Feb 25, 2014 | equity of access to healthcare
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
Résumé
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.
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Feb 4, 2014 | equity of access to healthcare, health policy analysis
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.
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Jan 27, 2014 | equity of access to healthcare, health policy analysis
Ridde, V., Agier, I., Jahn, A., Mueller, O., Tiendrebéogo, J., Yé, M., & De Allegri, M. (2014). The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso. The European journal of health economics : HEPAC : health economics in prevention and care, 5. doi:10.1007/s10198-013-0553-5.
Résumé
Background
User fee removal policies have been extensively evaluated in relation to their impact on access to care, but rarely, and mostly poorly, in relation to their impact on household out-of-pocket (OOP) spending. This paucity of evidence is surprising given that reduction in household economic burden is an explicit aim for such policies. Our study assessed the equity impact on household OOP spending for facility-based delivery of the user fee reduction policy implemented in Burkina Faso since 2007 (i.e. subsidised price set at 900 Communauté Financière Africaine francs (CFA) for all, but free for the poorest). Taking into account the challenges linked to implementing exemption policies, we aimed to test the hypothesis that the user fee reduction policy had favoured the least poor more than the poor.
Methods
We used data from six consecutive rounds (2006-2011) of a household survey conducted in the Nouna Health District. Primary outcomes are the proportion of households being fully exempted (the poorest 20 % according to the policy) and the actual level of household OOP spending on facility-based delivery. The estimation of the effects relied on a Heckman selection model. This allowed us to estimate changes in OOP spending across socio-economic strata given changes in service utilisation produced by the policy.
Findings
A total of 2,316 women reported a delivery between 2006 and 2011. Average household OOP spending decreased from 3,827 CFA in 2006 to 1,523 in 2011, without significant differences across socio-economic strata, neither in terms of households being fully exempted from payment nor in terms of the amount paid. Payment remained regressive and substantially higher than the stipulated 900 CFA.
Conclusions
The Burkinabè policy led to a significant and sustained reduction in household OOP health spending across all socio-economic groups, but failed to properly target the poorest by ensuring a progressive payment system.
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Dec 16, 2013 | research methodology
Dagenais, C., Malo, M., Robert, E., Ouimet, M., Berthelette, D., & Ridde, V. (2013). Knowledge transfer on complex social interventions in public health: a scoping study. (W. Glanzel, Ed.) PLoS ONE, 8(12), e80233. doi:10.1371/journal.pone.0080233. [texte intégral]
Résumé
Objectives
Scientific knowledge can help develop interventions that improve public health. The objectives of this review are (1) to describe the status of research on knowledge transfer strategies in the field of complex social interventions in public health and (2) to identify priorities for future research in this field.
Method
A scoping study is an exploratory study. After searching databases of bibliographic references and specialized periodicals, we summarized the relevant studies using a predetermined assessment framework. In-depth analysis focused on the following items: types of knowledge transfer strategies, fields of public health, types of publics, types of utilization, and types of research specifications.
Results
From the 1,374 references identified, we selected 26 studies. The strategies targeted mostly administrators of organizations and practitioners. The articles generally dealt with instrumental utilization and most often used qualitative methods. In general, the bias risk for the studies is high.
Conclusion
Researchers need to consider the methodological challenges in this field of research in order to improve assessment of more complex knowledge transfer strategies (when they exist), not just diffusion/dissemination strategies and conceptual and persuasive utilization.
Oct 28, 2013 | research methodology
Bertone, M. P., Meessen, B., Clarysse, G., Hercot, D., Kelley, A., Kafando, Y., Lange, I., Pfaffmann, J., Ridde, V., Sieleunou, I., Witter, S. (2013). Assessing communities of practice in health policy: a conceptual framework as a first step towards empirical research. Health Research Policy and Systems, 11(1), 39. doi:10.1186/1478-4505-11-39 (open access)
Abstract
Communities of Practice (CoPs) are groups of people that interact regularly to deepen their knowledge on a specific topic. Thanks to information and communication technologies, CoPs can involve experts distributed across countries and adopt a ‘transnational’ membership. This has allowed the strategy to be applied to domains of knowledge such as health policy with a global perspective. CoPs represent a potentially valuable tool for producing and sharing explicit knowledge, as well as tacit knowledge and implementation practices. They may also be effective in creating links among the different ‘knowledge holders’ contributing to health policy (e.g., researchers, policymakers, technical assistants, practitioners, etc.).
CoPs in global health are growing in number and activities. As a result, there is an increasing need to document their progress and evaluate their effectiveness. This paper represents a first step towards such empirical research as it aims to provide a conceptual framework for the analysis and assessment of transnational CoPs in health policy.
The framework is developed based on the findings of a literature review as well as on our experience, and reflects the specific features and challenges of transnational CoPs in health policy. It organizes the key elements of CoPs into a logical flow that links available resources and the capacity to mobilize them, with knowledge management activities and the expansion of knowledge, with changes in policy and practice and, ultimately, with an improvement in health outcomes. Additionally, the paper addresses the challenges in the operationalization and empirical application of the framework.
Oct 9, 2013 | equity of access to healthcare
Ly, A., Ridde, V., Kouanda, S., & Queuille, L. (2013). [Heath staff workload in a context of user fees exemption policy for health care in Burkina Faso and Niger]. Bulletin de la Societe de pathologie exotique (1990), 1–8. doi:10.1007/s13149-013-0307-8. Article in French [pdf]
Abstract
User fees exemption policy supported by NGOs in Burkina Faso and Niger resulted in a higher utilization of health services in primary health care facilities. We conducted a survey in 2 health districts in Burkina Faso and Niger in 2011. The study objective was to assess whether the higher utilization associated with the user fees exemption policy, may result in an overload for health staff at the front line in health facilities. The WHO’s recommended WISN method was used to compute a ratio of actual/required staff using a comparative study with 4 control facilities and 4 intervention sites where the user fees exemption policy was provided by local NGOs in both countries. Overall, 8 primary health facilities both in Burkina Faso and Niger were involved. In Burkina Faso, the ratio was ≥1 in all facilities both control and intervention, i.e. a sufficient staff in facilities. In Niger, 3 out of the 4 intervention facilities in Keita district were found to have a ratio ≤1, i.e. understaffed. In the 4 control facilities, the staff was sufficient with a ratio ≥1. In Burkina Faso, the actual number of staff in facilities appeared enough to face the higher utilization of health services that may follow the user fees exemption policy supported by local NGOs unlike Niger where we found that the actual number of staff was insufficient to face a possible higher utilization resulting from the same policy in intervention facilities.
Sep 19, 2013 | equity of access to healthcare, humanitarian aid
Belaid, L., Baudry, M., Queuille, L., & Ridde, V. (2013). Pharmacy system performance and integration: two essential conditions for the success of free healthcare measures in Côte d’Ivoire.
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Sep 3, 2013 | equity of access to healthcare
Samb, O. M., Belaid, L., & Ridde, V. (2013). Burkina Faso : la gratuité des soins aux dépens de la relation entre les femmes et les soignants ? Revue Humanitaire, 35, 34–43. [html]
Abstract
Les trois auteurs de cet article ont mené deux études en 2010 et 2011 dans deux régions du Burkina Faso durant six mois passés sur le terrain. S’ils constatent que la gratuité des soins permet indéniablement un meilleur accès des femmes au système de santé, ils remarquent qu’elle ne met pas fin pour autant aux discriminations dont ces dernières sont victimes. Ce faisant, ils font leur cette affirmation d’Amartya Sen : « L’indépendance économique tout comme l’émancipation sociale des femmes créent une dynamique qui remet en cause les principes gouvernant les divisions, au sein de la famille et dans l’ensemble de la société et influence tout ce qui est implicitement reconnu comme étant leurs “droits”. »
Aug 28, 2013 | equity of access to healthcare
Robert, E., & Ridde, V. (2013). Global health actors no longer in favor of user fees: a documentary study. Globalization and health, 9(1), 29. [html]
Résumé
Contexte
Depuis l′avènement des paiements directs des soins dans les années 1980 dans les pays à faible et moyen revenu, le discours des acteurs de la santé mondiale a évolué en défaveur de ce mode de financement de la santé. L’objectif de l’étude est de déterminer et d’analyser la position des acteurs de la santé mondiale dans le débat sur les paiements directs.
Méthodes
Nous avons mené une recherche documentaire à partir de l’analyse des documents publiés et officiellement attribués aux acteurs de la santé mondiale entre 2005 et 2011. Nous avons catégorisé les acteurs en quatre groupes : les organisations intergouvernementales, les organisations internationales non gouvernementales, les agences gouvernementales de coopération, et les réseaux et groupes de travail transnationaux. Nous avons ensuite classé chaque acteur selon sa position par rapport à l’abolition des paiements directs. Nous avons enfin mené une analyse thématique des discours pour comprendre les arguments utilisés par chaque acteur pour défendre sa position.
Résultats
Nous avons répertorié 56 acteurs de la santé mondiale pour lesquels nous avons retenu 140 documents. Parmi eux, 55% sont en faveur de l’abolition des paiements directs des soins ou de la gratuité des soins au point de service. Si aucun acteur ne se prononce plus en faveur des paiements directs, 30% ne prennent pas position. Seule la Banque Mondiale s’exprime à la fois en faveur des paiements directs et en faveur de la gratuité des soins au point de service. Les acteurs circonscrivent généralement leur position positive à certaines populations (femmes enceintes, enfants de moins de 5 ans, etc.) ou à certains soins (soins primaires, de base, essentiels). Trois types d’arguments sont utilisés par les acteurs pour défendre leur position : économique, moral/éthique et pragmatique.
Conclusion
Le principe de l’utilisateur-payeur semble avoir fait long feu. Les données scientifiques et certains réseaux d’acteurs ont sans doute contribué à ce changement de discours. Pour autant, les acteurs de la santé mondiale qui ont maintenant trouvé un consensus ne doivent plus se contenter de prendre position. Ils doivent transformer leurs paroles en actes et soutenir tant techniquement que financièrement les pays qui ont choisi de mettre en place des mesures d’exemption, parfois sous leur influence.
Aug 28, 2013 | equity of access to healthcare
Ridde, V., Druetz, T., Poppy, S., Kouanda, S., & Haddad, S. (2013). Implementation Fidelity of the National Malaria Control Program in Burkina Faso. PLoS ONE, 8(7), e69865. [html]
Abstract
Background
Every 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.
Methods
We 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.
Results
The 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.
Conclusions
The 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.
