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Hunt, M. R., Gogognon, P., & Ridde, V. (2014). Ethical considerations related to participation and partnership: an investigation of stakeholders’ perceptions of an action-research project on user fee removal for the poorest in Burkina Faso. BMC Medical Ethics, 15(1), 13. doi:10.1186/1472-6939-15-13. [html]
Healthcare user fees present an important barrier for accessing services for the poorest (indigents) in Burkina Faso and selective removal of fees has been incorporated in national healthcare planning. However, establishing fair, effective and sustainable mechanisms for the removal of user fees presents important challenges. A participatory action-research project was conducted in Ouargaye, Burkina Faso, to test mechanisms for identifying those who are indigents, and funding and implementing user fee removal. In this paper, we explore stakeholder perceptions of ethical considerations relating to participation and partnership arising in the action-research.
We conducted 39 in-depth interviews to examine ethical issues associated with the action-research. Respondents included 14 individuals identified as indigent through the community selection process, seven members of village selection committees, six local healthcare professionals, five members of the management committees of local health clinics, five members of the research team, and four regional or national policy-makers. Using constant comparative techniques, we carried out an inductive thematic analysis of the collected data.
The Ouargaye project involved a participatory model, included both implementation and research components, and focused on a vulnerable group within small, rural communities. Stakeholder perceptions and experiences relating to the participatory approach and reliance on multiple partnerships in the project were associated with a range of ethical considerations related to 1) seeking common ground through communication and collaboration, 2) community participation and risk of stigmatization, 3) impacts of local funding of the user fee removal, 4) efforts to promote fairness in the selection of the indigents, and 5) power relations and the development of partnerships.
This investigation of the Ouargaye project serves to illuminate the distinctive ethical terrain of a participatory public health action-research project. In carrying out such projects, careful attention and effort is needed to establish and maintain respectful relationships amongst those involved, acknowledge and address differences of power and position, and evaluate burdens and risks for individuals and groups.
Druetz, T., Ridde, V., & Haddad, S. (2014). The divergence between community case management of malaria and renewed calls for primary healthcare. Critical Public Health, (Février 2014), 1–13. doi:10.1080/09581596.2014.886761
Thirty years after Alma-Ata, there has been an upsurge of interest in community health workers (CHWs) in low- and middle-income countries. This echoes several strategic policies recently endorsed by the World Health Organization and its global call to re-establish the primary healthcare (PHC) policy. However, we are witnessing a reframing of this approach rather than its renewal. In particular, the way CHWs are conceptualized has changed considerably. Far from serving as promoters of social change and community empowerment, today we expect them to act as front-line clinicians. This medicalization of CHWs results from a systemic erosion of health promotion’s influence over the last 20 years. Community case management of malaria perfectly illustrates this shift towards a pragmatic, medically centered, use of CHWs. Taking this example, we will discuss the pitfalls of this task-shifting strategy put forward by international health actors, and make suggestions to reattribute a mission of health promotion to CHWs, as intended by the Alma-Ata’s PHC policy.
Queuille, L., & Ridde, V. (2013). User fees exemption: one step on the path toward universal access to healthcare. Pilot experience in Burkina Faso (DVD).
In 2008, the regional health department (RHD) of the Sahel region in Burkina Faso and the German NGO HELP, funded by the European Community Humanitarian Office (ECHO), decided to experiment with user fee exemptions for children under five years of age and pregnant and nursing women. The objectives of this initiative were to provide healthcare services to vulnerable populations and to improve the national health policy. The project established a scientific partnership with the University of Montreal (CRCHUM). This DVD presents the results of studies carried out between 2008 and 2013, including nearly 70 scientific articles, a book, book chapters, policy briefs, publications for the general public, and documentary films in French and /or English.
To obtain a copy of the DVD, please contact us.
Visit the project page for more information.