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Contextual factors as a key to understanding the heterogeneity of effects of a maternal health policy in Burkina Faso?

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dc.contributor.author Belaid, Loubna
dc.contributor.author Ridde, Valéry
dc.date.accessioned 2015-01-20T20:24:44Z
dc.date.available 2015-01-20T20:24:44Z
dc.date.copyright 2014
dc.date.issued 2014
dc.identifier.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 en
dc.identifier.uri http://hdl.handle.net/10625/53566
dc.description Co-published with The London School of Hygiene and Tropical Medicine en
dc.description.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. en
dc.format Text en
dc.format.extent 1 digital file (p. 1-13) en
dc.format.mimetype application/pdf
dc.language.iso en
dc.publisher Oxford University Press en
dc.subject MATERNAL HEALTH POLICY en
dc.subject CONTEXTUAL FACTORS en
dc.subject HETEROGENEITY OF EFFECTS en
dc.subject QUALITATIVE STUDY en
dc.subject HEALTH WORKER LEADERSHIP en
dc.subject BURKINA FASO en
dc.subject MATERNAL AND CHILD HEALTH en
dc.subject PUBLIC HEALTH en
dc.subject PRIMARY HEALTH CARE en
dc.subject MATERNAL MORTALITY en
dc.title Contextual factors as a key to understanding the heterogeneity of effects of a maternal health policy in Burkina Faso? en
dc.type Journal Article (peer-reviewed) en
idrc.project.number 105309
idrc.project.componentnumber 105309001
idrc.project.title Abolition of Direct Payment for Health Services in West Africa en
idrc.copyright.holder The Author
idrc.dspace.access IDRC Only en
idrc.rims.adhocgroup IDRC SUPPORTED en
idrc.recordsserver.bcsnumber IC01-4313-45
idrc.noaccess Due to copyright restrictions the full text of this research output is not available in the IDRC Digital Library or by request from the IDRC Library. / Compte tenu des restrictions relatives au droit d'auteur, le texte intégral de cet extrant de recherche n'est pas accessible dans la Bibliothèque numérique du CRDI, et il n'est pas possible d'en faire la demande à la Bibliothéque du CRDI. en


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