title: Analysis of the policymaking process in Burkina Faso's health sector: case studies of the creation of two health system support units.
abstract: BACKGROUND
  Burkina 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Key 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.
  
  
  CONCLUSIONS
  Efforts 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.
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda. zidaandr@yahoo.fr.|Ministry of Health, 01 PO Box 7009, Ouagadougou 01, Burkina Faso. zidaandr@yahoo.fr.
authors.forename: Andre
authors.initials: A
authors.lastname: Zida
authors.affiliation: McMaster Health Forum, Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.|Department of Political Science, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.
authors.forename: John N
authors.initials: JN
authors.lastname: Lavis
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda.
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.affiliation: Ministry of Health, 01 PO Box 7009, Ouagadougou 01, Burkina Faso.
authors.forename: Bocar
authors.initials: B
authors.lastname: Kouyate
authors.affiliation: McMaster Health Forum, Centre for Health Economics and Policy Analysis, and Department of Clinical Epidemiology and Biostatistics, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.
authors.forename: Kaelan
authors.initials: K
authors.lastname: Moat
authors.affiliation: PATH, PO Box 900922, Seattle, WA, 98109, United States of America.
authors.forename: Jessica
authors.initials: J
authors.lastname: Shearer
mesh_terms: D002050:Burkina Faso; D005380:Financing, Government; D063005:Health Information Systems / Q000592:standards; D006291:Health Policy; D006296:Health Services / Q000191:economics*; D006801:Humans; D011050:Policy Making; D019984:Quality Indicators, Health Care; D013223:Statistics as Topic / Q000592:standards
keywords: Agenda setting; Burkina Faso; Health policy; Health system financing; Policymaking