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Katena NA, Shamu S, Fana GT, Dewa E, Dombojena A, Rusakaniko S. Acceptability of a community health worker- led health literacy intervention on lifestyle modification among hypertensive and diabetes patients in the City of Harare, Zimbabwe. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.10.24310219. [PMID: 39040189 PMCID: PMC11261947 DOI: 10.1101/2024.07.10.24310219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Deploying community health workers (CHWs) is a vital strategy to improve health at a community level in low- and middle-income countries. Whilst there is substantial evidence on the effectiveness of CHWs interventions, there is a need for more research on the mechanisms through which these interventions work. Understanding the acceptability of these interventions is one way of assessing the mechanisms through which they work. This article examines the acceptability of a community health worker- led health literacy intervention on lifestyle modification among hypertensive and diabetes patients based on the perspectives of the CHWs, community nurses and diabetes and hypertensive patients. A qualitative study was imbedded within a cluster randomized trial to assess the effectiveness community health worker- led health literacy intervention on lifestyle modification among hypertensive and diabetes patients in the City of Harare, Zimbabwe. Data were gathered through semi-structured interviews with 3 community health nurses and 15 diabetes and hypertension patients as well as 2 focus group discussions with CHWs. Data were analyzed manually using the thematic analysis method. There was consensus that the intervention had many benefits amongst CHWs and community nurses. However, among patients, there were mixed perceptions regarding the benefits of the intervention. The main challenges that were mentioned by CHWs include resistance to advice by patients, insufficient resources, and lack of acceptance at some of the patient's homes. All participants believed the intervention was acceptable. Our study provides vital information that should be considered in upscaling CHW led interventions.
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Affiliation(s)
- Nyaradzai Arster Katena
- Global Public Health and Family Medicine Department, University of Zimbabwe, Faculty of Medicine &Health Sciences
| | - Shepherd Shamu
- Global Public Health and Family Medicine Department, University of Zimbabwe, Faculty of Medicine &Health Sciences
| | - Golden Tafadzwa Fana
- Department of Medicine, University of Zimbabwe, Faculty of Medicine& Health Sciences
| | | | | | - Simbarashe Rusakaniko
- Global Public Health and Family Medicine Department, University of Zimbabwe, Faculty of Medicine &Health Sciences
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Musoke D, Jonga M, Ndagire GK, Musasizi B, Gidebo A, Tolossa A, Thomas M, Waiswa P, Rumsey R. Involvement of community health workers in the COVID-19 pandemic response in Uganda: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003312. [PMID: 38905244 PMCID: PMC11192370 DOI: 10.1371/journal.pgph.0003312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 05/13/2024] [Indexed: 06/23/2024]
Abstract
Community Health Workers (CHWs) are a key human resource for health particularly in low- and middle-income countries. In many parts of the world, CHWs are known to have played an instrumental role in controlling the COVID-19 pandemic. This study explored the involvement of CHWs in the COVID-19 response in Uganda. A qualitative study that involved 10 focus group discussions (FGDs) among CHWs was conducted. The study was carried out in 5 districts of Amuria, Karenga, Kamwenge, Bugiri and Pader. The FGD guide used explored the role of CHWs in the COVID-19 response in their communities including lived experiences, challenges, and coping mechanisms. The data were analyzed thematically with the support of NVivo version 12 pro (QSR International). CHWs were at the frontline of COVID-19 prevention interventions at households and in the community. CHWs raised awareness on prevention measures including wearing face masks, hand hygiene, and social distancing. They identified suspected cases such as new members entering the community, as well as individuals returning from abroad with signs and symptoms of COVID-19. CHWs mobilized the community and increased awareness on COVID-19 vaccination which played an important role in reducing misinformation. They also supported home-based management of mild COVID-19 cases through isolation of patients; provided health and nutritional guidance among patients in their homes; and referred suspected cases to health facilities for testing and management. Both monetary and non-monetary incentives were provided to support CHWs in the COVID-19 response. However, the adequacy and timing of the incentives were inadequate. Routine services of CHWs such as health promotion and treatment of childhood illnesses were disrupted during the pandemic. CHWs played an instrumental role in response to the pandemic especially on surveillance, risk communication, and observance of preventing measures. Strategies to ensure that routine services of CHWs are not disrupted during pandemics are needed.
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Affiliation(s)
- David Musoke
- Makerere University School of Public Health, Kampala, Uganda
| | - Micheal Jonga
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | | | | | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda
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Panda R, Lahoti S, Mishra N, Prabhu RR, Singh K, Rai AK, Rai K. A mixed methods evaluation of the impact of ECHO ® telementoring model for capacity building of community health workers in India. HUMAN RESOURCES FOR HEALTH 2024; 22:26. [PMID: 38654359 DOI: 10.1186/s12960-024-00907-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION India has the largest cohort of community health workers with one million Accredited Social Health Activists (ASHAs). ASHAs play vital role in providing health education and promoting accessible health care services in the community. Despite their potential to improve the health status of people, they remain largely underutilized because of their limited knowledge and skills. Considering this gap, Extension for Community Healthcare Outcomes (ECHO)® India, in collaboration with the National Health System Resource Centre (NHSRC), implemented a 15-h (over 6 months) refresher training for ASHAs using a telementoring interface. The present study intends to assess the impact of the training program for improving the knowledge and skills of ASHA workers. METHODS We conducted a pre-post quasi-experimental study using a convergent parallel mixed-method approach. The quantitative survey (n = 490) assessed learning competence, performance, and satisfaction of the ASHAs. In addition to the above, in-depth interviews with ASHAs (n = 12) and key informant interviews with other stakeholders (n = 9) examined the experience and practical applications of the training. Inferences from the quantitative and qualitative approaches were integrated during the reporting stage and presented using an adapted Moore's Expanded Outcomes Framework. RESULTS There was a statistically significant improvement in learning (p = 0.038) and competence (p = 0.01) after attending the training. Participants were satisfied with the opportunity provided by the teleECHO™ sessions to upgrade their knowledge. However, internet connectivity, duration and number of participants in the sessions were identified as areas that needed improvement for future training programs. An improvement in confidence to communicate more effectively with the community was reported. Positive changes in the attitudes of ASHAs towards patient and community members were also reported after attending the training. The peer-to-peer learning through case-based discussion approach helped ensure that the training was relevant to the needs and work of the ASHAs. CONCLUSIONS The ECHO Model ™ was found effective in improving and updating the knowledge and skills of ASHAs across different geographies in India. Efforts directed towards knowledge upgradation of ASHAs are crucial for strengthening the health system at the community level. The findings of this study can be used to guide future training programs. Trial registration The study has been registered at the Clinical Trials Registry, India (CTRI/2021/10/037189) dated 08/10/2021.
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Affiliation(s)
- Rajmohan Panda
- Public Health Foundation of India (PHFI), Gurugram, Haryana, India
| | - Supriya Lahoti
- Extension for Community Healthcare Outcomes (ECHO) India, Okhla Phase III, New Delhi, India.
| | - Nivedita Mishra
- Extension for Community Healthcare Outcomes (ECHO) India, Okhla Phase III, New Delhi, India
| | | | | | - Apoorva Karan Rai
- Extension for Community Healthcare Outcomes (ECHO) India, Okhla Phase III, New Delhi, India
| | - Kumud Rai
- Extension for Community Healthcare Outcomes (ECHO) India, Okhla Phase III, New Delhi, India
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Soepnel LM, Norris SA, Mabetha K, Motlhatlhedi M, Nkosi N, Lye S, Draper CE. A qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of the Bukhali randomised controlled trial. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002578. [PMID: 38483881 PMCID: PMC10939222 DOI: 10.1371/journal.pgph.0002578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
Community health workers (CHWs) play an important role in health systems in low- and middle-income countries, including South Africa. Bukhali is a CHW-delivered intervention as part of a randomised controlled trial, to improve the health trajectories of young women in Soweto, South Africa. This study aimed to qualitatively explore factors influencing implementation of the preconception and pregnancy phases of Bukhali, from the perspective of the CHWs (Health Helpers, HHs) delivering the intervention. As part of the Bukhali trial process evaluation, three focus group discussions were conducted with the 13 HHs employed by the trial. A thematic approach was used to analyse the data, drawing on elements of a reflexive thematic and codebook approach. The following six themes were developed, representing factors impacting implementation of the HH roles: interaction with the existing public healthcare sector; participant perceptions of health; health literacy and language barriers; participants' socioeconomic constraints; family, partner, and community views of trial components; and the HH-participant relationship. HHs reported uses of several trial-based tools to overcome implementation challenges, increasing their ability to implement their roles as planned. The relationship of trust between the HH and participants seemed to function as one important mechanism for impact. The findings supported a number of adaptations to the implementation of Bukhali, such as intensified trial-based follow-up of referrals that do not receive management at clinics, continued HH training and community engagement parallel to trial implementation, with an increased emphasis on health-related stigma and education. HH perspectives on intervention implementation highlighted adaptations across three broad strategic areas: navigating and bridging healthcare systems, adaptability to individual participant needs, and navigating stigma around disease. These findings provide recommendations for the next phases of Bukhali, for other CHW-delivered preconception and pregnancy trials, and for the strengthening of CHW roles in clinical settings with similar implementation challenges. Trial registration: Pan African Clinical Trials Registry; PACTR201903750173871, Registered March 27, 2019.
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Affiliation(s)
- Larske M. Soepnel
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Shane A. Norris
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Khuthala Mabetha
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Molebogeng Motlhatlhedi
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nokuthula Nkosi
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Lye
- Department of Physiology and Medicine, Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Catherine E. Draper
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Maphosa T, Denoeud-Ndam L, Kapanda L, Khatib S, Chilikutali L, Matiya E, Munthali B, Dambe R, Chiwandira B, Wilson B, Nyirenda R, Nyirenda L, Chikwapulo B, Musopole OM, Tiam A, Katirayi L. Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi. BMC Health Serv Res 2024; 24:244. [PMID: 38408975 PMCID: PMC10897989 DOI: 10.1186/s12913-024-10700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Despite tremendous progress in antiretroviral therapy (ART) and access to ART, many patients have advanced human immunodeficiency virus (HIV) disease (AHD). Patients on AHD, whether initiating ART or providing care after disengagement, have an increased risk of morbidity and mortality. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) launched an enhanced care package using a hub-and-spoke model to optimize AHD care in Malawi. This model improves supply availability and appropriate linkage to care. We utilized a hub-and-spoke model to share health facility challenges and recommendations on the AHD package for screening and diagnosis, prophylaxis, treatment, and adherence support. METHODS This qualitative study assessed the facility-level experiences of healthcare workers (HCWs) and lay cadres (LCs) providing AHD services to patients through an intervention package. The study population included HCWs and LCs supporting HIV care at four intervention sites. Eligible study participants were recruited by trained Research Assistants with support from the health facility nurse to identify those most involved in supporting patients with AHD. A total of 32 in-depth interviews were conducted. Thematic content analysis identified recurrent themes and patterns across participants' responses. RESULTS While HCWs and LCs stated that most medications are often available at both hub and spoke sites, they reported that there are sometimes limited supplies and equipment to run samples and tests necessary to provide AHD care. More than half of the HCWs stated that AHD training sufficiently prepared them to handle AHD patients at both the hub and spoke levels. HCWs and LCs reported weaknesses in the patient referral system within the hub-and-spoke model in providing a linkage of care to facilities, specifically improper referral documentation, incorrect labeling of samples, and inconsistent availability of transportation. While HCWs felt that AHD registers were time-consuming, they remained motivated as they thought they provided better patient services. CONCLUSIONS These findings highlight the importance of offering comprehensive AHD services. The enhanced AHD program addressed weaknesses in service delivery through decentralization and provided services through a hub-and-spoke model, improved supply availability, and strengthened linkage to care. Additionally, addressing the recommendations of service providers and patients is essential to improve the health and survival of patients with AHD.
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Affiliation(s)
- Thulani Maphosa
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
| | | | - Lester Kapanda
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Sarah Khatib
- George Washington University, Washington, DC, USA
| | | | | | | | - Rosalia Dambe
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Brown Chiwandira
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Bilaal Wilson
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | | | | | | | | | - Leila Katirayi
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
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van der Hoeven M, van Lettow M, Boonstra P, Hoekstra T, Rutebemberwa E, Tweheyo R, Kok MO. Uptake of community health care provision by community health entrepreneurs for febrile illness and diarrhoea: a cross-sectional survey in rural communities in Bunyangabu district, Uganda. BMJ Open 2024; 14:e074393. [PMID: 38316585 PMCID: PMC10860046 DOI: 10.1136/bmjopen-2023-074393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To assess the uptake of services provided by community health workers who were trained as community health entrepreneurs (CHEs) for febrile illness and diarrhoea. DESIGN A cross-sectional survey among households combined with mapping of all providers of basic medicine and primary health services in the study area. PARTICIPANTS 1265 randomly selected households in 15 rural villages with active CHEs. SETTING Bunyangabu district, Uganda. OUTCOME MEASURES We describe the occurrence and care sought for fever and diarrhoea in the last 3 months by age group in the households. Care provider options included: CHE, health centre or clinic (public or private), pharmacy, drug shop and other. Geographic Information Ssystem (GIS)-based geographical measures were used to map all care providers around the active CHEs. RESULTS Fever and diarrhoea in the last 3 months occurred most frequently in children under 5; 68% and 41.9%, respectively. For those who sought care, CHE services were used for fever among children under 5, children 5-17 and adults over 18 years of age in 34.7%, 29.9% and 25.1%, respectively. For diarrhoea among children under 5, children 5-17 and adults over 18 years of age, CHE services were used in 22.1%, 19.5% and 7.0%, respectively. For those who did not seek care from a CHE (only), drug shops were most frequently used services for both fever and diarrhoea, followed by health centres or private clinics. Many households used a combination of services, which was possible given the high density and diversity of providers found in the study area. CONCLUSIONS CHEs play a considerable role in providing care in rural areas where they are active. The high density of informal drug shops and private clinics highlights the need for clarity on the de facto roles played by different providers in both the public and private sector to improve primary healthcare.
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Affiliation(s)
- Marinka van der Hoeven
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Monique van Lettow
- Department of Implementation and Operational Research, Madiro, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Division of Epidemiology and Centre of Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Pien Boonstra
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Trynke Hoekstra
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Raymond Tweheyo
- School of Public Health, Makerere University, Kampala, Uganda
| | - Maarten Olivier Kok
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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Gebremeskel AT, Udenigwe O, Etowa J, Yaya S. Unpacking the challenges of fragmentation in community-based maternal newborn and child health and health system in rural Ethiopia: A qualitative study. PLoS One 2023; 18:e0291696. [PMID: 37733782 PMCID: PMC10513239 DOI: 10.1371/journal.pone.0291696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION In Ethiopia, country-wide community-based primary health programs have been in effect for about two decades. Despite the program's significant contribution to advancing Maternal Newborn and Child Health (MNCH), Ethiopia's maternal and child mortality is still one of the highest in the world. The aim of this manuscript is to critically examine the multifaceted fragmentation challenges of Ethiopia's Community Health Workers (CHWs) program to deliver optimum MNCH and build a resilient community health system. METHODS We conducted a qualitative case study in West Shewa Zone, rural Ethiopia. A purposive sampling technique was used to recruit participants. Data sources were two focus group discussions with sixteen CHWs, twelve key informant interviews with multilevel public health policy actors, and a policy document review related to the CHW program to triangulate the findings. Thematic analysis of the qualitative data was conducted. The World Health Organization's health systems framework and socio-ecological model guided the data collection, analysis, and interpretation. RESULTS The CHWs program has been an extended arm of Ethiopia's primary health system and has contributed to improved health outcomes. However, the program has been facing unique systemic challenges that stem from the fragmentation of health finance; medical and equipment supply; working and living infrastructures; CHWs empowerment and motivation, monitoring, supervision, and information; coordination and governance; and community and stakeholder engagement. The ongoing COVID-19 and volatile political and security issues are exacerbating these fragmentation challenges. CONCLUSION This study emphasized the gap between the macro (national) level policy and the challenge during implementation at the micro (district)level. Fragmentation is a blind spot for the community-based health system in rural Ethiopia. We argue that the fragmentation challenges of the community health program are exacerbating the fragility of the health system and fragmentation of MNCH health outcomes. This is a threat to sustain the MNCH outcome gains, the realization of national health goals, and the resilience of the primary health system in rural Ethiopia. We recommend that beyond the current business-as-usual approach, it is important to emphasize an evidence-based and systemic fragmentation monitoring and responsive approach and to better understand the complexity of the community-based health system fragmentation challenges to sustain and achieve better health outcomes. The challenges can be addressed through the adoption of transformative and innovative approaches including capitalizing on multi-stakeholder engagement and health in all policies in the framework of co-production.
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Affiliation(s)
- Akalewold T. Gebremeskel
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- School of Nursing, Faculty of Health Sciences University of Ottawa, Ottawa, Ontario, Canada
| | - Ogochukwu Udenigwe
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Josephine Etowa
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- School of Nursing, Faculty of Health Sciences University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Banke-Thomas A, Offosse MJ, Yameogo P, Manli AR, Goumbri A, Avoka C, Boxshall M, Eboreime E. Stakeholder perceptions and experiences from the implementation of the Gratuité user fee exemption policy in Burkina Faso: a qualitative study. Health Res Policy Syst 2023; 21:46. [PMID: 37280694 DOI: 10.1186/s12961-023-01008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND In 2016, the Gratuité policy was initiated by the Government of Burkina Faso to remove user fees for maternal, newborn, and child Health (MNCH) services. Since its inception, there has not been any systematic capture of experiences of stakeholders as it relates to the policy. Our objective was to understand the perceptions and experiences of stakeholders regarding the implementation of the Gratuité policy. METHODS We used key informant interviews (KIIs) and focus group discussions (FGDs) to engage national and sub-national stakeholders in the Centre and Hauts-Bassin regions. Participants included policymakers, civil servants, researchers, non-governmental organizations in charge of monitoring the policy, skilled health personnel, health facility managers, and women who used MNCH services before and after the policy implementation. Topic guides aided sessions, which were audio recorded and transcribed verbatim. A thematic analysis was used for data synthesis. RESULTS There were five key themes emerging. First, majority of stakeholders have a positive perception of the Gratuité policy. Its implementation approach is deemed to have strengths including government leadership, multi-stakeholder involvement, robust internal capacity, and external monitoring. However, collateral shortage of financial and human resources, misuse of services, delays in reimbursement, political instability and health system shocks were highlighted as concerns that compromise the government's objective of achieving universal health coverage (UHC). However, many beneficiaries were satisfied at the point of use of MNHC services, though Gratuité did not always mean free to the service users. Broadly, there was consensus that the Gratuité policy has contributed to improvements in health-seeking behavior, access, and utilization of services, especially for children. However, the reported higher utilization is leading to some perceived increased workload and altered health worker attitude. CONCLUSIONS There is a general perception that the Gratuité policy is achieving what it set out to do, which is to increase access to care by removing financial barriers. While stakeholders recognized the intention and value of the Gratuité policy, and many beneficiaries were satisfied at the point of use, inefficiencies in its implementation undermines progress. As the country moves towards the goal of realizing UHC, reliable investment in the Gratuité policy is needed.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- ThinkWell Institute, 11 B.P. 1255 CMS 11 Ouagadougou, Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
- School of Human Sciences, University of Greenwich, London, United Kingdom.
| | - Marie-Jeanne Offosse
- ThinkWell Institute, 11 B.P. 1255 CMS 11 Ouagadougou, Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | | | - Astrid Raissa Manli
- ThinkWell Institute, 11 B.P. 1255 CMS 11 Ouagadougou, Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Aude Goumbri
- ThinkWell Institute, 11 B.P. 1255 CMS 11 Ouagadougou, Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Cephas Avoka
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matt Boxshall
- ThinkWell Institute, 11 B.P. 1255 CMS 11 Ouagadougou, Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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