BackgroundDelay in decision-making to use skilled care during pregnancy and childbirth is an important factor for maternal death in many developing countries. This paper examines how decisions for maternal care are made in two rural communities in Burkina Faso.MethodsFocus group discussions (FGDs) and individual interviews (IDIs)) were used to collect information with 30 women in Ouargaye and Diapaga medical districts. All interviews were tape recorded and analyzed using QSR Nvivo 2.0.ResultsDecision-making for use of obstetric care in the family follows the logic of the family’s management. Husbands, brothers-in-law and parents-in-law make the decision about whether to use a health facility for antenatal care or for delivery. In general, decision-makers are those who can pay, including the woman herself. Payment of care is the responsibility of men, according to women interviewed, because of their social role and status.ConclusionsTo increase use of health facilities in Ouargaye and Diapaga, the empowerment of women could be helpful as well as exemption of fees or cost sharing for care.

Background A knowledge brokering (KB) intervention was implemented in Burkina Faso. By creating partnerships with health system actors in one district, the broker was expected to assess their knowledge needs, survey the literature to provide the most recent research evidence, produce various knowledge translation tools, and support them in using research to improve their actions. The purpose of this study was to analyze the key factors that influenced the KB project and to make recommendations for future initiatives. Methods The qualitative design involved a single case study in which the KB intervention implementation was evaluated retrospectively. Data came from interviews with the intervention team (n = 4) and with various actors involved in the intervention (n = 16). Data from formative evaluations conducted during the KB implementation and observation data from a two-month field mission were also used. Two conceptual frameworks were combined to guide the analysis: the Consolidated Framework for Implementation Research (Damschroder et al., 2009) and the Ecological Framework (Durlak & DuPre, 2008). Results Various KB activities were conducted during the first two years of implementation at the local level. The project came to an early end following vain efforts to relocate the intervention at the central level in order to further influence the policy process. Certain shortcomings in the implementation team negatively influenced the implementation: inadequate leadership, no shared vision regarding the reorientation of the intervention, challenges related to the KB role, and lack of frank communications internally. Other impediments to the intervention’s deployment included local actors' lack of decision-making authority, the unavailability of resources and of organizational incentives for involvement in the KB intervention, and contextual challenges in accessing the central level. However, the KB strategy presented several strengths: collaborative development, support provided to local partners by the broker, and training opportunities and support provided to the broker. Conclusions More attention must be paid to intervention planning, partners’ engagement, human, financial and technical resources availability, continuous development of skills and of communications within the KB team, and periodic assessment of potential obstacles related to the complexity of the system within which the intervention has been implemented. Using implementation science frameworks when developing KB strategies in the West African context should be promoted.

Objectif : Les agents de santé communautaires (ASC) ont été promus au Bénin pour améliorer les soins de santé maternelle et infantile. Pour améliorer leur performance, des équipes d’amélioration de la qualité (EAQ) ont été mises en place avec pour rôle de renforcer les capacités des ASC. L’objectif de ce travail est de présenter une évaluation de la contribution des EAQ à la performance des ASC et à la couverture des indicateurs de santé maternelle et infantile dans la commune de Savè. Méthodologie : Le design de l’étude est une analyse avant et après. Les données ont été extraites des rapports d’activités des ASC et de ceux du système d’information sanitaire de 2011 à 2014 dans 22 centres de santé de Savè. Des entretiens individuels approfondis ont aussi été réalisés avec des informateurs clés. La performance des ASC et les indicateurs de santé maternelle et infantile ont été déterminés selon la politique nationale de santé communautaire. Résultats : Les EAQ ont amélioré la performance des ASC et les indicateurs de santé maternelle et infantile à Savè. Les sessions éducatives, l’assistance qualifiée à l’accouchement, les pourcentages de nouveau-nés vus au moins deux fois dans la semaine, d’enfants traités selon les standards nationaux, d’enfants complètement vaccinés, de femmes utilisant des méthodes de planning familial ont été améliorés. Conclusion : La mise en place des EAQ a amélioré la performance des ASC et l’utilisation des services de santé maternelle et infantile à Savè. Cette stratégie pourrait être utile pour la surveillance à base communautaire

Due to their inadequacy and poor quality, the interventions failed to significantly reduce the three delays. Priority needs to be given to new interventions, especially community-based interventions, and reinforcement of the quality of care by health training.

Background Between 2008 and 2013, the West African Health Organisation (WAHO) conducted a series of post-graduate capacity building in research methodology in West Africa. This work evaluated the contribution of these trainings in terms of knowledge acquisition and influence of research and policy practice. Cooke’s conceptual framework for assessing research capacity building was used with three data sources to construct the indicators (training reports, research project implementation reports and WAHO research programme evaluation report). Results There was an improvement in the knowledge of the 84 participants between the pre- and post-test. At the end of the training, the learners developed 19 protocols, 14 of which were finalised, financed and implemented, reflecting the learners’ confidence to engage in research at the end of the training. The implementation of the protocols was conducted with the partnership and collaboration between the agents of the control programmes and the research centres. Some research results have been disseminated and a small portion used to strengthen the programmes. Conclusion This evaluation showed that the training was linked to practice with little publication and use of the results to improve the programmes. This regional capacity building programme should be maintained and strengthened by adding modules in data analysis, scientific communication and knowledge transfer.