Abstract
BackgroundBurkina Faso has made a number of health system policy decisions to improve performance on health indicators and strengthen responsiveness to health-related challenges. These included the creation of a General Directorate of Health Information and Statistics (DGISS) and a technical unit to coordinate performance-based financing (CT-FBR). We analysed the policymaking processes associated with the establishment of these units, and documented the factors that influenced this process.MethodWe used a multiple-case study design based on Kingdon’s agenda-setting model to investigate the DGISS and CT-FBR policymaking processes. Data were collected from interviews with key informants (n = 28), published literature, policy documents (including two strategic and 230 action plans), and 55 legal/regulatory texts. Interviews were analysed using thematic qualitative analysis. Data from the documentary analysis were triangulated with the qualitative interview data.ResultsKey factors influencing the policymaking processes associated with the two units involved the ‘problem’ (problem identification), ‘policy’ (formation of policy proposals), and ‘politics’ (political climate/change) streams, which came together in a way that resulted in proposals being placed on the decision agenda. A number of problems with Burkina Faso’s health information and financing systems were identified. Policy proposals for the DGISS and CT-FBR units were developed in response to these problems, emerging from several sources including development partners. Changes in political and public service administrations (specifically the 2008 appointment of a new Minister of Health and the establishment of a new budget allocation system), with corresponding changes in the actors and interests involved, appeared key in elevating the proposals to the decision agenda.ConclusionsEfforts to improve performance on health indicators and strengthen responsiveness to health-related challenges need focus on the need for a compelling problem, a viable policy, and conducive politics in order to make it to the decision agenda.
Highlights
Burkina Faso has made a number of health system policy decisions to improve performance on health indicators and strengthen responsiveness to health-related challenges
Key factors influencing the policymaking processes associated with the two units involved the ‘problem’, ‘policy’, and ‘politics’ streams, which came together in a way that resulted in proposals being placed on the decision agenda
Policy proposals for the General Directorate of Health Information and Statistics (DGISS) and CT-FBR units were developed in response to these problems, emerging from several sources including development partners
Summary
Burkina Faso has made a number of health system policy decisions to improve performance on health indicators and strengthen responsiveness to health-related challenges. This resulted in greater emphasis being placed on system performance, and led to important policy changes These changes included establishing performance contracts with health districts under the Health Development Support Program, launching a new process for contracting with non-governmental organisations (NGOs) and other private sector actors, and extending subsidies for births and emergency obstetric and neonatal care [9]. Despite these actions, many concerns were raised; for example, the operationalisation of the National Health Information System remained inadequate [10]. This system, characterised by poor sub-system coordination, low quality of available data, and insufficient human and material resources, made timely access to information difficult, and affected the ability to monitor progress towards the MDGs
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