Burkina Faso's Health Care System

I realized I have never really explained much about the health system in Burkina so I figure its about time. Not sure how interested everyone is but am guessing that at least my fellow public health students would like to know some background info. I also figure I can start including some of the acronyms we all use here into my blogs now. Don't hold me responsible if any of this is incorrect since all of my info is from meetings and discussions held in French and there always are possibilities for misunderstandings!

Back in the day, Burkina's health care system was completely state-funded following a top-down approach and not very efficient or affective. In 1987, following the Bamako Initiative, the Ministry of Health went through a huge restructuring to decentralize the health care system and bring a great deal of power to the community level. Instead of all of the money coming from the national government, communities are now expected to help support their local health centers through cost sharing with the goal of greater sustainability. Along with normal health services, there also is a focus on community outreach and preventive health care.

There are national, regional, and district hospitals throughout the country, but the first place that Burkinabe go for health services is their local CSPS (Centre de Sante et Promotion Sociale). There are currently about 1200 CSPSs around Burkina Faso. The idea is that they serve around 10,000 people each though this is not always the case. The CSPS is a general health clinic, maternity, and pharmacy and they all should provide preventive and curative services including prenatal consultations, nutritional consultations (baby-weighings), vaccinations, and family planning.

The staff at a CSPS includes several nurses appointed and paid by the state. There also are community-selected and paid employees that include the pharmacists, guards, janitors, ambulance drivers, etc. The head nurse usually has three years of education past high school and passed exams to reach a specific certification. He (or very rarely she) is called the Major. Other nurses often complete a two year program and certification. Some are specifically trained as midwives to deliver babies and give pre-natal consultations. Others are trained for immunization programs. In reality, most nurses provide a wide variety of services and have to fill in for each other often.

There often are community health agents and village midwifes selected by the community to help the CSPS with programs such as vaccination campaigns, educating the population on a variety of health topics, and encouraging villagers to utilize CSPS services.

The CSPS is overseen by a community-elected board called the COGES (Comite de Gestion--Rural Health Center Management Committee). Elections should be held every two years and nobody is allowed to serve more than four years. Committees are usually made up of six community members and the major. The COGES is the link between the community and the CSPS. The COGES makes money by charging consultation fees, evacuations (ambulance rides to the hospital), and medication sales. They then use this income to pay their staff other than the nurses, provide general upkeep of the CSPS, and purchase more medications. The idea is that this will keep a continuous stock of supplies at the CSPS instead of waiting for the national government to send new medications and constantly running out. There are still frequent ruptures of stock at many CSPSs but it probably is still more effective to have the community overseeing this than waiting for the state to handle any problems.

If anyone has any specific questions, I can try to find some answers though everything is still a bit blurry to me even though I've gone through lots of training and three months observing the operations at my CSPS!