L'efficacité Des Politiques Publiques De Santé Dans Un Pays De l'Afrique De L'Ouest: Le Cas Du Burkina Faso

Abstract

Cet article analyse l'efficacité des deux principales composantes de la politique de santé mise en oeuvre au Burkina Faso, «les soins de santé primaires» et l'«Initiative de Bamako», à partir des résultats de deux études régionales et d'une revue documentaire nationale. L'efficacité de ces deux politiques est mise en doute: aucune n'a pu, malgré un important investissement des pouvoirs publics, améliorer les conditions d'accès aux soins pour tous. Pour mieux comprendre leur relative inefficacité, il est urgent d'étudier en profondeur le rôle interactif joué par les principaux acteurs dans la mise en oeuvre des politiques de santé au Burkina Faso.

Implementation Fidelity of the National Malaria Control Program in Burkina Faso

“…Supervision was limited to sporadic visits by facilitators and did not include any meetings among CHWs to share their experiences, nor any monitoring by committees of community members, even though these two strategies were found to be useful elsewhere [32]. Furthermore, most of the CHWs recruited for the HMM had already occupied this position in other, earlier programs (path dependency) that were not found to be effective [33]. Many of them had been CHWs for more than 20 years, without really having the means to respond to the populations’ needs.…”

“…The program is not sufficiently integrated into the health system, as was the case elsewhere where NGOs were used [36], [40]. The Ministry of Health’s nurses rarely supervise CHWs, which is not new in Burkina Faso [33], whereas such ongoing supervision is essential to ensure both the quality of the CHWs’ work, as was shown in Zambia [41], and integration into the health system [37]. Stock shortages of ACTs occur regularly and persistently.…”

“…A national evaluation deplored the systematic involvement of CHWs in the HMM program nationally without having first evaluated it in the pilot project in three districts [42]. This situation is particularly surprising given that CHWs have existed in Burkina Faso since the 1980s and that, despite their failings [33], the Ministry of Health decided in 2011 to create a new Department of Community Health largely consecrated to CHWs. However, the status of CHWs in the health system has not yet been resolved, creating challenges for their integration into the health system and the fight against malaria, as has been clearly shown in this study in Burkina Faso and was also seen in Senegal, for example [43].…”

Multidimensional Analysis for Agricultural Producers’ Health Care in Cameroon

“…Experiences in connection with the implementation of public policies in West Africa (Ridde, 2005), particularly in Burkina Faso (Nitièma and al., 2003;Haddad and al., 2004;Ridde and al., 2005), produce the same results. Thus, understanding the concept of equity, according to the viewpoint of stakeholders, is essential (Ridde, 2006).…”

Kingdon à Bamako : conceptualiser l’implantation d’une politique publique de santé en Afrique

“…Des analystes sont même allés jusqu'à affirmer que cela explique, entre autres choses, l'absence de la prise en compte de l'accès aux soins pour les indigents 43 prise en charge des plus démunis » 44 . Près de dix ans après, nous n'avons pas constaté de nombreuses avancées en la matière, et ce, dans le cas des deux principales politiques de santé burkinabé 45 . La mise en place du paiement direct des soins a réduit l'utilisation des services de santé, et aucune mesure de prise en charge des indigents n'a été organisée, ni même socialement souhaitée.…”