Axis of research and intervention
Research and community-based interventions for health equity in Burkina Faso
This program takes place in Burkina Faso, given that the country is at the end of the classification of the Human Development Index – measured under the United Nations Program for Development (2010) – and its indicators of health and equity health are alarming. This suggests that the objectives of the Millennium Development Goals will not be achieved in 2015. However, the Commission on Social Determinants of Health of the World Health Organization (WHO), the World Bank and the Countdown to 2015 Core Group have provided an overview of theoretically effective interventions to improve health equity. In addition, a recent review shows that nearly 90% of interventions that follow a participatory and community process have beneficial effects on the population. However, if the content of these interventions is described in international reports, the conditions for their implementation and their effectiveness in natural experiments are still very poorly understood. Several meta-analyses show that the potential effectiveness of interventions is subjected to multiple reduction factors often exceeding 50%. This is especially true in Africa, where there is very little research on the subject. Furthermore, according to WHO, these interventions are rarely carried out in Burkina Faso.
The aim of the program is to document the effectiveness and the procedures of promising community-based interventions to improve health equity in the context of one of the world’s poorest countries. The primary objective is to evaluate community-based interventions that are currently underway in the health district of Kaya and that have been selected by the program’s stakeholders (researchers, practitioners, policy makers, communities) in a preliminary participatory planning process. The aim would be to provide evidence of their effectiveness regarding health equity. The second objective would be to articulate, implement and evaluate the best practices of community interventions favoring equity, based on the work and results of experiments using a participatory approach. It will also be important to take action and conduct research in accordance with ethical principles and negotiated partnership approaches with stakeholders, while having due regard to the application of the knowledge produced.
Evaluative research will be undertaken both on community interventions that are underway as well as on those created within the program. This project comprises several scientific assets that favor socially and scientifically relevant knowledge including:
- Intervention heterogeneity (nutrition, malaria, financial protection, family planning, etc.);
- Intervention temporality (before 2012, during the program);
- Variety of assessment type (impact, equity, process, sustainability, scalability);
- Variety of methods of assessment (quantitative, qualitative, mixed);
- Existence of a research infrastructure with exceptional population data for the region (demographic surveillance system with a panel of 50,000 people since 2007)
This program is also an opportunity to experience and evaluate the best research practices and potential interventions that could favor equity. These new practices will allow to meet the needs of knowledge in the following areas:
- Practice of collaborative research (North/South partnerships and relationships between researchers, stakeholders, policy makers, and community partnership);
- Development and evaluation of a code of ethics;
- Knowledge application through the implementation and evaluation of a strategy for knowledge brokering;
- Identification of new community-based interventions aimed to improve health equity.
Finally, this project will advance the state of knowledge regarding three methodological developments:
- The use of geographic information systems for health equity;
- The use of a realistic approach in terms of evaluation;
- The analysis of the impact of profits using a method allowing to evaluate the effects of an intervention without resorting to external standards of success
The interdisciplinary aspect of this program is guaranteed through the mobilization of researchers from different disciplines (anthropology, social sciences, geography) and experts in complementary fields (public health, evaluation, knowledge transfer, nutrition).