Implementation Fidelity of the National Malaria Control Program in Burkina Faso

Abstract

BackgroundEvery year 40,000 people die of malaria in Burkina Faso. In 2010, the Burkinabè authorities implemented a national malaria control program that provides for the distribution of mosquito nets and the home-based treatment of children with fever by community health workers. The objective of this study was to measure the implementation fidelity of this program.MethodsWe conducted a case study in two comparable districts (Kaya and Zorgho). Data were collected one year after the program’s implementation through field observations (10 weeks), documentary analysis, and individual interviews with stakeholders (n = 48) working at different levels of the program. The analysis framework looked at the fidelity of (i) the intervention’s content, (ii) its coverage, and (iii) its schedule.ResultsThe program’s implementation was relatively faithful to what was originally planned and was comparable in the two districts. It encountered certain obstacles in terms of the provision of supplies. Coverage fidelity was better in Kaya than in Zorgho, where many community health workers (CHW) experienced problems with the restocking of artemisinin-based combination therapy and with remuneration for periods of training. In both districts, the community was rarely involved in the process of selecting CHWs. The components affected by scheduling all experienced successive implementation delays that pushed nets distribution and the initial provision of artemisinin-based combination therapies to the CHWs past the 2010 malaria season.ConclusionsThe activities intended by the program were mostly implemented with good fidelity. However, the implementation was plagued by delays that probably postponed the expected beneficial effects.

Do community health workers perceive mechanisms associated with the success of community case management of malaria? A qualitative study from Burkina Faso

“…Prior to this study, a multiple case study was conducted by the research team to assess MEILUP implementation fidelity (Ridde et al, 2013). The fidelity was found good and similar between sites, although we observed some process differences: the involvement of NGO supervisors was larger in Zorgho; CHWs' remuneration was less irregular in Kaya; and the distribution of material was not exactly the same between the two districts.…”

“…Several factors explain the absence of this mechanism in our study. First, none of the MEILUP components focus on CHWs' accountability to the community (Ridde et al, 2013). Second, most of the CHWs were automatically designated because of their past experience as CHWs; they were not elected from among several volunteers.…”

“…NGO supervisors co-led awareness sessions with CHWs and bring them monthly compensation of 5000 Francs CFA. Further details on the program and its implementation fidelity are available elsewhere (Ridde et al, 2013).…”

The Need for More Research and Public Health Interventions on Dengue Fever in Burkina Faso

“…In Burkina Faso, dengue represents an added burden in an epidemiological landscape dominated by malaria and in which national antimalarial programs are experiencing a number of problems in implementation (such as stock shortages of ACT and malaria RDTs) [6]. Despite this, neither the 2010 General Health Forum nor the March 2013 review of the health sector mentioned the problem of dengue fever.…”

Determinants of bed net policy implementation: A case study of Southern Benin

“…Communities thus had limited opportunities to air their views in the planning process. In rural districts in Burkina Faso, communities were rarely involved in decision‐making processes in malaria programs . In Zambia, decision‐makers only perceived government bodies, donors, and NGOs to be legitimate stakeholders to involve during delivery of malaria services while patients perceived government bodies, patients, indigenous healers, chiefs, and politicians to be legitimate stakeholders during both planning and delivery of malaria services …”