Abstractobjectives Universal healthcare coverage cannot be achieved in Africa as long as the indigent, the poorest, are unable to access healthcare systems. This study was carried out in Burkina Faso to obtain street-level workers' perspectives on what criteria should be used to select indigents to be exempted from user fees.methods Two group consensus techniques were used (Delphi and Concept Mapping). The participants were nurses (CM; n = 24), midwives (CM; n = 23) from a rural district and Social Action agents (CM; n = 31) and healthcare workers (Delphi n = 23) in training at two national schools.results Altogether, 446 criteria were proposed. The nurses put forward criteria related to being ill without support and being a victim of society. The midwives focused more on the disabled poor and those who were ill and unsupported. The healthcare workers in training mentioned disabled persons and the elderly with no family support. The Social Action agents spoke about vulnerability related to illness or disability and the fact of being excluded or being a disaster victim.conclusions These criteria proposed by street-level workers add to other studies conducted in Burkina Faso and should help the State to improve indigents' access to care.

Introduction : L’objectif de ce texte est de présenter des logiques qui influencent le refus de se soigner directement au centre de santé, en dehors de l’obstacle financier fréquemment évoqué dans diverses études. Méthodes : L’étude repose sur une enquête ethnographique. Les techniques des entretiens semi-directifs, des observations directes et des entretiens libres (approfondis et centrés sur des récits de vie) ont été mobilisées au cours de cette enquête. Résultats : L’évitement du recours aux structures sanitaires a été étudié pour une dizaine de personnes. Bien qu’elles disposent de ressources économiques pour poursuivre des soins biomédicaux quand elles sont malades, certaines personnes sont animées par un désir d’indépendance ou de souveraineté qui les amène à préférer initialement la voie de l’automédication. Discussion : Les logiques favorisant ce désir d’indépendance ou de souveraineté sont analysées autour de quatre axes : le poids des connaissances profanes ; la volonté d’anticipation sur la prescription médicale (essayer de se soigner soi-même) ; l’emprise des occupations professionnelles, et le manque de confiance envers l’agent de santé. Conclusion : Ces logiques affectent le recours aux centres de santé. Dans un contexte de mortalité élevée, une prise en compte de ces logiques est nécessaire pour améliorer l’attrait de l’offre de santé dans le secteur formel.

BackgroundHealth personnel retention in remote areas is a key health systems issue wordwide. To deal with this issue, since 2002 the government of Burkina Faso has implemented a staff retention policy, the regionalized health personnel recruitment policy, aimed at front-line workers such as nurses, midwives, and birth attendants. This study aimed to describe the policy’s development, formulation, and implementation process for the regionalization of health worker recruitment in Burkina Faso.MethodsWe conducted a qualitative study. The unit of analysis is a single case study with several levels of analysis. This study was conducted in three remote areas in Burkina Faso for the implementation portion, and at the central level for the development portion. Indepth interviews were conducted with Ministry of Health officials in charge of human resources, regional directors, regional human resource managers, district chief medical officers, and health workers at primary health centres. In total, 46 indepth interviews were conducted (February 3 - March 16, 2011).ResultsDevelopmentThe idea for this policy emerged after finding a highly uneven distribution of health personnel across urban and rural areas, the availability of a large number of health officers in the labour market, and the opportunity given to the Ministry of Health by the government to recruit personnel through a specific budget allocation.FormulationThe formulation consisted of a call for job applications from the Ministry of Health, which indicates the number of available posts by region.The respondents interviewed unanimously acknowledged the lack of documents governing the status of this new personnel category.ImplementationDuring the initial years of implementation (2002-2003), this policy was limited to recruiting health workers for the regions with no possibility of transfer. The possibility of job-for-job exchange was then approved for a certain time, then cancelled. Starting in 2005, a departure condition was added. Now, regionalized health workers can leave the regions after undergoing a competitive selection process.ConclusionThe policy was characterized by the absence of written directives and by targeting only one category of personnel. Moreover, there was no associated incentive—financial or otherwise—which poses the question of long-term viability.

Looking back at what has effectively improved nutrition may inform policy makers on how to accelerate progress to end all forms of malnutrition by 2030. As under-five stunting declined substantially in Burkina Faso, we analyzed its nutrition story at the micro-level. We conducted a regression-decomposition analysis to identify demographic and health drivers associated with change in height-for-age using longitudinal, secondary, nationally-representative data. We triangulated results with findings from semi-structured community interviews (n = 91) in two “model communities” with a history of large stunting reduction. We found that improvement in immunization coverage, assets accumulation and reduction in open defecation were associated with 23%, 10% and 6.1% of the improvement in height-for-age, respectively. Associations were also found with other education, family planning, health and WASH indicators. Model communities acknowledged progress in the coverage and quality of nutrition-specific and nutrition-sensitive sectoral programs co-located at the community level, especially those delivered through the health and food security sectors, though delivery challenges remained in a context of systemic poverty and persistent food insecurity. Burkina Faso’s health sector’s success in improving coverage of nutrition and healthcare programs may have contributed to improvements in child nutrition alongside other programmatic improvements in the food security, WASH and education sectors. Burkina Faso should continue to operationalize sectoral nutrition-sensitive policies into higher-quality programs at scale, building on its success stories such as vaccination. Community leverage gaps and data gaps need to be filled urgently to pressure for and monitor high coverage, quality delivery, and nutrition impact of agriculture, education, and WASH interventions.

Background: The evidence-based practices of implementation science constitute the integration of study ndings into routine practice of public health interventions such as HIV testing services (HTS). While young people are at high risk of HIV infection, a national survey showed that adolescents and youths were less likely to go for an HIV test. This study aimed to develop and implement a systematic and multifaceted HIV self-testing (HIVST) intervention to promote the uptake of HTS among young people. Methods: The study was conducted at Africa University, Mutare where desk and literature review was conducted to gather evidence on HIVST. Multiple stakeholder consultation was carried out to understand contextual enablers and barriers that either promote or undermine adoption of the intervention. Strategies for situation analysis and evidence gathering included community engagement meetings, training of implementers and conducting a baseline survey. A consensus group adapted the Consolidated Framework for Implementation Research (CFIR) to understand the realities of context and intervention while the Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) guide was used to analyze the intervention implementation and evaluation survey. Results: The baseline enquiry indicated that the CFIR dimensions which positively in uences intervention implementation were: network, network and communications, preparation of implementation, availability of resources, plani cation, implication and formally appointed internal leadership while origin of intervention and self-e cacy had negatively in uenced implementation. Evaluating the intervention delity using the RE-AIM framework revealed that high performance with regard to reach, effectiveness, adoption and implementation but low maintenance. This study also applied the APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects, and equity) for selecting the nal components used in implementation.