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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