Contextual factors as a key to understanding the heterogeneity of effects of a maternal health policy in Burkina Faso?
Date
2014
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Publisher
Oxford University Press
Abstract
Burkina Faso implemented a national subsidy for emergency obstetric and
neonatal care (EmONC) covering 80% of the cost of normal childbirth in public
health facilities. The objective was to increase coverage of facility-based
deliveries. After implementation of the EmONC policy, coverage increased
across the country, but disparities were observed between districts and between
primary healthcare centres (PHC). To understand the variation in coverage, we
assessed the contextual factors and the implementation of EmONC in six PHCs
in a district. We conducted a contrasted multiple case study. We interviewed
women (n¼71), traditional birth attendants (n¼7), clinic management
committees (n¼11), and health workers and district health managers
(n¼26). Focus groups (n¼62) were conducted within communities.
Observations were carried out in the six PHCs. Implementation was nearly
homogeneous in the six PHCs but the contexts and human factors appeared to
explain the variations observed on the coverage of facility-based deliveries. In
the PHCs of Nogo and Tara, the immediate increase in coverage was attributed
to health workers’ leadership in creatively promoting facility-based deliveries
and strengthening relationships of trust with communities, users’ positive
perceptions of quality of care and the arrival of female professional staff. The
change of healthcare team at Iata’s PHC and a penalty fee imposed for home
births in Belem may have caused the delayed effects there. Finally, the
unchanged coverage in the PHCs of Fati and Mata was likely due to lack of
promotion of facility-based deliveries, users’ negative perceptions of quality of
care, and conflicts between health workers and users. Before implementation,
decision-makers should perform pilot studies to adapt policies according to
contexts and human factors.
Description
Co-published with The London School of Hygiene and Tropical Medicine
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Journal Article (peer-reviewed)
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Keywords
MATERNAL HEALTH POLICY, CONTEXTUAL FACTORS, HETEROGENEITY OF EFFECTS, QUALITATIVE STUDY, HEALTH WORKER LEADERSHIP, BURKINA FASO, MATERNAL AND CHILD HEALTH, PUBLIC HEALTH, PRIMARY HEALTH CARE, MATERNAL MORTALITY
Citation
Belaid, L., & Ridde, V. (2014). Contextual factors as a key to understanding the heterogeneity of effects of a maternal health policy in Burkina Faso?. Health Policy and Planning, 1-13. doi:10.1093/heapol/czu012