Lessons Learned on the Community Management of Health Care Services in Two Provinces of Burkina Faso: Implications for the Implementation of the Bamako Initiative in West Africa

The participation of communities in health care management is one of the basic principles of the Bamako Initiative. However, few communities have received the necessary management skills. MWANGAZA Action, a Burkina Faso NGO, established community health committees by providing intensive management training and support through the Community Health Support Project (CHSP) from 1993 to 1995 when the funding agency, USAID, closed. In order to identify the lessons learned from the CHSP and to determine the current level of functioning of the committees eighteen months after the Project's termination, a study was conducted in the two provinces of Burkina Faso where the program was implemented. The specific objectives of the study were to identify the determinates of committee functioning and to determine the potential for replicating the approach in other parts of Burkina Faso and West Africa. One of the revenue generating activities managed by the committees, a market-based approach to providing health services including family planning, was also examined for potential replication.

This study included several data collection approaches, both qualitative and quantitative (semi-structured interviews, focus group discussions, observation, and document review), to capture information from diverse target groups (committee members, health personnel, and community members). A final phase of the study consisted of a series of workshops with each community to review and complement the results of the study to ensure their validity. A total of 30 health centers, approximately half of all centers in the two provinces, representing a range of environments were selected for inclusion in the study.

The results of the study revealed that the majority of the communities function at a minimum level. Most committees have a president, vice-president, treasurer, and secretary. Twenty-four out of the 33 committees studied achieved the objectives they set out for themselves. The dynamism of committee members and support from the community and health personnel contributed to the achievement of the objectives. The inability to achieve objectives were due to lack of financial resources and delays in execution. The most common activities undertaken were maintenance of the facility, reforestation , and organization of market-based services (Laafi Raaga). The most common improvements made were physical including construction of hospital rooms, pharmacy posts, latrines, and fencing around the health center. In addition, many facilities were refurbished. The majority of these projects were funded by the committees.

The most common difficulties encountered by the committees were the irregularity of meetings and insufficient funds to carry out activities. The motivation of committee members is also affected by the absence of any financial compensation. The needs expressed by the committee members include the further development of revenue generating activities and additional technical support, including training and monitoring. The workshops revealed that committees want health agents to receive training in how to support the committees.

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