in health resources and improve access to maternal health services.

2. Address socio-economic disparities: Implement policies and interventions that target socio-economic disparities, as these have been found to be correlated with health outcomes. This can include initiatives to improve income levels, education, and access to basic amenities in disadvantaged areas.

3. Reduce financial barriers: Implement strategies to reduce financial barriers to accessing maternal health services, such as providing subsidies or waivers for healthcare costs, especially for vulnerable populations. This can help ensure that financial constraints do not prevent women from seeking necessary maternal healthcare.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify key indicators that reflect access to maternal health, such as the number of skilled birth attendants, antenatal care coverage, and maternal mortality rates. These indicators should be measurable and representative of the target population.

2. Collect baseline data: Gather baseline data on the selected indicators for each health district in Burkina Faso. This data can be obtained from existing health management information systems, national surveys, and other relevant sources.

3. Implement interventions: Simulate the impact of the recommendations by introducing the proposed interventions in the simulation model. For example, allocate additional resources to specific health districts, implement socio-economic interventions, and reduce financial barriers.

4. Analyze the impact: Use statistical analysis techniques, such as regression analysis or modeling, to assess the impact of the interventions on the selected indicators. Compare the simulated results with the baseline data to determine the extent of improvement in access to maternal health.

5. Validate the model: Validate the simulation model by comparing the simulated results with real-world data, if available. This can help ensure the accuracy and reliability of the model’s predictions.

6. Refine and iterate: Based on the analysis and validation results, refine the simulation model and interventions as needed. Repeat the simulation process to assess the impact of the refined interventions on improving access to maternal health.

It is important to note that the methodology outlined above is a general framework and may require further customization based on the specific context and available data in Burkina Faso. Additionally, the simulation results should be interpreted with caution and considered alongside other factors and considerations in the decision-making process.

Statistics:
Citations: 4
Authors: 3
Identifiers:
DOI: 10.1002/hpm.2979
ISSN: 07496753
Research Areas:
Disparities, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care
Study Countries:
Burkina Faso
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
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