Francophone West Africa Research Articles

How does community health feature in Global Financing Facility planning documents to support reproductive, maternal, newborn, child and adolescent health and nutrition (RMNAH-N)? insights from six francophone West African countries

ABSTRACT Background Community health is key for improving Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH-N). However, how community health supports integrated RMNCAH-N service delivery in francophone West Africa is under-researched. Objective We examined how six francophone West African countries (Burkina Faso, Côte d’Ivoire, Guinea, Mali, Niger, and Senegal) support community health through the Global Financing Facility for Women, Children and Adolescents (GFF). Methods We conducted a content analysis on Investment Cases and Project Appraisal Documents from selected countries, and set out the scope of the analysis and the key search terms. We applied an iterative hybrid inductive-deductive approach to identify themes for data coding and extraction. The extracted data were compared within and across countries and further grouped into meaningful categories. Results In country documents, there is a commitment to community health, with significant attention paid to various cadres of community health workers (CHWs) who undertake a range of preventive, promotive and curative roles across RMNCAH-N spectrum. While CHWs renumeration is mentioned, it varies considerably. Most community health indicators focus on CHWs’ deliverables, with few related to governance and civil registration. Challenges in implementing community health include poor leadership and governance and resource shortages resulting in low CHWs performance and service utilization. While some countries invest significantly in training CHWs, structural reforms and broader community engagement are lacking. Conclusions There is an opportunity to better prioritize and streamline community health interventions, including integrating them into health system planning and budgeting, to fully harness their potential to improve RMNCAH-N.

Double-edged sword in the quality assurance toolkit: uncovering the influence of self-study on higher education institutions in francophone West Africa

ABSTRACT Policy discussions related to higher education in sub-Saharan Africa often include concerns related to quality. Rather than being an abstract characteristic, quality of higher education is the result of a series of actions and practices, and yet there is limited research on the practices associated with quality in higher education in Africa. This article explores the practice of self-study in West African higher education institutions. After conducting 21 semi-structured interviews with key stakeholders from four public and private institutions in the West African region, which were selected on the basis of their respective strength in quality culture, the study suggests that protecting one’s institutional image can have a significant impact on the uses of self-study. Research participants, regardless of weak or strong quality cultures, were very sensitive about, and even protective of, institutional self-image. The pursuit of a strong institutional image resulted in substantive changes within stronger cultures, or cosmetic changes, among weaker cultures. Having weighed the evidence collected in the study, we argue that the link between self-study and academic activities, including teaching and learning, is weak at best. This study serves as a reminder that self-study is an instrument and therefore its uses are subject to revision and improvement.

Decentralisation, subsidiarity and capacity development for local governments in francophone West Africa

ABSTRACT There is an obvious general trend towards decentralisation in West Africa. This leads to changes in administrative structure. In this article, we develop and elaborate on a point that is often overlooked in decentralisation reform, namely local government capacity. We present empirical evidence from local governments in three francophone West African countries: Burkina Faso, Mali and Niger. For local administrations to effectively deliver services, a sufficiently qualified staff is needed. Our argument is that staffing in general and a well-qualified staff capacity in particular are missing in most of the local governments studied. At the same time, the vocational training systems for the local civil service are structurally weak. The ongoing effort to close the capacity gap shows at once the concurrent need for and the typical limitations of externally planned development projects.

Beyond the law-in-the-books: Labour enforcement in Senegal

Abstract Extant research often assumes that the letter of labour codes is an adequate proxy for effective regulation. This paper empirically shows that such an assumption makes little sense for Senegal. We collect new objective measures of private and public labour enforcement, including workers’ awareness of their rights, access to the judiciary, penalties, and labour inspection resources and activities. We document that Senegal, as well as other countries in Francophone West Africa, is characterised by a combination of protective/stringent in-form labour codes and little enforcement efforts. Furthermore, we show that labour inspections target large and registered firms, while labour violations are more prevalent in small and unregistered firms, implying that the problem is substantially more complex than a lack of public inspection funding. We speculate it is mostly about the lack of effective representation of vulnerable workers in the policymaking process.

Effective bilingual education in Francophone West Africa: constraints and possibilities

ABSTRACT Bilingual education that incorporates a local language alongside the official language has become an increasingly common approach in sub-Saharan Africa for improving literacy rates and learning outcomes. Evidence suggests that bilingual instruction is largely associated with positive learning and literacy outcomes globally. However, the adoption of bilingual education does not guarantee positive learning outcomes. This paper reviews bilingual programs in sub-Saharan Africa, with a particular focus on programs in six Francophone West African countries (Niger, Senegal, Mali, Burkina Faso, Côte d’Ivoire, Cameroon). We identified factors critical to high-quality and effective bilingual programs. Implementation factors, such as teacher training and classroom resources, and socio-cultural factors, such as perceptions of local languages in education, constrain and contribute to the quality of bilingual education. These insights may help inform policy-makers and other stakeholders seeking to improve bilingual education programs in Francophone West Africa and other contexts.

From Dazzle to Diesel

The rise of Turkish television drama series—or dizi as they are known in Turkey—is one of the most notable media phenomena of the past decade in francophone West Africa, particularly Guinea. This is taking place at a time when Turkey has significantly ramped up its economic, political, and cultural investments in Africa, with countries such as Guinea, rich in natural resources and with geostrategic sea access, rapidly emerging as new targets for Turkey's outsized ambitions. This article asks what we can learn about the global circulation of Turkish modernity—a unique blend of tantalizing consumerism and piety conceptualized as “neo-Ottoman cool”—in francophone West Africa by analyzing the hugely popular dizi alongside public debates on Turkey's investments in energy, transportation, energy, culture, or construction. Drawing on Joseph Tonda's notion of éblouissement (dazzlement), it argues that Guineans, like other West Africans, encounter the dazzling images of Istanbul's rich and famous that permeate dizi in stark contrast with Turkish investments in floating power plants and public transport or the Turkish-built Abdul Hamid II Mosque in Bambeto, a popular quarter of Conakry. The article proposes the phrase dazzle-to-diesel to account for the constant oscillation between blinding power and toxic fumes that accompanies encounters with neo-Ottoman cool in West Africa.

The impact of cascade training-A FIGO and WHO Department of Sexual and Reproductive Health and Research collaboration to improve access to quality family planning globally.

Globally, there are considerable barriers to accessing safe and effective contraceptive methods. Increased awareness and utilization among obstetricians and gynecologists (OB/GYNs) and allied health professionals of the WHO's tools and guidelines on contraception is a possible avenue to changing this. A cascade-training model, based on regional training-of-trainer workshops followed by national workshops, was used to share key WHO global family planning tools and guidelines among OB/GYNs in 29 countries across three regions-Anglophone Africa, Middle East and Mediterraean, and Francophone West Africa. Monitoring and evaluation was performed through pre- and post-knowledge questionnaires as well as in-depth interviews of key informants before and after the training was instituted. The training increased both participants' knowledge and understanding of the relevant guidelines, as well as their confidence in using them. Qualitative data suggested that this improved in-country clinical practice and influenced national policy through dissemination and engagement with country leadership. The cascade-training model was a practical, locally adaptable means of disseminating up-to-date WHO family planning guidelines and tools. It resulted in sustainable changes in many participating countries, including training curriculum updates, policy changes, and increased government engagement with family planning. Future iterations of the initiative would benefit from additional support for multidisciplinary training.

Measuring private tutoring: methodological lessons and insights from Francophone Africa

ABSTRACT This paper examines and builds on an earlier contribution to this journal focusing on private supplementary tutoring – widely known as shadow education – in Francophone West and Central Africa. Drawing on wider literature about research methods in this domain, it examines the basis for the numerical estimates presented in the original article and supplements those statistics with data from a subsequent survey. The paper stresses the significance of the topic, and highlights methodological lessons not only for these African settings but also more widely. In this way it contributes to further research agendas relating not only to private tutoring but also to methods in cross-national surveys of educational achievement.

SBCC Training in Francophone West Africa: Overview, Lessons Learned, Challenges and Future Directions

The study explores the SBCC training experience in Francophone West Africa and how training programs have been impacted by major pandemics that this region has experienced, COVID-19 particularly. To stay focused, we have selected Côte d’Ivoire as a case study because it is representative of Francophone African countries which faced political instability, pandemics and epidemics in the past two decades. Data were collected through desk review and interviews with key informants. Taking stock of the past to recent experience, both in long-term and academic training, and on-the-job and short-term training on one hand, and examining the influence of COVID-19 crisis on SBCC training in the country and sub-region on the other hand, lessons learned, and challenges ahead are identified. The paper focuses on multidisciplinary, multisectoral and sub-regional responses, e-learning, and professionalizing SBCC, as future directions.

Editorial

This issue is one of two that spotlight Francophone West Africa, a long-planned project. Here, all the papers are in French, an editorial decision informed by the need to increase further the visibility and readership of the journal in French speaking countries worldwide. To be sure, this has been the case in the past decades as revealed in our analysis of downloads of papers in French following increased submission and published peer review of such papers. Yet, as the journal became swamped with submissions in French, we feel we must not relent in ensuring that they do not lag behind those in English. The second of the two issues will be in English with, of course, all papers focusing on Francophone West Africa. It will focus on different socio-economic aspects of some of the countries the authors chose for their respective research and analyses. Dr Hélène V Quashie, of LARTES-IFAN Université Cheikh Anta Diop / Institut des Mondes Africains Senegal was charged with the responsibility of co-ordinating all the papers for this special issue, in terms of getting them ready after the mandatory blind review. She titled the issue which is essentially a monograph given its specialised focus.

Increasing Contraceptive Use Through Free Family Planning Special Days in Poor Urban Areas in Francophone West Africa.

In francophone West Africa (FWA), contraceptive uptake remains limited, often due to geographic, economic, and social barriers. With technical support from The Challenge Initiative (TCI), municipalities and health systems implemented Family Planning Special Days (FPSDs) to improve family planning (FP) uptake and reduce high unmet need. The FPSD intervention consisted of organizing free FP services on a monthly or quarterly basis over 2 to 5 consecutive days within health facilities or sites close to the population. These events helped to educate, inform, and mobilize the community around FP and improve geographic and financial access to FP services. We describe the process of implementing FPSDs in FWA countries and analyze the results. We used several techniques and data sources in our descriptive analysis, including document review of activity reports, analysis of health management information system data, and retrospective data collection on the profile of FPSD users and implementation costs. Between July 2020 and June 2021, municipalities and health systems collaborated to hold 1,046 FPSDs in 452 health facilities in 10 FWA cities. This collaboration was made possible through the establishment of city-level management and coordination units composed of municipal, health system, and TCI focal points. In the 10 FWA cities, 181,792 people were made aware of the FPSDs and 71,669 contraceptive users were served. The overall cost of organizing the FPSDs was about 145382501 Central African CFA francs (US$252839), 35% of which came from the municipalities' local financial contribution. Results from our analysis showed that, with appropriate financial support from municipalities, the health system could offer high-quality free FP services. Nonetheless, there are still challenges to the sustainability of conducting FPSDs, including the availability of contraceptive products and continued financing of the strategy during system shocks such as the COVID-19 pandemic.

MILITARY JUNTA IN FRANCOPHONE WEST-AFRICA

This study focused on military junta in Francophone West-Africa. Prior to the early 1990s this region has been less interfered by the military, as they had a close relationship with their colonial masters. What could have led to the recent military takeovers in this region, was what formed the basis for our study. The secondary method of data collection was maximally explored in our study. We made ample use of both the interventionists theory put forward by S.E. Finer. From our observations, it is clear that the current military junta in this region is as a result of several factors viz, rejection of French dominance cum presidents that are stooges to their colonial masters, institutional coup, and unnecessary delay in power by the leaders, etcetera. For this to stop, there should be a well-planned tenure system for leaders enshrined in their respective constitutions, also institutions should be strengthened to stop and/or avert institutional coup. You cannot support institutional coups and then consider military coup illegitimate. Lastly, the French government should maintain the principles of the UNO on diplomatic relations with other countries.

Changing the Script: Intergenerational Communication about Sexual and Reproductive Health in Niamey, Niger

ABSTRACT Most strategies to reduce adolescent pregnancies have been designed to educate adolescents directly about family planning (FP), while adolescents often cite peers and parents as their primary sources of sexual health information. Yet parents’ lack of knowledge about sexual and reproductive health (SRH), low self-efficacy to initiate conversations, and adverse social norms act as barriers to open intergenerational communication. To better understand the normative environment influencing communication between parents and youth about FP/SRH in francophone West Africa, the USAID supported Breakthrough RESEARCH project conducted a multi-stage qualitative study in Niger. During Stage 1, the research team developed a screening tool (based on a literature review) to categorize research participants into those who practiced open intergenerational communication about FP/SRH, and those who did not. Stage 2 consisted of 40 in-depth interviews with young people (ages 15–24) and adults (≥25 years old), stratified by whether they practiced open intergenerational communication. Results showed restrictive social norms related to youth SRH and access to information and services. However, particularly among participants classified as open-communicators, there is a hierarchy of norms and normative beliefs, with abstinence as the most virtuous decision for youth, but approving communication about and access to SRH services in order to minimize harm. Participants rely on values such as the protection of youth, protection of family honor and promotion of well-being as means to act in counter-normative ways and communicate about FP/SRH. Implications for the field include demystifying and destigmatizing SRH topics, increasing adults’ communication skills, and changing the “script” to a more life-affirming view of SRH.

Supporting young women in Francophone West and Central Africa with their reproductive health decisions: what can we learn from the Lydia Conseil Call Centre?

Supporting young women in Francophone West and Central Africa with their reproductive health decisions: what can we learn from the Lydia Conseil Call Centre?

Out of the shadows: the incidence and patterns of private tuition provision in Francophone West and Central Africa

ABSTRACT Comprehensive national surveys of primary schools were conducted in nine Francophone West African countries in 2014. These surveys include information on private tutoring which enables in-depth analysis to be undertaken of both the overall incidence of tutoring provision among primary school students and teachers. The main conclusion of this study is that, among this group of countries, many of the broad generalisations and received wisdom concerning private tutoring in the sub-Saharan Africa either do not hold or need to be substantially qualified.

Estimating the Cost of the Design, Production, and Dissemination of Social Media Videos for Social and Behavioral Change: Evidence From Merci Mon Héros in Niger and Côte d'Ivoire.

Merci Mon Héros (MMH) is a youth-led multi-media campaign in Francophone West Africa seeking to improve reproductive health and family planning outcomes using radio, television, social media, and community events. One component to this project is the development of a series of youth-driven videos created to encourage both youth and adults to break taboos by talking to each other about reproductive health and family planning. A costing study was conducted to capture costs associated with the design, production, and dissemination of 11 MMH videos (in French) on social media in Côte d'Ivoire and Niger. The total costs to design, produce and disseminate 11 of the campaign videos for MMH in both Côte d'Ivoire and Niger were $44,981. Unit costs were calculated using three different denominators, resulting in average unit costs of $0.16 per reach, $1.29 per engagement, and $4.27 per video view. These findings can be useful for future studies of SBC interventions using social media for framing the analysis and selecting the appropriate metrics for the denominator, as well as for budgeting and planning SBC programs using social media.

The Failure of Cotton Imperialism in Africa: Seasonal Constraints and Contrasting Outcomes in French West Africa and British Uganda

Cash-crop diffusion in colonial Africa was uneven and defied colonizers’ expectations and efforts, especially for cotton. This study investigates how agricultural seasonality affected African farmers’ cotton adoption, circa 1900–1960. A contrast between British Uganda and the interior of French West Africa demonstrates that a short rainy season and the resulting short farming cycles generated seasonal labor bottlenecks and food security concerns, limiting cotton output. Agricultural seasonality also had wider repercussions, for colonial coercion, investment, and African income-earning strategies. A labor productivity breakthrough in post-colonial Francophone West Africa mitigated the seasonality constraint, facilitating impressive cotton output growth post-1960.

The COVID-19 pandemic in francophone West Africa: from the first cases to responses in seven countries

BackgroundIn early March 2020, the COVID-19 pandemic hit West Africa. In response, countries in the region quickly set up crisis management committees and implemented drastic measures to stem the spread of the SARS-CoV-2 virus. The objective of this article is to analyse the epidemiological evolution of COVID-19 in seven Francophone West African countries (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Niger, Senegal) as well as the public health measures decided upon during the first 7 months of the pandemic.MethodsOur method is based on quantitative and qualitative data from the pooling of information from a COVID-19 data platform and collected by a network of interdisciplinary collaborators present in the seven countries. Descriptive and spatial analyses of quantitative epidemiological data, as well as content analyses of qualitative data on public measures and management committees were performed.ResultsAttack rates (October 2020) for COVID-19 have ranged from 20 per 100,000 inhabitants (Benin) to more than 94 per 100,000 inhabitants (Senegal). All these countries reacted quickly to the crisis, in some cases before the first reported infection, and implemented public measures in a relatively homogeneous manner. None of the countries implemented country-wide lockdowns, but some implemented partial or local containment measures. At the end of June 2020, countries began to lift certain restrictive measures, sometimes under pressure from the general population or from certain economic sectors.ConclusionMuch research on COVID-19 remains to be conducted in West Africa to better understand the dynamics of the pandemic, and to further examine the state responses to ensure their appropriateness and adaptation to the national contexts.

Key factors to facilitate locally driven family planning programming: a qualitative analysis of urban stakeholder perspectives in Africa and Asia

BackgroundThere has been greater recognition of the importance of country ownership in global health and development. However, operationalising country ownership to ensure the scale up and sustainability of proven interventions remains elusive at best. To address this challenge, we undertook a thematic analysis of interviews collected from representatives of local governments, public health systems, and communities in poor urban areas of East Africa, Francophone West Africa, India, and Nigeria, supported by The Challenge Initiative (TCI), aiming to rapidly and sustainably scale up evidence-based reproductive health and family planning solutions.MethodsThe main objective of this study was to explore critical elements needed for implementing and scaling evidence-based family planning interventions. The research team conducted thematic analysis of 96 stories collected using the Most Significant Change (MSC) technique between July 2018 and September 2019. After generating 55 unique codes, the codes were grouped into related themes, using TCI’s model as a general analytical framework.ResultsFive key themes emerged: (1) strengthening local capacity and improving broader health systems, (2) shifting mindsets of government and community toward local ownership, (3) institutionalising the interventions within existing government structures, (4) improving data demand and use for better planning of health services, and (5) enhancing coordination of partners.ConclusionWhile some themes feature more prominently in a particular region than others, taken together they represent what stakeholders perceive to be essential elements for scaling up locally-driven health programmes in urban areas in Africa and Asia.

Return to pregnancy after contraceptive discontinuation to become pregnant: a pooled analysis of West and East African populations

BackgroundThe fear of infertility or delayed return to fertility is a common barrier to contraceptive use in sub-Saharan Africa, particularly among young or nulliparous women. Global evidence on return to pregnancy after method discontinuation suggests these fears may be misplaced; yet the topic has not been widely studied in sub-Saharan Africa nor by age and parity group.MethodsReproductive calendar data from recent Demographic and Health Surveys of 15 sub-Saharan African countries were used to analyze time-to-pregnancy following discontinuation of a contraceptive method with the reason to become pregnant. The probability of pregnancy at 12 months was estimated using single-decrement life tables run by type of method discontinued, age and parity. Results are presented by region: francophone West Africa, anglophone West Africa and East Africa.ResultsThe 12-month probability of pregnancy after discontinuation of contraception to become pregnant was 73.0% in francophone West Africa, 78.8% in anglophone West Africa, and 82.0% in East Africa. Our results showed significant regional differences in return to pregnancy by 12 months, with probabilities in francophone West Africa being significantly lower than in anglophone West Africa or East Africa. A lower return to pregnancy by 12 months was seen among women ages 35–49 years and was lowest after discontinuation of a hormonal method for all age groups. Differences by parity group were only evident after discontinuation of hormonal methods in francophone West Africa.ConclusionsSustainable gains in increasing contraceptive uptake, especially among youth, may be difficult to achieve without information and counseling that address concerns about infertility and potential delays in return to pregnancy following use of hormonal methods.