Sylvie Zongo

Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso

BackgroundThe low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications.Methods/DesignThe study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods.DiscussionPerformance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.

Dengue rapid diagnostic tests: Health professionals’ practices and challenges in Burkina Faso

Objectives: Dengue fever remains unrecognized and under-reported in Africa due to several factors, including health professionals’ lack of awareness, important prevalence of other febrile illnesses, most of which are treated presumptively as malaria, and the absence of surveillance systems. In Burkina Faso, health centers have no diagnostic tools to identify and manage dengue, which remains ignored, despite the evidence of seasonal outbreaks in recent years. A qualitative study was conducted to analyze the use of rapid diagnostic tests in six health and social promotion centers (i.e. health-care centers, from the French Centers de Santé et de Promotion Sociale) of Ouagadougou (Burkina Faso) in an exploratory research context. Methods: Dengue rapid diagnostic tests were introduced into fever-related consultations from December 2013 to January 2014. In-depth individual interviews were conducted in May and June 2014 with 32 health professionals. Results: Prior to the introduction of the tests, dengue was not well known or diagnosed by health professionals during consultations. Most febrile cases were routinely presumed to be malaria and treated accordingly. With training and routine use of rapid diagnostic tests, health professionals became more knowledgeable about dengue, improving the diagnosis of non-malaria febrile cases and its management, and better prescription practices. Conclusions: In a context of dengue re-emergence and high prevalence of other febrile illnesses, having rapid diagnostic tools available, especially during epidemics reinforces health professionals’ diagnostic and prescribing capacities, allowing an opportune and accurate case management and facilitates diseases surveillance.