scholarly journals An Exploration of the Unintended Consequences of Performance-Based Financing in 6 Primary Healthcare Facilities in Burkina Faso

2020 ◽  
Author(s):  
Anne-Marie Turcotte-Tremblay ◽  
Idriss Ali Gali Gali ◽  
Valéry Ridde
Keyword(s):  
Burkina Faso ◽  
Low Income ◽  
Diffusion Of Innovations ◽  
Secondary Data ◽  
Healthcare Services ◽  
Unintended Consequences ◽  
Low Income Countries ◽  
Structured Interviews ◽  
Healthcare Facilities ◽  
Performance Based Financing

Background: Performance-based financing (PBF) is promoted to improve the quality and quantity of healthcare services in low-income countries. Despite the complexity of the intervention, little attention has been given to studying its unintended consequences. Our objective is to increase evidence on the unintended consequences of PBF in Burkina Faso. Methods: Using the diffusion of innovations theory, we conducted a multiple case study. The cases were 6 healthcare facilities in two districts. Between April 2015 and 2016, we collected data through 101 semi-structured interviews, discussions, observations, and documents. We conducted thematic analysis using a hybrid deductive-inductive approach. Secondary data was used to illustrate the evolution of reported services. We conducted a cross-case synthesis to identify the results arising independently from more than 1 case. Results: A desirable unintended consequence of PBF was that 3 facilities limited the sale of non-prescribed medication to encourage patients to consult. Undesirable unintended consequences were found in the majority of facilities including fixation on measures rather than on underlying objectives, the pursuit of narrow and less relevant performance indicators, gaming, and teaching trainees improper practices. Providers in all facilities deliberately manipulated medical registers and documents, such that the reported quantity and quality of care differed from what was actually delivered. While most participants indicated that PBF was more advantageous than previous practices, the long payment delays were a source of dissatisfaction and demotivation across all facilities. Dissatisfaction also emerged in relation to the distribution of subsidies and the non-attribution of quality points for services delivered by certain staff considered "unqualified" in guidelines. Results in many facilities revealed suboptimal planning, a perception of the intervention as "budgetivorous," as well as tensions related to the principle of managerial autonomy. Conclusion: PBF led to numerous unintended consequences that could undermine the intervention’s effectiveness. The findings contribute to a more comprehensive picture of the consequences of implementing PBF. Policy-makers can use the results of this study to devise effective strategies before, during and after the implementation of the intervention to minimize undesirable unintended consequences and promote desirable ones.

scholarly journals Investigating COVID-19 in Low-income Settings: Protocol for a Multidisciplinary Mixed Methods Research in Burkina Faso

2021 ◽  
Author(s):  
Isidore Traoré ◽  
Samiratou Ouedraogo ◽  
Dramane Kania ◽  
Nongodo Firmin ◽  
Blahima Konaté Kaboré ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Burkina Faso ◽  
Low Income ◽  
Mixed Methods Research ◽  
Lessons Learned ◽  
Low Income Countries ◽  
Preventive Strategies ◽  
Structured Interviews ◽  
Hygiene Measures ◽  
Bobo Dioulasso

Abstract Background: The world has high hopes of vaccination against COVID-19 to protect the population, boost economies and return to normal life. Vaccination programmes are being rolled out in high income countries, but the pandemic continues to rage in many low-income countries (LICs) despite implementation of strict hygiene measures. We aim to present a comprehensive research protocol that will generate epidemiological, sociological, and anthropological data about the COVID-19 epidemic in Burkina Faso a landlocked country in West Africa with scares resources. Methods: We will perform a multidisciplinary research using mixed methods in the two main cities in Burkina Faso (Ouagadougou and Bobo-Dioulasso). Data will be collected in general population and in COVID-19 patients, caregivers and health care professional in reference care centers: (i) to determine cumulative incidence of SARS-CoV-2 infection in the Burkinabe population using blood samples collected from randomly selected households according to the WHO-recommended protocol; (ii) develop a score to predict severe complications of COVID-19 in persons infected with SARS-CoV-2 using retrospective and prospective data; (iii) perform semi-structured interviews and direct observation on site, to describe and analyze the healthcare pathways and experiences of patients with COVID-19 attending reference care centers, and to identify the perceptions, acceptability and application of preventive strategies among the population. Discussion: This study will generate comprehensive data that will contribute to improve COVID-19 response strategies in Burkina Faso. The lessons learned from the management of the epidemic may serve as examples to the country authorities to better design preventive strategies in the case of future epidemics or pandemics.Ethics and disseminationThis project was approved by the Ministry for Health (N° 2020 - 00952/MS/CAB/INSP/CM) and the Ethics Committee for Health Research of Burkina Faso (N° 2020-8-140).

scholarly journals Birth companionship in a government health system: a pilot study in Kigoma, Tanzania

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Paul Chaote ◽  
Nguke Mwakatundu ◽  
Sunday Dominico ◽  
Alex Mputa ◽  
Agnes Mbanza ◽  
...  
Keyword(s):  
Low Income ◽  
Pilot Project ◽  
Low Income Countries ◽  
Respectful Maternity Care ◽  
Health Providers ◽  
Structured Interviews ◽  
Government Officials ◽  
Government Health ◽  
Project Data ◽  
Birth Companion

Abstract Background Having a companion of choice throughout childbirth is an important component of good quality and respectful maternity care for women and has become standard in many countries. However, there are only a few examples of birth companionship being implemented in government health systems in low-income countries. To learn if birth companionship was feasible, acceptable and led to improved quality of care in these settings, we implemented a pilot project using 9 intervention and 6 comparison sites (all government health facilities) in a rural region of Tanzania. Methods The pilot was developed and implemented in Kigoma, Tanzania between July 2016 and December 2018. Women delivering at intervention sites were given the choice of having a birth companion with them during childbirth. We evaluated the pilot with: (a) project data; (b) focus group discussions; (c) structured and semi-structured interviews; and (d) service statistics. Results More than 80% of women delivering at intervention sites had a birth companion who provided support during childbirth, including comforting women and staying by their side. Most women interviewed at intervention sites were very satisfied with having a companion during childbirth (96–99%). Most women at the intervention sites also reported that the presence of a companion improved their labor, delivery and postpartum experience (82–97%). Health providers also found companions very helpful because they assisted with their workload, alerted the provider about changes in the woman’s status, and provided emotional support to the woman. When comparing intervention and comparison sites, providers at intervention sites were significantly more likely to: respond to women who called for help (p = 0.003), interact in a friendly way (p < 0.001), greet women respectfully (p < 0.001), and try to make them more comfortable (p = 0.003). Higher proportions of women who gave birth at intervention sites reported being “very satisfied” with the care they received (p < 0.001), and that the staff were “very kind” (p < 0.001) and “very encouraging” (p < 0.001). Conclusion Birth companionship was feasible and well accepted by health providers, government officials and most importantly, women who delivered at intervention facilities. The introduction of birth companionship improved women’s experience of birth and the maternity ward environment overall.

Climate Change And Food Security In Nepal

2013 ◽  
Vol 13 ◽  
pp. 9-19 ◽  
Author(s):  
Krishna Prasad Pant
Keyword(s):  
Climate Change ◽  
Regression Analysis ◽  
Food Security ◽  
Low Income ◽  
Secondary Data ◽  
Low Income Countries ◽  
Farm Production ◽  
Agriculture And Environment ◽  
Policy Measures ◽  
The Government

Climate change is posing a threat on present and future food security in low income countries. But, the actual effect of the climate change on food security is not known. Using secondary data reported by the government, the paper examines the effects of climate change on food security in Nepal in the context of policies of commercialization of farm production. Statistical analysis is used to delineate the situation of food security in the country and regression analysis for exploring the effects of global warming on domestic production of major cereals. The results are discussed at global, national, household and individual levels empirically and qualitatively. The results suggest that a rise in minimum temperature decreases the productivity of rice increasing threat of food insecurity. The paper suggests some policy measures for improving food security situation in the country and open up some areas for further research. The Journal of Agriculture and Environment Vol:13, Jun.2012, Page 9-19 DOI: http://dx.doi.org/10.3126/aej.v13i0.7582

scholarly journals Global Nursing - A Qualitative Case Study of Tanzanian Nursing Students' Experiences of Student Exchange in Sweden

2020 ◽  
Author(s):  
Tara Alden-Joyce ◽  
Elina Scheers-Andersson ◽  
Jane Rogathi ◽  
Paulo Kidayi ◽  
Jenny Cadstedt ◽  
...  
Keyword(s):  
Nursing Education ◽  
Nursing Students ◽  
Low Income ◽  
Qualitative Content Analysis ◽  
Inductive Reasoning ◽  
Low Income Countries ◽  
Structured Interviews ◽  
Global Perspectives ◽  
Purposeful Sampling ◽  
Student Exchange

Abstract Background: Due to globalization and a shift in population demographics, needs within healthcare are changing and nurses require new skills and knowledge. Nursing education needs to facilitate these new demands and student exchange programmes provide an opportunity to develop necessary skills.Aim: The aim of this study was to explore Tanzanian nursing students' experiences of student exchange in Sweden. Method: A qualitative design was used for this empirical study. Semi-structured interviews were conducted with six Tanzanian nursing students who had participated in student exchange in Sweden. The participants were recruited by purposeful sampling. Inductive reasoning and qualitative content analysis were applied.Results: The findings revealed that the students experienced new approaches in Sweden, allowing them to develop skills and competences. Furthermore, they increased their global perspectives on nursing and interest in working with global health issues. However, they also experienced challenges in the new environment.Conclusion: The present study showed that the Tanzanian nursing students benefitted from their student exchange, both personally, as well as for their future careers as nurses. More research is needed examining nursing students from low-income countries participating in student exchange in high-income countries.

scholarly journals User-centric work environments in modular healthcare facilities

2019 ◽  
Vol 26 (6) ◽  
pp. 1047-1062
Author(s):  
Leena Aalto ◽  
Pia Sirola ◽  
Tiina Kalliomäki-Levanto ◽  
Marjaana Lahtinen ◽  
Virpi Ruohomäki ◽  
...  
Keyword(s):  
Work Environment ◽  
Healthcare Services ◽  
Healthcare Sector ◽  
Structured Interviews ◽  
Public And Private ◽  
Content Type ◽  
Healthcare Facilities ◽  
Safety Issues ◽  
User Centric ◽  
Traditional Construction

Purpose The challenges arising from the reform of the social and healthcare sector call for efficient, effective and novel processes in both public and private health and medical care. Facilities need to be designed to suit the new processes and to offer usable workspaces at different levels of healthcare services. Along with traditional construction, modular facility innovations could be one solution to these pressures. The paper aims to discuss these issues. Design/methodology/approach This case study analyzed the different usability characteristics of the work environment in modular and non-modular healthcare facilities (HCFs). The qualitative research method was based on semi-structured interviews of employees and observations of the case buildings. Findings According to the results, the usability characteristics were divided into four main categories: functionality, healthiness, safety/security and comfort. The main differences between the modular and non-modular facilities appeared to be room size, soundproofing, safety issues and the utilization of colors and artwork, which were all perceived as better realized in the non-modular facilities. The staff highlighted functionality as the most important characteristic in their work environment. They even considered functionality as a feature of a comfortable work environment. Originality/value This paper presents new knowledge and a detailed description of the opinions and experiences of healthcare professionals concerning a user-centric, usable environment in the context of modular and non-modular HCFs.

scholarly journals Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003–2017

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chijioke Okoli ◽  
Mohammad Hajizadeh ◽  
Mohammad Mafizur Rahman ◽  
Rasheda Khanam
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Healthcare Services ◽  
Socioeconomic Inequalities ◽  
Low Income Countries ◽  
Theil Index ◽  
Maternal Healthcare ◽  
North East ◽  
Birth Attendance ◽  
Urban And Rural Areas

Abstract Background Maternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular. This study examines the geographical and socioeconomic inequalities in maternal healthcare utilization in Nigeria over the period between 2003 and 2017. Methods The study used four rounds of Nigeria Demographic Health Surveys (DHS, 2003, 2008, 2013, and 2018) for women aged 15–49 years old. The rate ratios and differences (RR and RD) were used to measure differences between urban and rural areas in terms of the utilization of the three maternal healthcare services including antenatal care (ANC), facility-based delivery (FBD), and skilled-birth attendance (SBA). The Theil index (T), between-group variance (BGV) were used to measure relative and absolute inequalities in the utilization of maternal healthcare across the six geopolitical zones in Nigeria. The relative and absolute concentration index (RC and AC) were used to measure education-and wealth-related inequalities in the utilization of maternal healthcare services. Results The RD shows that the gap in the utilization of FBD between urban and rural areas significantly increased by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in ANC and FBD across the six geopolitical zones by 7, and 1.8% per year, respectively. The BGV results do not suggest any changes in absolute inequalities in ANC, FBD, and SBA utilization across the geopolitical zones over time. The results of the RC and the AC suggest a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period. Conclusion We found that the utilization of maternal healthcare is lower among poorer and less-educated women, as well as those living in rural areas and North West and North East geopolitical zones. Thus, the focus should be on implementing strategies that increase the uptake of maternal healthcare services among these groups.

scholarly journals Access to Controlled Medicines in Low-Income Countries: Listening to Stakeholders in the Field

2020 ◽  
pp. 002073142090674
Author(s):  
Agnes Vitry ◽  
Gilles Forte ◽  
Jason White
Keyword(s):  
Low Income ◽  
Low Income Countries ◽  
Structured Interviews ◽  
African Countries ◽  
Country Level ◽  
Written Information ◽  
Health Authorities ◽  
Psychotropic Medicines ◽  
Republic Of The Congo ◽  
International Conventions

Little is known on current practices and challenges associated with the legal trade of medicines controlled under international conventions in low-income countries. This qualitative survey involved semi-structured interviews of stakeholders engaged in the trade of controlled medicines at a global level or at a country level in 3 African countries (Uganda, Kenya, Democratic Republic of the Congo). Nine interviews were conducted, including 3 international wholesalers, 2 relief organizations, 2 procurement officers, and 2 regulatory officers. Additionally, 4 other participants provided written information. All participants consistently reported that the current process of procuring controlled medicines in compliance with international conventions was long and complex given the number of administrative steps required for obtaining export and import authorizations, which are mandatory for both narcotic and psychotropic medicines. It may be difficult or impossible to obtain import authorizations from some health authorities in low-income countries because of long delays, mistakes in forms, absence or shortage of staff, or when annual national estimates are exceeded. The complexities of the trade of controlled medicines directly contribute to the lack of access to essential controlled medicines, both narcotics and psychotropics, in low-income countries.

scholarly journals ENDOGENOUS PERCEPTIONS AND MEASURES FOR AGROPASTORALISTS’ ADAPTATION IN THE SAHELIAN AREA OF BURKINA FASO

2020 ◽  
Vol 7 (10) ◽  
pp. 62-74
Author(s):  
Sanou Daouda ◽  
Toe Bernadette ◽  
Traore Almamy ◽  
Kabore Adama ◽  
Tamboura H. Hamidou ◽  
...  
Keyword(s):  
Climate Change ◽  
Burkina Faso ◽  
Local Adaptation ◽  
Temporal Evolution ◽  
Meteorological Data ◽  
Secondary Data ◽  
Adaptation Strategies ◽  
Structured Interviews ◽  
Pastoral Production ◽  
Livestock Farmers

The study was conducted to understand the perceptions and local adaptation strategies of rural sahelian communities in Burkina Faso to climate change on ruminant rearing practices. For this purpose, the study was carried out in the rural commune of Bani by collecting primary from semi-structured interviews with 143 producers and secondary data of temperature, rainfall and their spatial and temporal evolution from 2005 to 2016. Analysis of these data reveals that 67.13% of the producers are male and 32.86% female, with an average age of 55 ± 0.3 years. These respondents were agropastoralists with an average of 3.5 ha of cultivated land, using traditional seeds (100% of respondents) and improved seeds (58.7%) and rearing local breeds of ruminants. For climate change, respondents notified an increase in temperature and a decrease in rainfall that corroborates the analysis of the meteorological data collected. The consequences of climate change on livestock farmers' resources are food insecurity, lack of pasture, drought and low animal productivity. The local adaptation strategies applied by livestock farmers are the diversification of agro-sylvo-pastoral production (88.11%) and income-generating activities (70%).  In the study area, diversification is the strategy adopted by agro-pastoralists to ensure food security and provide income to meet the daily needs of families.

scholarly journals Tobacco Use and Associated Risk Factors in Burkina Faso: Results from a Population-Based Cross-Sectional Survey.

2019 ◽  
Author(s):  
Bruno Bonnechère ◽  
Cissé Kadari ◽  
Millogo Tiéba ◽  
Ouédraogo H. Gautier ◽  
Garanet Franck ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alcohol Consumption ◽  
Burkina Faso ◽  
Tobacco Use ◽  
Low Income ◽  
Associated Factors ◽  
World Health ◽  
Low Income Countries ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Tobacco is a leading preventable cause of non-communicable diseases (NCDs). Studies characterizing the prevalence of tobacco use in low-income countries are lacking. This study describes the prevalence of tobacco use in Burkina Faso and its associated factors. Methods : Data from the 2013 Burkina Faso World Health Organization (WHO) Stepwise approach to Surveillance (STEPS) were analyzed. The prevalence of any tobacco product use, cigarette smoking, and other tobacco use was calculated. Logistic regression analyses identified factors associated with tobacco use. Overall, 4,691 people were included in this analysis. Results: The prevalence of any tobacco use was 19.8% (95% CI: 18.4–21.2). Tobacco use was higher for men (29.2% [27.0–31.5]) than women (11.8% [10.3–13.4]). The prevalence of smoked tobacco was 11.3% (10.3–12.4), with a significantly higher prevalence among men (24.5% [22.1–27.0]) than women (0.1% [0.01–0.3]). The overall prevalence of other tobacco use was 8.9% (7.4–10.7), with lower values for men (5.6% [4.1–7.2]) compared to women (11.7% [9.4–14.1]). Tobacco smoking among men was significantly associated with an increased age and alcohol consumption. The analysis of risk factors for other tobacco use stratified by gender showed that age, education, residence, and alcohol consumption were significantly associated with consumption for women, and age and alcohol consumption for men. Conclusion: Tobacco use is common in Burkina Faso. To effectively reduce tobacco use in Burkina Faso, a comprehensive tobacco control program should consider associated factors, such as gender, age, and alcohol consumption.

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