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      Decentralization and health resources transfer to local governments in Burkina Faso: A SWOT analysis among health care decision makers


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          Background and Aims

          In line with the decentralization policy, in 2009, the central government of Burkina Faso issued a decree to transfer health resources to local governments for fulfilling their new responsibilities in health care provision. The first stage of this health care decentralization process involved the basic health care facilities, composed of primary health care facilities, maternities, dispensaries, maternal and child health centers, and essential drugs depots.

          This study seeks to explore the strengths, weaknesses, opportunities, and threats (SWOT) associated with the health resources transfer in Burkina Faso, from the perspective of decision makers.


          We used a qualitative research approach. We conducted 17 semistructured interviews with 17 representatives of key decision‐making groups, in August to December 2017 in Burkina Faso. The participants included mayors of municipalities, health district managers, policy decision makers, and donors/partners. The data collected were subjected to a directed qualitative content analysis, and the SWOT framework was used to select themes and codes for the analysis.


          The most cited strength was the improvement of local governance, which also creates the opportunity for an enhanced partnership and decentralized cooperation. As expected, however, the limited financial capacity of local governments is an important weakness. Furthermore, misuse of financial resources threatens the resources transfer. Recommendations to improve decentralization and health resources transfer included effective enforcement of decentralization's laws and policies, strengthening local governments' capacities, adequate funding, and evaluation of the resources transfer process.


          An analysis of the preconditions for a successful resources transfer is needed to provide guidance to policy.

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          Most cited references 23

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          Reforming the health sector in developing countries: the central role of policy analysis.

           John Walt,  L Gilson (1994)
          Policy analysis is an established discipline in the industrialized world, yet its application to developing countries has been limited. The health sector in particular appears to have been neglected. This is surprising because there is a well recognized crisis in health systems, and prescriptions abound of what health policy reforms countries should introduce. However, little attention has been paid to how countries should carry out reforms, much less who is likely to favour or resist such policies. This paper argues that much health policy wrongly focuses attention on the content of reform, and neglects the actors involved in policy reform (at the international, national sub-national levels), the processes contingent on developing and implementing change and the context within which policy is developed. Focus on policy content diverts attention from understanding the processes which explain why desired policy outcomes fail to emerge. The paper is organized in 4 sections. The first sets the scene, demonstrating how the shift from consensus to conflict in health policy established the need for a greater emphasis on policy analysis. The second section explores what is meant by policy analysis. The third investigates what other disciplines have written that help to develop a framework of analysis. And the final section suggests how policy analysis can be used not only to analyze the policy process, but also to plan.
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            Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space.

            This study reviews the experience of decentralization in four developing countries: Ghana, Uganda, Zambia and the Philippines. It uses two analytical frameworks to describe and compare the types and degrees of decentralization in each country. The first framework specifies three types of decentralization: deconcentration, delegation and devolution. The second framework uses a principal agent approach and innovative maps of 'decision space' to define the range of choice for different functions that is transferred from the centre to the periphery of the system. The analysis finds a variety of different types and degrees of decentralization, with the Philippines demonstrating the widest range of choice over many functions that were devolved to local government units. The least choice was transferred through delegation to an autonomous health service in Ghana. Uganda and Zambia display variations between these extremes. There was insufficient evidence of the impact of decentralization to assess how these differences in 'decision space' influenced the performance of each health system. The authors suggest that this is a major area for future research.
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              Is Open Access

              District decision-making for health in low-income settings: a systematic literature review

              Health management information systems (HMIS) produce large amounts of data about health service provision and population health, and provide opportunities for data-based decision-making in decentralized health systems. Yet the data are little-used locally. A well-defined approach to district-level decision-making using health data would help better meet the needs of the local population. In this second of four papers on district decision-making for health in low-income settings, our aim was to explore ways in which district administrators and health managers in low- and lower-middle-income countries use health data to make decisions, to describe the decision-making tools they used and identify challenges encountered when using these tools. A systematic literature review, following PRISMA guidelines, was undertaken. Experts were consulted about key sources of information. A search strategy was developed for 14 online databases of peer reviewed and grey literature. The resources were screened independently by two reviewers using pre-defined inclusion criteria. The 14 papers included were assessed for the quality of reported evidence and a descriptive evidence synthesis of the review findings was undertaken. We found 12 examples of tools to assist district-level decision-making, all of which included two key stages—identification of priorities, and development of an action plan to address them. Of those tools with more steps, four included steps to review or monitor the action plan agreed, suggesting the use of HMIS data. In eight papers HMIS data were used for prioritization. Challenges to decision-making processes fell into three main categories: the availability and quality of health and health facility data; human dynamics and financial constraints. Our findings suggest that evidence is available about a limited range of processes that include the use of data for decision-making at district level. Standardization and pre-testing in diverse settings would increase the potential that these tools could be used more widely.

                Author and article information

                Health Sci Rep
                Health Sci Rep
                Health Science Reports
                John Wiley and Sons Inc. (Hoboken )
                14 April 2019
                June 2019
                : 2
                : 6 ( doiID: 10.1002/hsr2.v2.6 )
                [ 1 ] National Laboratory of Public Health, Ministry of Health Ouagadougou Burkina Faso
                [ 2 ] Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht The Netherlands
                [ 3 ] Top Institute Evidence‐Based Education Research (TIER) Maastricht University Maastricht The Netherlands
                Author notes
                [* ] Correspondence

                Hilaire Zon, National Laboratory of Public Health, Ministry of Health, Ouagadougou, Burkina Faso, PO Box 6753.

                Email: hilairezon@ 123456yahoo.fr

                HSR2119 HSR-2018-08-0251.R2
                © 2019 The Authors. Health Science Reports published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                Page count
                Figures: 0, Tables: 4, Pages: 13, Words: 6947
                Health & Social Care
                Research Article
                Research Article
                Custom metadata
                June 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:19.06.2019


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