Insécurité au Sahel, comment maitriser les efforts d'accès et d'utilisation des services de santé : cas du district sanitaire de Barsalogho au Burkina Faso

Abstract

Introduction : The health district model is the core of the health care system organization in sub-Saharan African countries, but its success remains hampered by the security crisis aggravated by the Covid-19 pandemic in the Sahel region of West Africa. The Barsalogho health district in north-central Burkina Faso is facing serious disruptions to its service due to terrorist attacks, inter-community violence, population displacement and other phenomena. An analysis of the ability of the Barsalogho health district to maintain its essential functions in a security crisis was conducted to identify ways to maintain and improve health coverage and utilization of health services. The objective of the document is to analyze the resilience of the Barsalogho health district in a context of insecurity. Methods : Using data from the statistical yearbooks, we conducted a secondary analysis that focused on public health facilities in the Barsalogho health district from 2013 to 2020. The indicators of interest were human resource coverage and infrastructure, health service utilization, and effectiveness in addressing priority problems. In statistical analysis, the graphical representation of the CUSUM square test with 95% CI was used to characterize the trend of the indicators of interest. This analysis was supplemented by structured interviews with sixteen (16) health care workers from public health facilities in this health area from June 7 to July 7, 2021. The interviews focused on the health workers' assessment of access to and use of the health services of the health district, despite the unfavorable conditions. Results : Since the beginning of the security crisis in Burkina Faso in 2015, the public health facilities in the Barsalogho health district have remained functional. However, the ratio of inhabitants per CSPS remains very low during this period with the best ratio of one (01) CSPS for 15417 inhabitants obtained in 2020 although the number of CSPS has increased from eleven (11) in 2013 to thirteen (13) in 2020. The cost of the health services offered are considered inaccessible for the population served. The quantity and quality of medical and paramedical staff is insufficient in most health facilities. In 2018, the ratio of doctors was evaluated at one (01) for 18536.7 inhabitants, that of nurses at one (01) for 3288.8 inhabitants and that of midwives at one (01) for 8496 inhabitants. From 2018 to 2020, there was a gradual decrease in the number of healthy infant consultations (2018= 89708, 2019= 48663 and 2020 =45680), the number of CPN1 (proportion in 2018= 93.8%, 2019= 41.4% and 2020 =33 ,4%), the number of CPN4 (proportion in 2018= 34%, 2019= 13% and 2020 =7.9%), and assisted deliveries (proportion in 2018 = 85%, 2019= 31.4% and 2020 =30.3%), with a high proportion of acute malnourished observed in 2020 (6.5%) and many lost to follow-up between CPN1 and CPN4. At the CUSUM statistical test (95% CI), there is no break in the trend of the indicators of interest. Conclusion : While the resilience of a health system is difficult to measure, in the face of the security crisis and other stresses, the Barsalogho health district has managed to remain functional. This means that despite adverse conditions, district health systems can withstand and maintain access to and use of health services. However, if urgent strategies are not implemented in the near future, the burden of the security crisis and its consequences will be difficult to remedy in the most affected areas.