Learning from health system reforms: lessons from Burkina Faso.
OBJECTIVE
Burkina Faso has implemented a macroeconomic adjustment programme (MAP) along with an ambitious reform of the health care system. Our aim was (1) to verify whether MAPs led to a reduction in health resources, and (2) to analyze the consequences of health policies implemented.


METHODS
Cross-sectional and retrospective study, spanning the years 1983-2003. The macro aspect is based upon documents from national and international sources, a database of secondary socioeconomic data, and interviews of key informants working in upper management. Household and health facility surveys were conducted in three regions covering 53 communities.


RESULTS
Within the reforms, the health sector benefited from an important flow of resources. There were significant increases in public expenditures, health care staff, the number of primary care facilities and the availability of generic drugs. However, health facilities in the public sector remain underused and major inequities subsist. Access to health care is constrained by the population's ability to pay. Health expenditures impoverish households, creating new poor and impoverishing the already poor.


CONCLUSIONS
The success of reforms depends largely on the extent to which they remove financial barriers to access to services. The experience of Burkina Faso also reveals the need for fundamental changes that will motivate staff, improve productivity, and ensure good quality services. Integrating health development policies with strategic plans for poverty reduction can provide new opportunities for African countries to redesign their health systems within this type of perspective.
Haddad
Slim
S
Groupe de Recherche Interdisciplinaire en Santé, Université de Montréal, Québec, Canada. slim.haddad@umontreal.ca
Nougtara
Adrien
A
Fournier
Pierre
P
D002050:Burkina Faso; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000639:trends; D003906:Developing Countries; D018166:Health Care Reform; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends; D006295:Health Resources / Q000706:statistics & numerical data / Q000639:trends; D006296:Health Services / Q000706:statistics & numerical data / Q000639:trends; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends; D006302:Health Services Research; D006801:Humans; D012189:Retrospective Studies