Abdourahmane Coulibaly

Few studies have focused on the presence of families in the hospital in the context of an epidemic. The present study aims to contribute to filling this gap by answering the following question: How did professionals, patients and their families cope with more or less drastic restrictions to family visits and presence during the COVID-19 pandemic in a French and a Malian hospital during the COVID-19 pandemic? Data were collected during the first two waves of the pandemic through 111 semi-structured interviews (France = 55, Mali = 56). Most of the interviews were conducted with staff (n = 103), but also with families in the case of Mali (n = 8). The investigators also conducted 150 days of field observations, 44 in France and 106 in Mali. Thematic analysis was applied using an inductive approach. Interviews were content analyzed to identify passages in the interviews that were relevant to these different themes. The study highlighted the difficulty for the medical-clinical system to provide appropriate responses to the many emotional needs of patients in a pandemic context. Families in France benefited from a support service to reduce stress, while in Mali, no initiative was taken in this sense. In both countries, families often used the telephone as an alternative means of communicating with relatives. The results showed that in the two contexts, the presence and involvement of the families contributed to a better response to the patients' psycho-affective demands and thus promoted resilience in this field.

Background and objective: The AIRE project aims to improve the detection of respiratory distress in children under five years of age by introducing the routine use of pulse oximeters (POs) during consultations in primary health centers (PHCs) in four countries (Burkina Faso, Guinea, Mali,...

Objectif : L’objectif de cette recherche était de rendre compte des stratégies de résilience mobilisées par l’Hôpital du Mali face à la maladie à coronavirus (COVID-19). Méthode : Les données collectées ont concerné une période correspondant aux premiers mois de gestion de la pandémie à l’hôpital (avril - juillet 2020). Au total, 32 entretiens semi-directifs et 53 séances d’observation ont été réalisés. Les analyses se sont appuyées sur un cadre conceptuel et ont été menées selon l’approche déductive. Résultats : Les résultats montrent que, face aux multiples effets de la COVID-19 tels que l’aggravation de la pénurie du personnel et de la charge de travail, le besoin de créer des infrastructures dédiées, la baisse drastique des recettes liée à la baisse de fréquentation de l’hôpital, le personnel a mis en place de multiples stratégies (ex. réduction ou report de certaines dépenses, réquisition de bâtiment, recrutements de contractuels et le redéploiement du personnel fonctionnaire). La mise en place de ces stratégies a globalement permis de maintenir l’accès aux soins des patients, même si les restrictions ont été nombreuses pour les patients non COVID-19. L’hôpital a été en mesure de s’inscrire dans une résilience absorptive. Conclusion : Cette recherche qualitative a permis une meilleure compréhension des faits liés à la gestion de la COVID-19 en milieu hospitalier, et notamment de sa résilience. Les leçons tirées de la recherche devraient permettre de concevoir, à l’avenir, des réponses plus adaptées et plus efficaces pour faire face aux pandémies.

Introduction: Numerous sub-Saharan African countries have experimented with performance-based financing (PBF) with the goal of improving health system performance. To date, few articles have examined the implementation of this type of complex intervention in Francophone West Africa. This qualitative research aims to understand the process of implementing a PBF pilot project in Mali's Koulikoro region.Method: We conducted a contrasted multiple case study of performance in 12 community health centres in three districts. We collected 161 semi-structured interviews, 69 informal interviews and 96 non-participant observation sessions. Data collection and analysis were guided by the Consolidated Framework for Implementation Research adapted to the research topic and local context.Results: Our analysis revealed that the internal context of the PBF implementation played a key role in the process. High-performing centres exercised leadership and commitment more strongly than low-performing ones. These two characteristics were associated with taking initiatives to promote PBF implementation and strengthening team spirit. Information regarding the intervention was best appropriated by qualified health professionals. However, the limited duration of the implementation did not allow for the emergence of networks or champions. The enthusiasm initially generated by PBF quickly dissipated, mainly due to delays in the implementation schedule and the payment modalities.Conclusion: PBF is a complex intervention in which many actors intervene in diverse contexts. The initial level of performance and the internal and external contexts of primary healthcare facilities influence the implementation of PBF. Future work in this area would benefit from an interdisciplinary approach combining public health and anthropology to better understand such an intervention. The deductive–inductive approach must be the stepping-stone of such a methodological approach.

L’ambition des programmes de planification des naissances est de changer les conduites reproductives des acteurs sociaux à travers les messages sanitaires. Il s’agit d’une démarche pédagogique visant à susciter chez le récepteur du message une disponibilité au changement conforme aux prescriptions des programmes. À travers des exemples concrets, notre travail montre que la réalité est beaucoup plus complexe et que les acteurs sociaux ne sont pas des êtres passifs. En effet, leurs pratiques quotidiennes montrent qu’ils empruntent des arguments à des ensembles normatifs variés (coutume, religion, normes sexuelles mondialisées, etc.) pour justifier leurs actes. Ils hésitent, résistent, se soumettent… Loin d’accepter les normes « officielles » des programmes, ils les transforment à leur façon, les manipulent, les adaptent, les soumettent.

Results-based financing (RBF) is emerging as a new alternative to finance health systems in many African countries. In Mali, a pilot project was conducted to improve demand and supply of health services through financing performance in targeted services. No study has explored the sustainability process of such a project in Africa. This study’s objectives were to understand the project’s sustainability process and to assess its level of sustainability. Sustainability was examined through its different determinants, phases, levels and contexts. These were explored using qualitative interviews to discern, via critical events, stakeholders’ ideas regarding the project’s sustainability. Data collection sites were chosen with the participation of different stakeholders, based on a variety of criteria (rural/urban settings, level of participation, RBF participants still present, etc.). Forty-nine stakeholders were then interviewed in six community health centres and two referral health centres (from 11/12/15 to 08/03/16), including health practitioners, administrators, and those involved in implementing and conceptualizing the program (government and NGOs). A theme analysis was done with the software © QDA Miner according to the study’s conceptual framework. The results of this project show a weak level of sustainability due to many factors. While some gains could be sustained (ex.: investments in long-term resources, high compatibility of values and codes, adapted design to the implementations contexts, etc.) other intended benefits could not (ex.: end of investments, lack of shared cultural artefacts around RBF, loss of different tasks and procedures, need of more ownership of the project by the local stakeholders). A lack of sustainability planning was observed, and few critical events were associated to phases of sustainability. While this RBF project aimed at increasing health agents’ motivation through different mechanisms (supervision, investments, incentives, etc.), these results raise questions on what types of motivation could be more stable and what could be the place of local stakeholders in the project; all this with the aim of more sustained and efficient results.