Abel Bicaba

Background:In the implementation of the results-based financing (PBF) strategy in Burkina Faso, there is heterogeneity in the performance of technical quality of healthcare in basic healthcare facilities. This study aims to identify the factors that may explain this heterogeneity. Methods:We carried out a quantitative study in 30 basic public health facilities, thirteen of which have a quality score greater than or equal to 50% and 17 of which have a quality score less than 50%. Data from their profiles were collected using a direct observation grid. A total of 94 health professionals answered a series of semi-structured questions. A bivariate analysis using the Chi-square test and a multivariate analysis using the multiple regression model were used. Results:The difference is statistically significant in favour of health facilities with good performance in technical quality in terms of health infrastructure (p=0.020), health equipment (p=0.004) and compliance with norms and standards in terms of health personnel (p=0.004). The variables used in the multiple regression model are ongoing training (p=0.000), internal communication (p=0.000) and financial motivation (p=0.003) of health professionals.Conclusion:These results suggest that the effectiveness of the technical quality of healthcare in implementing the PBF depends on certain basic conditions in the health facilities, such as the presence of infrastructures, equipment and human resources that meet established norms and standards and the managerial dynamics of healthcare workers.

Since 2014, the Burkina Faso government has made Seasonal Malaria Chemoprevention (SMC) a priority in its strategic plan to fight against malaria among children aged from 3 to 59 months. Very few studies have examined the care provided by community health workers in the framework of this strategy. The purpose of this study was to evaluate the level of quality of care provided by the latter. This was a mixed study. The quantitative component consisted of a non-participant observation of community health workers during the administration of care. The qualitative component consisted of one-on-one interviews with community health workers, child caregivers and head nurses. Five dimensions (organizational accessibility, interpersonal relationship, technical competence, safety of care and satisfaction of child caregivers) adapted from the Donabedian quality of care model were used to assess the quality level of care. The Corlien et al. Health Systems Research Program Implementation Scale was used to establish quality scores for each of the five dimensions. The study sites were the health centers located in the administrative centers of the 4 communes of the health district of Boulsa. The data were collected during the first cycle of the 2017 SMC campaign. A total of 14 active pairs (28 CHWs) were observed and 40 in-depth interviews with community health workers, Head nurses in duty and community leaders were conducted. The results show that community health workers worked in pairs. They had all received SMC training and possessed equipment to do their job. The dimensions of organizational accessibility and satisfaction of the caregivers were rated as good. The dimensions of interpersonal relationship and technical competence were judged to be of an acceptable score. Safety of care was judged to be of a low-level score. The overall quality of care was considered acceptable. The results of this study have shown that despite the difficulties faced by community health workers, they manage to deliver acceptable quality of care. Their use would be an asset for SMC in particular and for the health system in general.