Health in Burkina Faso

Burkina Faso (former Upper Volta) means land (or country) of “upright people” as literally translated from two of the local languages (Mooré and Dioula). It is a landlocked, francophone country situated in the middle of West Africa. It is surrounded by Côte d'Ivoire, Ghana, Benin and Togo in the South, by Mali in the North-west and by Niger in the North-eastern part. In 2012, the average life expectancy was estimated at 57 for male and 59 for female. The under five mortality rate and the infant mortality rate were respectively 102 and 66 per 1000 live births.^[1] In 2014, the median age of its inhabitants is 17 and the estimated population growth rate is 3.05%.^[2] In 2011, health expenditures was 6.5% of GDP; the maternal mortality ratio was estimated at 300 deaths per 100000 live births and the physician density at 0.05/1000 population in 2010. In 2012, it was estimated that the adult HIV prevalence rate (ages 15–49) was 1.0%.^[3] According to the 2011 UNAIDS Report, HIV prevalence is declining among pregnant women who attend antenatal clinics.^[4] According to a 2005 World Health Organization report, an estimated 72.5% of Burkina Faso's girls and women have suffered female genital mutilation, administered according to traditional rituals.^[5]

The government of Burkina Faso took on the project of improving the quality of health services by upgrading facilities and skills, achieving control of endemic parasitic diseases, and strengthening sector institutions. Total health care expenditures were an estimated 4.1% of GDP. Central government spending on health was 3% in 2001.^[6]

Current statistics

Statistics for Burkina Faso in 2012.^[1]

Health system

Evolution

Trucks being donated to Upper Volta in 1969 as part of the global smallpox eradication campaign.

• 1960-1979 In place was an “all state” model, strongly centralized with a weak health system infrastructure, and a strong presence of mobile health teams coming from a centralized level. There was no involvement of the local populations. Under the “all state” model, the state managed everything. Communities were not consulted, nor were they implicated in the management of the health services provided. Consequences of this model were geographic and financial inaccessibility as well as a weak frequentation of health services, causing high levels of illness and death.
• 1980-1990 The concept of primary healthcare was introduced along with the creation of primary healthcare posts. However, the healthcare system was still largely based on the “all state” model which was showing its limitations.
• 1987 At the conference of African Ministers of Health in Bamako, Mali, it was found that there were many weaknesses in centralization. All decisions were made at high levels. Local communities had no forum to voice concerns of weak coverage and the lack of services available. Also within the health infrastructure, it was found that the cost of services were high, as were levels of death. L’Initiative de Bamako (IB) – The Bamako Initiative was therefore developed based on decentralizing resources in order to reinforce the ideology of Primary Health Care - Soins de Santé Primaires (SSP). This system gave the responsibility for the management of their own healthcare entirely to the community level. Les Soins de Santé Primaires (SSP) – Primary Health Care was essentially based on practical techniques and methodology. Scientifically valuable and socially acceptable, the system was rendered universally accessible to individuals and families in the community. The country could then assume autonomy and self-determination in each step of their health development.
• 1991–present The healthcare system was reorganized into Health Districts that function under the Bamako Initiative. This was effectively put into place in Burkina Faso in October 1993.^[7]

The three level pyramidal health system

• Administratively, Burkina Faso has a three-level pyramidal health system that comprises from the top to the bottom:
  • The national and central health directorates, all located in Ouagadougou, the capital city. These are the national directorates of the Ministry of Health and also the cabinet of the Minister of Health in Burkina Faso. The role of this top level is to draw the national health policy in Burkina Faso and to take appropriate measures for funding and implementation of the health policy.
  • The regional structures at the intermediate level consist of 13 regional health directorates that are in charge of health policy implementation in each of the 13 administrative regions of the country.
  • The peripheral or district level at the bottom is made of 63 health districts and 1495 primary health facilities (in 2012) which are named Centre de Santé et de Promotion Social (CSPS). This level is in charge of health policy implementation and also provides data and reports needed for changes or new recommendations about the national health policy.^[8]

Health System in Burkina Faso

• On the organizational aspect, the health care system comprises from the top to bottom:
  • Three university hospitals, two in Ouagadougou and one in Bobo-Dioulasso, and one national hospital. These facilities are expected to provide the highest available quality of care in Burkina Faso. Medical care is provided by medical experts (specialists) and clinical research should be conducted in these settings.
  • Nine regional hospitals scattered through the 13 regions of Burkina Faso. These facilities are referral hospitals for a given region and the staffs include specialists in gynaecology-obstetrics and in general surgery.
  • Sixty-three district hospitals of which 43 can provide comprehensive emergency obstetric care (i.e. caesarean section and transfusion) and 1429 primary health facilities (in 2012) that provide basic health care.^[8]

The Organization of the peripheral level

• District: The District Health Team provides technical assistance to and is the administrative authority over the CMA, CSPS, and CoGes. The District Team is responsible for technical guidance and the proper functioning of the Health District. The Team is composed of at least four staff members that oversee the following areas: planning, supervision, training, management, health research
• Medical centers with surgical services: The medical centers with surgical services serve as a technical assistant to the primary health facilities. Each has a large specialized staff. Technical Services Provided are Medical, Pediatric, Surgery, Laboratory, Orthodontist, Pharmacy
• Primary health facilities or Centre de Santé et Promotion Sociale (CSPS): The CSPS provides a Minimum Package of Services, comprising activities pertaining to both preventive and curative care, and also maternal and infant health.
  • Preventative Care: Health Education, prevention and Control of Locally Endemic Diseases, promotion of Food Supply and Proper Nutrition, adequate Supply of Safe Water and Basic Sanitation
  • Curative Care: General Consultations, treatment of Common Illnesses and Injuries, simple Surgery and Wound Dressing, provision of Essential Drugs, maternal and Infant Health (Prenatal Consultations, Postnatal Consultations, Births, Baby Weighings, Family Planning, Vaccinations)
• Community participation in healthcare - Comite de Gestion (CoGes): The Community participation in healthcare (based on the Bamako Initiative) is ensured through the election of Community Health Management Committees – Comite de Gestion (CoGes). The responsibilities of the CoGes include: managing the Finances of the CSPS and the Pharmacy, promoting Health Education in the Community, stocking the Pharmacy with Essential Drugs, serving as a Link between the Community and the primary health facilities staff, assuring Accessibility to Primary Healthcare.^[7]

Health care

In 2004, it was estimated that there were as few as 6 physicians per 100,000 people.^[9] In addition there were only 41 nurses, and 13 midwives per 100,000 people.^[9] However, the hospital at Ouagadougou is one of the most modern in Africa. Medical centers at Bobo-Dioulasso carry on research on insect-borne diseases. Mobile medical units attempt to control leprosy, sleeping sickness, yellow fever, and other contagious diseases.

Health status

Life Expectancy

Average life expectancy at birth in 2008 was estimated at 52 for females and 51 for males.^[10] In 2007 1.6% of people 15-49 have HIV/AIDS. The mortality rate from HIV/AIDS in 2007 was 62 per 100,000. According to the World Health Organization in 2006 an estimated 72.5% of Burkina Faso's girls and women have suffered female genital mutilation.^[11]

Endemic Diseases

One of Burkina Faso’s most serious health problems is onchocerciasis (river blindness), which touches 84% of the total land area and causes many thousands of people to desert settlements infected by the fly vector. A control program has had some success. About two-thirds of Burkina Faso residents have access to safe water. In early 1997, a meningitis epidemic in West Africa spread to Burkina Faso, resulting in 724 deaths out of 5,571 cases.

Maternal and Child Healthcare

The 2010 maternal mortality rate per 100,000 births for Burkina Faso was 560. This is compared with 332.4 in 2008 and 487.5 in 1990. The under 5 mortality rate, per 1,000 births was 169 and the neonatal mortality as a percentage of under 5's mortality was 22. In Burkina Faso the number of midwives per 1,000 live births was 5 and the lifetime risk of death for pregnant women was 1 in 28.^[12]

The incidence of low-birth weight babies was 21% in 1993–96. In 2000, only 12% of married women (ages 15 to 49) used contraception. In 1999, Burkina Faso immunized children up to one year old as follows: diphtheria, pertussis, and tetanus, 42% and measles, 53%. The fertility rate per woman was 6.6 in 2004.^[9]

See also

• Water supply and sanitation in Burkina Faso

External links

• The State of the World's Midwifery - Burkina Faso Country Profile

References

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