38 research outputs found
Inter-household transfers: An empirical investigation of the income-transfer relationship with novel data from Burkina Faso
No full textManuscript_Supplemental_Appendix.rjf_online_supp – Supplemental material for The Costs of Implementing Vaccination With the RTS,S Malaria Vaccine in Five Sub-Saharan African Countries
No full textSupplemental material, Manuscript_Supplemental_Appendix.rjf_online_supp for The Costs of Implementing Vaccination With the RTS,S Malaria Vaccine in Five Sub-Saharan African Countries by Elisa Sicuri, Fadima Yaya Bocoum, Justice Nonvignon, Sergi Alonso, Bakar Fakih, George Bonsu, Simon Kariuki, Oscar Leeuwenkamp, Khatia Munguambe, Mwifadhi Mrisho, Vincent Were and Christophe Sauboin in MDM Policy & Practice</p
Focus_On_Patient_REVISED.rjf_online_supp – Supplemental material for The Costs of Implementing Vaccination With the RTS,S Malaria Vaccine in Five Sub-Saharan African Countries
No full textSupplemental material, Focus_On_Patient_REVISED.rjf_online_supp for The Costs of Implementing Vaccination With the RTS,S Malaria Vaccine in Five Sub-Saharan African Countries by Elisa Sicuri, Fadima Yaya Bocoum, Justice Nonvignon, Sergi Alonso, Bakar Fakih, George Bonsu, Simon Kariuki, Oscar Leeuwenkamp, Khatia Munguambe, Mwifadhi Mrisho, Vincent Were and Christophe Sauboin in MDM Policy & Practice</p
Manuscript_Supplemental_STROBE_checklist.rjf_online_supp – Supplemental material for The Costs of Implementing Vaccination With the RTS,S Malaria Vaccine in Five Sub-Saharan African Countries
No full textSupplemental material, Manuscript_Supplemental_STROBE_checklist.rjf_online_supp for The Costs of Implementing Vaccination With the RTS,S Malaria Vaccine in Five Sub-Saharan African Countries by Elisa Sicuri, Fadima Yaya Bocoum, Justice Nonvignon, Sergi Alonso, Bakar Fakih, George Bonsu, Simon Kariuki, Oscar Leeuwenkamp, Khatia Munguambe, Mwifadhi Mrisho, Vincent Were and Christophe Sauboin in MDM Policy & Practice</p
Feasibility of introducing an onsite test for syphilis in the package of antenatal care at the rural primary health care level in Burkina Faso
No full textPhilosophiae Doctor - PhDBackground: Syphilis transmission remains a global problem with an estimated 12 million people infected each year. Ninety percent of syphilis cases occur in low income countries. Syphilis is a serious source of adverse pregnancy outcomes for both mother and infant. Ideally, syphilis screening should be provided as part of a package of maternal and newborn health-care services. This thesis reports on a pilot intervention study to develop, implement and evaluate a point of care test for syphilis in antenatal care services in rural Burkina Faso. Methods: This study used a pre post intervention mixed methods quasi-experimental design with a group of health facilities offering ANC services (primary health centers in rural area) as the sampling units. This study was conducted in three phases, which consisted of a situational analysis using qualitative methods (Phase 1), selecting an appropriate test through evaluating 4 candidate tests and the participatory design and implementation of an intervention that included onsite training, provision of supplies and medicines, quality control and supervision (Phase 2), and an evaluation combining review of record tools, interviews, time motion study and estimating incremental costs (Phase 3). The conceptual framework draws on multilevel assessment (MLA), policy triangle framework, MRC framework for designing complex interventions and the Normalization Process Model (NPM). Methods included document review, seventy five interviews were conducted with health providers, district managers, facility managers, traditional healers, pregnant women, community health workers, and Non-Governmental Organizations (NGO) managers in phase I and fourteen in phase III, non-participant observation, time-motion study, incremental cost analysis, and sensitivity, specificity and ease of use analysis of four candidate point-of care tests. Data were collected between 2012 and 2014. Qualitative data were analyzed through thematic analysis supported by Nvivo software. Quantitative data were analyzed through descriptive statistics such as frequency, mean and median supported by SPSS. Findings: Phase I identified barriers to implementation and uptake of syphilis testing at health provider and community levels. The most important barriers at provider level included fragmentation of services, poor communication between health workers and clients, failure to prescribe syphilis test, and low awareness of syphilis burden. Cost of testing, distance to laboratory and lack of knowledge about syphilis were identified as barriers at community level. Phase II: Alere DetermineTM Syphilis was the most sensitive of the four point-of-care tests evaluated. The components of the intervention were successfully implemented in the selected health facilities. Overall, phase III showed that it is feasible and acceptable to introduce a point of care test for syphilis in antenatal care services at primary health care level using the available staff. The intervention was reported as acceptable, but of 812 pregnant women who came for their first visit 39% were screened during the study period. Rural facilities had higher coverage (66.8%) than the urban ones (25.6%). Quality control found no discordance between the rapid test and TPHA results. The average cost of ANC per unscreened pregnant woman was 3.11 USD (±0.14) vs 5.06 USD (±0.16) per screened woman. The main cost driver was the material costs notably the test itself. The test’s cost is comparable to HIV test costs, but funder support for integrating this additional test is less readily available than for HIV tests. Conclusions: The findings suggested that an intervention that introduces point of care test for syphilis at antenatal care services is feasible, acceptable, and of comparable costs to HIV screening in pregnancy. Nonetheless, instructions and supervision need to be clearer to achieve optimal levels of screening and quality control, and barriers identified by health workers need to be overcome. The point-of care test for syphilis is likely to be acceptable by health workers as a routine service and incorporated as a normal practice in Burkina Faso context.This research was made financially possible by the UNICEF/UNDP/World Bank/WHO
Special Programme for Research and Training in Tropical Diseases (TDR); and the African Doctoral Dissertation Research Fellowship (ADDRF 2012) award offered by the African Population and Health Research Center (APHRC) in partnership with the International Development Research Centre (IDRC)
Feasibility of introducing an onsite test for syphilis in the package of antenatal care at the rural primary health care level in Burkina Faso
No full textPhilosophiae Doctor - PhDBackground: Syphilis transmission remains a global problem with an estimated 12 million people infected each year. Ninety percent of syphilis cases occur in low income countries. Syphilis is a serious source of adverse pregnancy outcomes for both mother and infant. Ideally, syphilis screening should be provided as part of a package of maternal and newborn health-care services. This thesis reports on a pilot intervention study to develop, implement and evaluate a point of care test for syphilis in antenatal care services in rural Burkina Faso. Methods: This study used a pre post intervention mixed methods quasi-experimental design with a group of health facilities offering ANC services (primary health centers in rural area) as the sampling units. This study was conducted in three phases, which consisted of a situational analysis using qualitative methods (Phase 1), selecting an appropriate test through evaluating 4 candidate tests and the participatory design and implementation of an intervention that included onsite training, provision of supplies and medicines, quality control and supervision (Phase 2), and an evaluation combining review of record tools, interviews, time motion study and estimating incremental costs (Phase 3). The conceptual framework draws on multilevel assessment (MLA), policy triangle framework, MRC framework for designing complex interventions and the Normalization Process Model (NPM). Methods included document review, seventy five interviews were conducted with health providers, district managers, facility managers, traditional healers, pregnant women, community health workers, and Non-Governmental Organizations (NGO) managers in phase I and fourteen in phase III, non-participant observation, time-motion study, incremental cost analysis, and sensitivity, specificity and ease of use analysis of four candidate point-of care tests. Data were collected between 2012 and 2014. Qualitative data were analyzed through thematic analysis supported by Nvivo software. Quantitative data were analyzed through descriptive statistics such as frequency, mean and median supported by SPSS. Findings: Phase I identified barriers to implementation and uptake of syphilis testing at health provider and community levels. The most important barriers at provider level included fragmentation of services, poor communication between health workers and clients, failure to prescribe syphilis test, and low awareness of syphilis burden. Cost of testing, distance to laboratory and lack of knowledge about syphilis were identified as barriers at community level. Phase II: Alere DetermineTM Syphilis was the most sensitive of the four point-of-care tests evaluated. The components of the intervention were successfully implemented in the selected health facilities. Overall, phase III showed that it is feasible and acceptable to introduce a point of care test for syphilis in antenatal care services at primary health care level using the available staff. The intervention was reported as acceptable, but of 812 pregnant women who came for their first visit 39% were screened during the study period. Rural facilities had higher coverage (66.8%) than the urban ones (25.6%). Quality control found no discordance between the rapid test and TPHA results. The average cost of ANC per unscreened pregnant woman was 3.11 USD (±0.14) vs 5.06 USD (±0.16) per screened woman. The main cost driver was the material costs notably the test itself. The test’s cost is comparable to HIV test costs, but funder support for integrating this additional test is less readily available than for HIV tests. Conclusions: The findings suggested that an intervention that introduces point of care test for syphilis at antenatal care services is feasible, acceptable, and of comparable costs to HIV screening in pregnancy. Nonetheless, instructions and supervision need to be clearer to achieve optimal levels of screening and quality control, and barriers identified by health workers need to be overcome. The point-of care test for syphilis is likely to be acceptable by health workers as a routine service and incorporated as a normal practice in Burkina Faso context.This research was made financially possible by the UNICEF/UNDP/World Bank/WHO
Special Programme for Research and Training in Tropical Diseases (TDR); and the African Doctoral Dissertation Research Fellowship (ADDRF 2012) award offered by the African Population and Health Research Center (APHRC) in partnership with the International Development Research Centre (IDRC)
Beyond physical accessibility, bypassing health facilities offering cesarean section: a study based on women living in the slums of Dakar
No full textObjective: the study examines the geographic accessibility of Comprehensive Emergency Obstetric Care (CEmONC) among women residing in the slums of Dakar.Design: the study is a cross-sectional geographic analysis of caesarean care utilisation in health facilities offering the service in Dakar.Setting: the study was conducted in urban slum areas in Dakar.Participants: 763 women living in urban slums who had undergone a caesarean section in six health facilities in Dakar between July and December 2022.Outcome measures The proportion of women bypassing the nearest health facility and travel time to health facilities.Results: key findings show that most women in Dakar’s urban slums live within 5 min from a health facility offering caesarean services, with an average travel time of 6.3 min. However, 44.3% bypassed nearby facilities, often travelling outside their district. Medical referral was the primary reason for bypassing (43.2%), followed by the search for higher quality care (13.5%) and reliance on family or social networks (14.9%). Only a small proportion (1.4%) cited more affordable treatment costs as a reason for bypassing.Conclusion: despite the good geographical accessibility of health facilities offering caesarean sections in Dakar, many women bypass nearby facilities due to medical referrals and the search for higher quality care, resulting in increased travel time and costs. Strengthening the quality and capacity of local health centres in urban slums is crucial to minimising unnecessary bypassing and ensuring timely access to essential obstetric services
The health care burden in rural Burkina Faso: Consequences and implications for insurance design
No full textThis paper maps the health care burden of households in rural Burkina Faso. More specifically we investigate the financial burden of health shocks and the manner in which households respond. Our data allows us to differentiate the burden of chronic illness and handicap, more frequent and recurring illnesses and episodes of severe illness, accident and mortality. We find that the burden of health shocks and health spending is high, ranging from one third of monthly non-medical consumption for the treatment of common infectious illnesses to almost three times the monthly non-medical spending in case of death of a household member. To cope, households deplete savings, sell livestock or reduce consumption. In case of severe shocks they are also heavily reliant on transfers from outside. Looking at the economic consequences of health shocks we find that illness of whichever type – severe, chronic or more common – reduces household consumption. Furthermore, households which suffered from a severe illness show significantly lower livestock holdings. Many of the health insurance schemes implemented in developing countries are not yet taking note of the burden of severe and chronic illness. However, in light of the universal health insurance coverage objectives of the Sustainable Development Goals (SDGs) it should be considered an area for future expansion
Can informal redistribution withstand formal safety nets? Insights from urban-rural transfers in Burkina Faso
No full textHouseholds in rural areas still depend on informal transfers to meet subsistence needs and cope with shocks. Yet, to provide additional monetary support, formal safety nets are increasingly introduced in developing countries. However, it remains unclear whether such social protection policies will have the desired welfare effects. This article addresses this question by analyzing the private transfer response to changes in the income of rural recipients using novel data from Burkina Faso. We assume that the transfer-income relationship is a non-linear one where transfer motives, and therefore also transfer responses, vary with the recipient's position in the income distribution. Our findings support this view. We find a pronounced, negative private transfer response among the poorest of the poor. This observation has important policy implications, because those households that depend most on private transfers, would be most affected by crowding-out effects. In terms of transfer motives, the negative relationship for the lowest income class is consistent with transfers being altruistically motivated. With increasing income levels, transfers cease being altruistic at the margin and switch toward exchange motives. However, the observed transfer pattern is also indicative of an (informal) insurance role of private transfers. Rural households receive higher private transfers in response to negative shocks. These results can serve as a basis for the design of formal social protection mechanisms in a context where informal redistribution still plays an important role
Émergence du régime d’assurance maladie universelle au Burkina Faso
No full textIn Burkina Faso, access to healthcare has long been a challenge, particularly for the most vulnerable populations. Since 2008, the country has taken significant steps by launching the Universal Health Insurance Scheme (RAMU), an initiative aimed at expanding health coverage. This article explores the factors that led to the emergence of this program. Drawing on public policy analysis tools and a field survey, this study was based on interviews conducted with key stakeholders from public administration, civil society, and partner institutions who were directly involved in the process. Primary data were supplemented with secondary data from documentary analysis. The results indicated that the universal health insurance scheme emerged from a widely shared observation : the need to better protect populations against health risks within the context of social inequality and economic insecurity. This program also reflects Burkina Faso's commitment to the global movement toward universal health coverage and strengthening of social protection systems.Au Burkina Faso, l’accès aux soins de santé a longtemps constitué un défi, en particulier pour les populations les plus vulnérables. Depuis 2008, le pays a franchi une étape importante en lançant le Régime d’Assurance Maladie Universelle (RAMU), une initiative visant à élargir la couverture sanitaire. Cet article, s’appuyant sur les outils d’analyse des politiques publiques et une enquête de terrain, explore les facteurs ayant conduit à l’émergence de ce dispositif. L’étude repose sur des entretiens menés auprès d’acteurs issus de l’administration publique, de la société civile et des institutions partenaires, directement impliqués dans le processus. Ce corpus a été enrichi de données secondaires issues de l’analyse documentaire. Les résultats montrent que le régime d’assurance maladie universelle est né d’un constat largement partagé : la nécessité de mieux protéger les populations contre les risques de maladie, dans un contexte marqué par les inégalités sociales et la précarité économique. Cette initiative reflète également l’engagement du Burkina Faso à rejoindre le mouvement mondial pour la couverture santé universelle et le renforcement des systèmes de protection sociale
