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Country Health Systems Surveillence (CHeSS) a brief assessment in Burkina Faso
Population: 14.0, 3.1% growth rate (2006 census) Percent urban: 23% Number of administrative areas: 13 regions, 45 provinces, 63 health districts, 300+ departments, and about 9000 villages Background The scale‐up for better health is unprecedented in both potential resources and the number of initiatives involved. Such a grand experiment requires a harmonized monitoring and evaluation effort that reinforces both country and global needs to demonstrate results, secure future funding, and enhance the evidence base for intervention. Eventually, the scale‐up efforts will be judged by country progress towards the health‐related MDGs, the degree to which major health constraints in countries have been addressed, and adherence to the Paris Declaration on Aid Effectiveness. A common framework for monitoring performance and evaluation of the scale‐up for better health aims to ensure that the demand for accountability and results from single donors and joint initiatives is translated into well‐coordinated efforts to monitor performance and evaluate progress in countries. It translates the tenets of the Paris declaration to a common accountability and results framework. It stresses the importance of working in ways that contribute to strengthening country organizational capacity and health information systems, as well as enabling evidence‐informed decision making and improved country performance. The global framework with its M&E implications and the six principles are shown in Annex A. The global framework needs to be made operational at the country level. The Country Health Systems Surveillance platform (CHeSS) aims to improve the availability, quality and use of the data needed to inform country health sector reviews and planning processes, and to monitor health‐system performance.1 There are three dimensions to this process to strengthen the monitoring and evaluation component of the country compact: Demand and use of information: improve the use of evidence in decision‐making processes,
focusing on country plans Supply of data and statistics: increase availability and quality of data used for decision
making Enhance institutional capacity: support country capacity for assessment and monitoring of
health systems and their performance The accountability and results framework aims to identify a minimum set of indicators with clear‐cut measurement strategies. These indicators will be the basis for regular reporting of reliable results to assess progress against targets and performance within and between countries. The framework, indicators and measurement strategies should cover specific (disease) programmes and health systems strengthening in general, as well as form a basis for global reporting. This should be supported by global efforts to minimize reporting requirements for countries.
1 Country Health Systems Surveillance. Report of a meeting in Bellagio, October 2008. WHO and Rockefeller Foundation.
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1. Country review processes Review of Burkina Faso's second Poverty Reduction Strategy Paper (PRSP‐2), finalized in 2004, is leading the way for the first Annual Sector Review (ASR) to take place in 2010. The PRSP‐2 (Box 8) includes a critical health component insofar as specific MDG targets are defined; the IDA and IMF Joint Staff Advisory Note (2005) estimates that MDG targets related to poverty and nutrition could be met, but those related to education, reproductive health, and gender need enabling policies and programs to bring them into reach. Indeed, several key documents concerning health have been produced and review committees have been established to prepare for the ASR. Key sectoral partners included WHO, UNICEF, EU, Belgium, the Global Fund, BAD, BID and others. The National Development Plan for Health, the PNDS 2001‐2010, was developed to operationalize the National Health Policy. The development of the PNDS was followed up by a Triennial Plan 2001‐2003 to operationalize implementation in 2003‐2005. The 2006‐2010 Plan, like the first five year period, aims to reduce mortality and morbidity and to improve the intermediary objectives necessary for these reductions. The 2006‐2010 Plan was developed in technical committees consisting of members from the Ministry of Health, regional and district health authorities, and technical and financial partners. The Plan takes into account the National Health Policy, the PNDS, the PRSP, the MDG, reports from monitoring committees reporting on PNDS implementation, and the PNDS Evaluation 'Mi‐parcours'. The 2006‐2010 Plan is based on 'rapid results intervention packages' where the focus is on a set of financing interventions and monitoring of related indicators that are expected to have an impact on HIV/AIDS, malaria, maternal and child health, and nutrition. In 2003, two technical entities were created to oversee the implementation of the PNDS, the multisectoral Comité de suivi and the Technical secretariat. The Comité de suivi has six thematic sub‐committees that were formed to provide regular oversight of the PNDS implementation, including: 1. Human resources, 2. Decentralization, 3. Institutional strengthening of MOH, 4. Private sector, 5. Sectoral approach and health financing, and 6. Indicators. (An observation was made by one partner, however, that the sub‐committees do not function as expected for the PNDS review and they should be made to function more effectively for the Annual Sector Review.) It was further envisioned to create an external committee to evaluate the PNSD 2001‐2010 prior to the development of the PNSD 2011‐2020. Quarterly Progress reports are produced with input from the Direction régionales de la santé (DRS), the Centres hospitaliers régionaux et universitaires (CHR/CHU) and the Districts sanitaires (DS). Based on the Progress reports, the Technical secretariat produces a Synthesis report, which contributes to decisions taken on actions to strengthen districts to accomplish their annual action plans. The indicators monitored in these progress reports were revised in 2003 and 2005, and again reviewed for the PNDS 2006‐2010. A workshop was held in July 2008 to obtain an updated list of indicators for the progress reports, and to reach consensus on which indicators will be regularly tracked. The Health Metrics Network conducted an assessment in 2008 which highlights the strengths and weaknesses of the national health information system, in particular as regards Resources and indicators, Information products including data quality, Dissemination and use of
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information, and Synthesis of information. The assessment findings and recommendations will be taken forward at a multi‐country workshop in Dakar, April 2009. A mission in March 2009 was made by a University of Oslo team to introduce the DHIS M&E system. A three day workshop to discuss a data warehouse has been tentatively scheduled, but the final date is still pending the availability of the MOH M&E unit. Phase one of data archiving work was initiated in 2008, by the Accelerated Data Programme (ADP) team based at OECD, to assist the Institut National de la Statistique with establishing a searchable survey catalogue of micro and meta data. Follow‐up work is planned to hold a DDI production workshop and to install the open‐source National Data Archive (NADA) application. For a description of the project and a list of surveys to be archived, see the Burkina Faso INSD/OECD report (January 2009). Burkina Faso is not currently an IHP+ Compact signatory. Although there have been high level discussions regarding signing a compact, Burkina Faso has taken the decision to not sign (which would entail developing and finalizing a compact draft, validating it by a country team at national level, organizing a high‐level round table, and signing and implementing the Compact). Rather, the Burkina delegation to the IHP+ meeting in Lusaka (March 2008) recommends further reflection and observation of other signatory countries to determine the value‐added in signing the Compact. Financing of the Annual Health Sector Review is ensured by the State budget. The Programme d'appuis au développement sanitaire (PADS) is the common funding modality that was created in 2002 to ensure that districts receive necessary funding. Partners contributing to this fund include the Netherlands, Sweden, France, UNFPA, UNICEF, and others. The WHO is not yet contributing but discussions are underway. The fact that WHO contributions for technical assistance, for example, must go through the Ministry of Finance, presently creates a tremendous delay and road block for tapping into their technical assistance resources‐‐ requests for TA may take 1‐2 years to pass through the Ministry of Finance. The World Bank does not accept such joint funding arrangements so is not a contributor. Donors that invest in infrastructure (e.g., Taiwanese, ADB, Islamic Foundation) also are not contributing to PADS. Overall, the PADS has significantly reduced the number of funding sources and resulted in common planning and procurement mechanisms, but unfortunately some contributors continue to earmark their funds for certain activities or geographical areas. The funding of districts plans are based on 'rapid results intervention packages' for MDGs 1, 4, 5, and 6 and categorized into intermediate objectives by theme area (see below). The resulting 200+ district activity budget lines are then funded by the national budget and partner commitments. 2. Monitoring & Evaluation The MOH/DEP has finalized the final list of intermediary indicators and quarterly district progress indicators to be monitored. There are total of 42 indicators to be monitored in the PNDS to track intermediary progress, including 19 input/process indicators, 18 outcome indicators, and 7 impact indicators. Indicators are reported and tracked annually, except 6 which are tracked bi‐annually, and 5 impact indicators that are reported every five years (Annex B). Intermediary indicators are divided into major thematic areas: I. Increase health coverage (1‐5) (input/process indicators) II. Improve service quality and utilization (6‐12) (3 outcome and 4 input/process)
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III. Strengthen the fight against infectious and non‐infectious diseases (13‐24) (11 outcome and 1 impact) IV. Reduce HIV transmission (25‐26a/26b) (outcome/impact) V. Develop human resources (27‐28) (input/process) VI. Reduce HIV transmission (29‐31) (input/process) VII. Increase financial resources for the health sector (32‐35) (input/process) VIII. Strengthen institutional capacity of the MOH (36‐37) (1 input/process and 1 outcome) IX. Impact indicators (38‐42) (impact) District progress report indicators. There are, in addition, 92 indicators to measure in the quarterly Progress reports at district level, categorized into 10 major sub‐areas: 1. Coordination (1‐4) 2. Community participation (5‐7) 3. Support to Health centers (8‐15) 4. Supervision (16‐21) 5. Health Information System (22‐30) 6. 'Contrôle' (31‐32) 7. Availability of MEG (33‐36) 8. Curative, preventive and promotional health care (37‐68, including curative, vaccination, antenatal and delivery care, infant health and family planning. 9. Complete package of activities (69‐84, including consultations, surgery and hospitalization) 10. Implementation of district plan (85‐92) The Canevas et guide (Jan. 2009) provides a list of the 45 essential medicines (Annex 1), as well as the 20 tracer generic medicines (Annex 2). An example of the quarterly report form is provided in Annex 3, it is seven pages long. 3. Data sources Over the past decade, data for population based indicators were collected by the INSD through national surveys and the national population census. Indicators calculated from routine data have been reported by the MOH/DEP. Note that a detailed assessment of the quality of these is presented in the Health Metrics Network assessment report (2008). Population Census. The INSD conducted a population census was conducted in 1996, and again in 2006. Preliminary results are available for 2006. Health Management Information System (HMIS). Patient registration and reporting of health service provision scored very high in the HMN self‐assessment. The MOH health information division has developed an MS‐Access database called RASI (Rapports Activité de Santé Informatisé) which is implemented in all districts since 2006. RASI furthermore constitutes a database of health facilities, with a unique code, but is not necessarily up to date to include all public and private facilities. There is also a Système d'information de Gestion d'indicateurs de Santé (SIGIS), also a MS‐Access database, which is considered more up to date than RASI. See Annex E for detailed information on the 2006 Carte Sanitaire, using HMIS data. Population based surveys. A schedule for national survey to be conducted in the coming decade was not available.
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‐ 4 Demographic and Health Surveys (DHS) have been conducted: 2009 DHS will be conducted in the summer, with HIV and parasitemia testing, also 2003 DHS, 1998/1999 DHS, 1992/1993 DHS ‐ Multiple Indicator Cluster Survey (MICS) 1996 ‐ EBCVM 2003 ‐ World Health Survey (WHS) 2003 ‐ Questionnaire des Indicateurs de Bien Etre (QUIBB) 2007 ‐ 2 HIV Most at risk population surveys ‐ 2 national surveys in 2005 and 2006, on commercial sex workers. Also case detection activities among military, miners and truckers (2003). ‐ District Comprehensive Assessment (DCA) in 13 districts, 2008 (Global Fund Health Impact Evaluation) ‐ Other social/economic ‐ Household economic survey 2001 (WB?); Ouagadougou Employment survey 2001‐2003 (ILO?); annual agricultural surveys (1994‐2008) Facility assessments. ‐ DCA 2008 in 13 districts, SAM/Health Mapper 2005 Vital registration. Vital registration information is reported to Administration Territoriale. According to the HMN self‐assessment (Dec. 2008) this aspect of the information system constitutes the weakest data management system. Demographic Sentinel Sites. There are four DSS in Burkina Faso, 3 of which are IN‐DEPTH network sites: 1) Nouna is the longest‐established site, 2) ISSP has a site in urban Ouaga, 3) Sapone is 20 km from Ouaga, and 4) Caya is 5 km from Ouaga and IRSS is currently registering it with IN‐DEPTH. Disease surveillance. ‐ acute outbreak disease surveillance, such as meningitis, yellow fever etc. (to be determined) ‐ ANC sentinel sites: 3 sites established in 1997. Currently 13 sites with 6 urban and 7 rural. 2nd generation protocol is used. 6500‐7000 pregnant women per year are tested for HIV and STI. ‐ TB ‐ fairly well functioning system according to an in‐depth evaluation of the results from GF evaluation study in 2008 Administrative data. ‐ Financing‐ The first National Health Accounts (NHA) exercise, using WHO‐recommended methodology, was conducted in 2005 and documented health expenses in 2003 and 2004. The second NHA was conducted in 2007, to take into account 2005 expenses with sub‐accounts for malaria and HIV/AIDS. The most recent NHA, in 2008, with sub‐accounts in HIV, TB and malaria, covers expenses from 2003 to 2006. The NHA 2008 report proposes putting in place tools that would facilitate collection of financial data in 'real time'. ‐ Human resources (to be determined) ‐ facility database with GPS coordinates and basic service information is available at the MOH‐MOH/DGIST, however, it needs to be updated with the GF DCA facility assessment data in 13 districts, as well as a plan to update facility information in the remaining districts. 4. Data quality control mechanisms Ascertaining the quality of clinic reporting systems. ‐ Reporting of completeness and timeliness of facility reports: The MOH/DEP collects monthly reports from facilities and enters these routinely reported data in an eletronic database (RASI).
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This routine automatically reveals reports that are missing and/or reports that are not complete. Whether timeliness and completeness of reporting is assessed on a regular basis is unknown, and whether follow‐up is done on missing or incomplete reports is also unknown. ‐ Assessments to verify the accuracy of the reports (e.g. revisits): MOH/DGISS indicates that it is too expensive to revisit facilities to recheck data. However, the DEP makes field supervision visits and is responsible for tracking district level indicators; these data therefore may provide a cross‐check to the routine data that are reported monthly. ‐ Reconciliation of survey and facility data: not aware that this is done regularly, although during the mission in March/April 2009 an initial attempt was made by the consultant to reconcile or update official facility codes and geo‐reference points from the DCA facility assessment, the 2005 SAM, and the MOH/RASI facility data base. ‐ Independent evaluation mechanisms in the countries: Not aware of any mechanisms. 5. Data access, analysis and dissemination The Direction des Etudes et de la Planification (DEO/MOH) has been prolific in using their routinely collected data to report regularly on the status of health indicators at the national and district levels. Findings are published annually in the Annuaire Statistique Santé. Specific areas of reporting in the Annuaire include maternal health, nutrition, curative care, sexually transmitted diseases, in‐patient care, surgery, laboratory, health education, special interest diseases, malaria, and health in the workplace. A series of indicators related to hospital consultations is also presented in the Annuaire. In 2007, DEP also published a Tableau de Bord that presents trends for key indicators in detailed tables, figures and maps. DEP produces regular Progress Reports based on six‐month supervision visits to districts, which are further used to produce a Synthesis report of findings. Another useful publication produced in 2007 is Indicateurs essentiels de système national d'information sanitaire: Manuel de reference. This manual includes indicator definitions, data source, and instructions on their calculation. In terms of datasets of routine data, the Direction General of Health Information & Statistics (DGISS) uses the RASI and the SIGIST for storing and analysis of routine data. Partial databases of health facilities include Health mapper (c. 1997‐2004, 2005) and the DCA Facility census (2008). Microdata for the latter have been archived by IRSS and will be available on the web after a dissemination workshop in June 2009. DEVINFO is not functioning sufficiently to provide information on MDGs, etc. 5. Institutional capacity The MOH DEP has been strategically divided into the newly created Direction General of Health Information & Statistics (DGISS), and a reorganized DEP. This new direction has been elevated to a high status within the Ministry and will expand routine data collection functions that were previously all under DEP. Several sub‐departments are also to be developed under the new direction. The DGISS is currently reviewing its tools, includes the MS‐Access databases for routine data, RASI and SIGIST.
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One of the main functions of the DEP/MOH (Direction des Etudes et de la Planification) is district supervision and overseeing the implementation of district annual health plans. Progress status is documented and synthesized in regular performance reviews. Research institutions. The Institut de Recherche en Sciences de la Santé (IRSS), in Ouagadougou, was created in 1997 as one of four National Centers of Scientific Research and Technology. It employs a team of 15‐20 interdisciplinary researchers, including epidemiologists, demographers, pharmacists, biostatisticians, nutritionists, health economists and anthropologists. IRSS conducts operational research in HIV/AIDS, malaria, nutrition and tuberculosis. Examples of recent research activities include: Impact du programme d’accélération de l’accès aux ARV dans le fonctionnement des formations sanitaires (World Bank); Evaluation des 5 ans du Fond Mondial de lutte contre le VIH, la Tuberculose et le paludisme au Burkina Faso (Macro International); Facteurs explicatifs des disparités spatiales de prévalence du VIH/sida au Burkina Faso; Pratiques de prise en charge des personnes vivant avec le VIH au Burkina faso (TDR/WHO); Système de Surveillance Démographique et Epidémiologique de Kaya (KaDESS); Les caractéristiques des revenus des professionnels de la santé et leur relation avec la fourniture des soins au Benin, Burkina Faso et Niger (Alliance for Health Policy and systems research/WHO); Stigmatisation et fréquentation des structures de PEC des PVVIH par les hommes au Burkina Faso. The GREFSaD, in Bobo‐Dioulasso, is another research institution with about a dozen fulltime staff and broad experience in data collection and data analysis, including experience gained in collecting household information on PDAs for the Global Fund Evaluation DCA. Some examples of GREFSaD's research portfolio include an assessment of the maternal mortality initiative (IMMPACT), the prevalence, prevention and treatment of obstetrical fistulaire, the development of civil society, validation study of using the verbal autopsy instrument on a PDA, the prevalence of HIV among infants born to HIV+ mothers who received PMTCT prophylaxis, and other research topics. Funding sources for these and other research projects include national sources (e.g., MOH and SP/CNLS) and international sources (e.g., Aberdeen University, London School of Hygiene and Tropical Medicine, Bill and Melinda Gates Foundation, Wellcome Trust, Macro International, DFID, USAID, and French state funding. 6. Conclusions and recommendations The strengths of the MOH monitoring & evaluation system are a result of many years of experience in collecting routine data. An electronic database tracks facility‐level data, and these data have been used to generate trends for a variety of indicators at national and sub‐national levels. These results are made available regularly in quarterly and annual publications, in hard copies or electronically, and are presented in detailed tables, graphics and maps to facilitate the reader's interpretation. Pressing forward, the greatest challenges lie in two major areas. First, there needs to be established a systematic and independent mechanism to check the quality of routine data. Second, databases need to be updated. In particular, the facility database needs to be updated on a regular basis to ensure all facilities, public and private, are operating according to national norms. The new DGISS is also currently reviewing its tools and may decide that the MS‐Access data bases of routine data currently in use could stand improvement in efficiency; consultation on this topic has been initiated with the University of Oslo on the DHIS.
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In particular, below are several strategies that would strengthen data sources (routine administrative data and other sources) and serve to inform the health sector review process starting in 2010: 1. Incorporate regular monitoring and evaluation of health facilities into annual review. One mechanism would be to conduct an annual facility census in a selection of districts, whereby the facility database would be replenished on a scheduled basis. For example, another sample of one‐fifth of districts (about 13 districts), to build on the original 13 selected during the Global Fund Evaluation, may be selected in the next year in which a facility census would be conducted. 2. Incorporate validation measures into the facility assessment to verify data at the central level vis‐à‐vis data from facilities aggregated to the district/regional level data. A few key variables and time periods could be selected to validate at the time of the facility census. 3. Facility data should be integrated into the MOH M&E system and made available for further analysis, mapping, etc. The IHSN Accelerated Data Project (ADP) has trained two research institutions to archive microdata on the web. A link could be established to access these data on the MOH M&E website. 4. Strengthen capacity for primary data collection. Existing capacity, for example the capacity acquired in the course of the Global Fund Evaluation District comprehensive assessment (DCA), could be reinforced among other partners (such as DGISS) so that primary data collection can be done increasingly independently and not reliant on scarce, expensive assistance from the north. In particular, data management capacity should be strengthened, including the designing of questionnaire applications, data collection and verification of data quality, and data analysis. This capacity strengthening could be done on a regional basis. For example, two research institutions in Burkina Faso, IRSS and GREFSaD, have already accumulated substantial knowledge and capacity with survey data management since the DCA, including collecting data with PDAs. The existing capacity could be built upon through further applied training of these and other national staff, as well as with participants from other countries in the region. The training would use as a basis the country‐adapted questionnaires to be fielded (i.e., a revised Facility census that includes specific information for the PNDS intermediary goals, essential medicines, and other modules as determined by the country). Burkina Faso could position itself to lend such expertise on a regional basis until other countries acquire the needed technical level and field experience. 5. Continue supporting DGISS capacity and its collaboration with partners. A technical person is invited from DGISS to attend a workshop on archiving the DCA facility database from the Global Fund Evaluation. The workshop on the IHSN Microdata Management Toolkit will take place in Nairobi, May 4‐8, 2009. 6. Further strengthen effective communication tools to inform decision making process WHO‐HQ may provide support to implement the above recommendations, at the request of the MOH‐DIGIST to indicate their collaboration with an entity with prior experience and capacity to do this (e.g. IRSS). WHO‐HQ may also provide assistance in conducting a validation of some key central level indicators, either as part of the facility assessment or a stand‐alone exercise. This should be done upon request of the MOH‐DIGIST, and in collaboration with an independent entity such as IRSS.
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List of Contacts: Cabral, K. Djamila. WHO/WR Kano, Hamissou. Director of the National Institute for Statistics (INSD) Kielem, David. WHO Kounda, Seni. Research Institute for Health Sciences (IRSS) Mbonji, Peter. WHO Inter‐country Team, M&E focal point Meda, Nicolas. Coordinator of the Global Fund Impact Evaluation Mothebesoane, Seipati. WHO Making Pregnancy Safer Nitiema, Abdoulaye. DEP Ouédraogo, Boureima. Directeur general for Health information and statistics (DGIS), MOH Sawadogo, Janvier. Asst. to the director DGIS, MOH Sanou, Souleyman. Directeur general of health, MOH Soumbey‐Alley, Edoh. WHO Regional Advisor, Health Information Systems Touré, Boka. Coordinator of the WHO Inter‐country Team Traore, Waramou. Secretary of Task Force for the Global Fund Impact Evaluation van der Horst, Jan. HIV/AIDS Advisor, Dutch Embassy
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Annex A IHP+ common evaluation framework: global The top section of the framework shows the sequence used in monitoring and evaluation frameworks from inputs and processes to outputs, outcomes and impact. At the bottom of the figure, the proposed actions for improved monitoring of performance and evaluation are shown. The framework for evaluation of the scale‐up in the spirit of the Paris declaration can be translated into the following six principles: 1. Collective action: the primary focus should be on the contribution of the collective efforts to
scale‐up the health sector response in countries. 2. Alignment with country processes: monitoring performance and evaluation should build
upon national processes that countries have established to evaluate and review progress in the implementation of national health sector plans.
3. Balance between country participation and independence: evaluation processes should be driven by country needs but conducted in a manner which maintains their independence.
4. Harmonised approaches to performance assessment: evaluations of the scale‐up should use common protocols and standardized outcome indicators and measurement tools, with appropriate country adaptations and leadership, minimizing the separate evaluation efforts of individual initiatives, grants and programmes.
5. Capacity building and health information system strengthening: systematic involvement of country institutions in performance monitoring and evaluation is necessary to strengthen health information systems and promote local capacity for analysis and application of information and evidence.
6. Adequate funding: as a general guide between 5% and 10% of the overall scale‐up funds need to be set aside for monitoring performance, evaluation, operational research and strengthening health information systems.
Inputs Outputs Outcomes Impact
FundingDomestic sourcesInternational sources
PlanCoherent, prioritised and funded
HarmonizationAligned international efforts with national planWell coordinated and harmonized support
National plan implementationSystems strengtheningPriority interventions scale-up
Capacity buildingProgrammesInstitutionsPeople
AccountabilityPerformance monitoring
Results focus and evaluation
Use for better practices
Health
system stren
gth
ened
Governance, H
R, m
edical products, information
Increased service utilization and intervention coverage
Reduced inequity (e.g. gender, socio-economic position)
Responsiveness
No drop-off non-health sector interventions (e.g. water & sanitation)
Improved survivalChild mortalityMaternal mortalityAdult mortality due to infectious diseases
Improved nutritionChildrenPregnant women
Reduced morbidityHIV, TB, malaria, repr. health
Improved equity
Social and financial risk protectionReduced impoverishment due to health expenditures
Imp
roved
servicesA
ccess, safety, quality, efficiency
Process
Aid process monitoring
Resource trackingStrengthen country health information systems
Evaluation: process, health systems strengthening, impact
M &
E a
ctio
n
Health system monitoring Coverage monitoring Impact monitoringImplementationMonitoring
IHP+ COMMON EVALUATION FRAMEWORK
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Annex B List of 42 official PNSD intermediate indicators I. LA LISTE DES INDICATEURS RETENUS DANS LE CADRE DU SUIVI DU PNDS
Indicateur / Programme Type d’indicateur Niveau de collecte Source de vérification Périodicité
I Accroissement de la couverture sanitaire nationale 1 Rayon moyen d’action des formations sanitaires (CSPS) Ressource/Processus Districts SNIS Annuelle
2 Pourcentage des formations sanitaires fonctionnelles selon les normes minimales en Ressource/Processus National Enquêtes Tous les 2 ans
3 Pourcentage des formations sanitaires remplissant les normes minimales en équipement Ressource/Processus National Enquêtes Tous les 2 ans
4 Pourcentage de districts opérationnels Ressource/Processus Régions Supervision Annuelle 5 Pourcentage des formations sanitaires privées transmettant régulièrement des rapports statistiques à la DEP (SNIS) Ressource/Processus Régions Rapport Annuelle II Amélioration de la qualité et l’utilisation des services
6 Nombre de médicaments traditionnels enregistrés à la nomenclature nationale Résultat National Rapport Annuelle 7 Nombre de nouveaux contacts par habitant et par an dans les structures de soins de 1er niveau (CMA et CSPS) Résultat Districts
SNIS/ Rapp. Progrès Annuelle
8 Pourcentage de dépôts MEG n’ayant pas connu de rupture des 10 molécules essentielles Ressource/Processus Districts
SNIS/ Rapp. Progrès Annuelle
9 Pourcentage de DRD n’ayant pas connu de rupture des 45 molécules essentielles Ressource/Processus Districts
SNIS/ Rapp. Progrès Annuelle
10 Taux d’hospitalisation Résultat Districts/Hôpitaux SNIS Annuelle 11 Pourcentage d’hôpitaux transmettant régulièrement des rapports statistiques aux DRS et à la DEP Ressource/Processus Hôpitaux SNIS Annuelle 12 Pourcentage de formations sanitaires disposant d’un système fonctionnel de traitement des déchets biomédicaux Ressource/Processus Districts/Hôpitaux Enquêtes Tous les 2 ans
III Renforcement de la lutte contre les maladies transmissibles et non transmissibles
13 Taux de couverture en CPN2 Résultat Districts SNIS/ Rapp. Progrès Annuelle
14 Proportion de césariennes réalisées Résultat Districts SNIS/ Rapp. Progrès Annuelle
15 Taux d’accouchements assistés par duvpersonnel qualifié dans les formations sanitaires Résultat Districts
SNIS/ Rapp. Progrès Annuelle
16 Taux de couverture en PENTA 1 Résultat Districts SNIS/ Rapp. Progrès Annuelle
17 Taux de couverture en PENTA 3 Résultat Districts SNIS/ Rapp. Progrès Annuelle
18 Taux de couverture en Vaccin antirougeoleux (VAR) Résultat Districts
SNIS/ Rapp. Progrès Annuelle
19 Taux de prévalence contraceptive couple années protection Résultat Districts
SNIS/ Rapp. Progrès Annuelle
20 Taux de couverture en Vitamine A chez les enfants de 6 à 59 mois Résultat Districts Rapport Annuelle
21 Taux de guérison des cas de tuberculose Résultat Districts SNIS/ Rapp. Progrès Annuelle
22 Taux de létalité du paludisme grave chez les enfants de moins de 05 ans Résultat Districts
SNIS/ Rapp. Progrès Annuelle
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23 Taux de létalité des complications obstétricales vues dans les formations sanitaires dans les structures de santé (CSPS, CM, CMA, CHR et CHN) Résultat Districts/Hôpitaux Enquêtes Annuelle
24 Incidence du tétanos néonatal (OMD, intervention à gain rapide) Impact SNIS Annuelle
IV Réduction de la transmission du VIH/Sida 25 Pourcentage de personnes atteintes de Sida justifiables du traitement qui sont sous traitement antirétroviral (ARV) Résultat Districts
SNIS/ Rapp. Progrès Annuelle
21 Pourcentage des femmes enceintes infectées par le VIH qui reçoivent un traitement complet pour réduire la transmission mère enfant Résultat Districts
SNIS/ Rapp. Progrès Annuelle
26 Prévalence de la syphilis Résultat/impact National Sero surveillance Annuelle
V Développement des ressources humaines
27 Pourcentage de structures sanitaires publiques (CSPS, CMA et CHR) remplissant les normes minimales en personnel de santé Ressource/Processus Districts/Hôpitaux
SNIS/ Rapp. Progrès Annuelle
28 Ratio différentes catégories de personnel par rapport à la population Ressource/Processus National SNIS Annuelle
VI Amélioration de la transmission du VIH
29 Coût moyen des prestations et des ordonnances à chaque niveau du système de soins Ressource/Processus Districts/Hôpitaux Enquêtes Tous les 2 ans
30 Coût moyen de la prise en charge du paludisme Ressource/Processus Districts/Hôpitaux Enquêtes Tous les 2 ans
31 Nombre de districts disposant de mécanismes de partage de risques maladie fonctionnels Ressource/Processus
Direction Régionale de la Santé Enquêtes Tous les 2 ans
VII Accroissement des financements en faveur de la santé
32 Taux de mobilisation des ressources Ressource/Processus Districts Bilan financier Annuelle
33 Taux d’absorption des ressources mobilisées Ressource/Processus Districts Bilan financier Annuelle 34 Pourcentage du budget de l’Etat alloué à la santé Ressource/Processus National Bilan financier Annuelle
35 Taux d’exécution du budget de l’Etat Ressource/Processus National Bilan financier Annuelle
VIII Renforcement des capacités institutionnelles du Ministère de la santé 36 Nombre de réunions du Comité Suivi du PNDS tenues Résultat Rapport Annuelle 37 Proportion de directions centrales disposant de plans de renforcement mis effectivement en oeuvre Ressource/Processus National Rapport Annuelle
IX Indicateurs d’impact
38 Ratio de mortalité maternelle Impact National
Enquête Démographique et de Santé Tous les 5 ans
39 Taux de mortalité Infantile Impact National
Enquête Démographique et de Santé Tous les 5 ans
40 Taux de mortalité infanto juvénile Impact National
Enquête Démographique et de Santé Tous les 5 ans
41 Taux de prévalence du VIH/SIDA Impact National Enquête Annuelle
13
42 Taux d’insuffisance pondérale chez les enfants de moins de 5 ans (OMD, intervention à gain rapide) Impact National
Enquête Démographique et de Santé Tous les 5 ans
14
Annex C Intermediate indicators Below is a selection of six of the official PNDS indicators that may be monitored with the DCA Facility census instrument, using data collected during the Global Fund Impact Evaluation in 2008.
Intermediate indicator 2 (MOH/DEP 2009). Percentage of health centres functioning according to minimal requirements for infrastructure The DCA Facility census 2008 collects data on infrastructure elements including but not limited to power, improved water source, communication, emergency transport, overnight observation beds. If the questionnaire does not include the nationally defined 'minimal requirements' for infrastructure then the questionnaire can be adapted for future rounds.
Percentage of health facilities with basic elements of infrastructure,
in 13 districts, DCA 2008
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Continuous power source
Improved water source
(500 m)
Communication
Emergency transport
Overnight observation
beds
n=555 health facilities
15
Percentage of health facilities with basic elements of infrastructure, DCA 2008
0% 20% 40% 60% 80% 100%
Diapaga (n=26)
Ouargaye (n=25)
Bogodo (Sect. 30) (n=86)
Ouahigouya (n=98)
Djibo (n=31)
Sindou (n=28)
Diebougou (n=15)
Bobo (Sect.22) (n=95)
Leo (n=32)
Manga (n=33)
Kongoussi (n=36)
Bousse (n=22)
Nouna (n=28)
Continuous power source Improved water source (500 m) Communication
Emergency transport Overnight observation beds
16
Intermediate indicator 3 (MOH/DEP 2009). Percentage of health centres fulfilling minimal requirements for equipment. The DCA Facility census 2008 collects data on availability of basic equipment including, but not limited to, child and adult weighing scales, thermometer, stethoscope and blood pressure cuff. Likewise, information is collected on availability of higher level equipment such as anaesthesia machine, oxygen, infusion, and radio and internet. If the questionnaire does not include the nationally defined 'minimal requirements' for equipment then the questionnaire may be adapted for future rounds.
Percentage of health centers with basic equipment*,
in 13 districts, DCA 2008
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Diapaga (n=26)
Ouargaye (n=25)
Bogodo (Sect. 30) (n=86)
Ouahigouya (n=98)
Djibo (n=31)
Sindou (n=28)
Diebougou (n=15)
Bobo (Sect.22) (n=95)
Leo (n=32)
Manga (n=33)
Kongoussi (n=36)
Bousse (n=22)
Nouna (n=28)
n= 555 health facil ities
*Basic equipment includes: adult scale, child scale, thermometer, stethoscope, blood pressure cuff
17
Intermediate indicator 9 (MOH/DEP 2009). Percentage of district medicine depots (DRD) with no stock‐outs for 45 tracer medicines. The DCA Facility census 2008 collects data on 13 of 45 tracer medicines and their availability in health facilities. The questionnaire may be adapted in future rounds to include other tracer medicines.
Availability of essential generic tracer medicines in health facilities
in 13 districts, DCA 2008
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Amoxicilline
Ceftriaxone
Ciprofloxacin
Co‐trimoxazole
Fluconazole
Mebendazole
Metrodinazole
Oxytocine
Paracétamol
Sachets SRO
Coartem/ACT
Fansidar/SP
Quinine
n= 555 health facil ities
18
Availability of Amoxicilline, Ceftriaxone, Ciprofloxacin, Cotrimoxazole,
DCA 2008
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Diapaga (n=26)
Ouargaye (n=25)
Bogodo (Sect. 30) (n=86)
Ouahigouya (n=98)
Djibo (n=31)
Sindou (n=28)
Diebougou (n=15)
Bobo (Sect.22) (n=95)
Leo (n=32)
Manga (n=33)
Kongoussi (n=36)
Bousse (n=22)
Nouna (n=28)
Amoxicilline Ceftriaxone Ciprofloxacin Co‐trimoxazole
19
Availability of Fluconazole, Mebendazole, Metrodinazole,
DCA 2008
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Diapaga (n=26)
Ouargaye (n=25)
Bogodo (Sect. 30) (n=86)
Ouahigouya (n=98)
Djibo (n=31)
Sindou (n=28)
Diebougou (n=15)
Bobo (Sect.22) (n=95)
Leo (n=32)
Manga (n=33)
Kongoussi (n=36)
Bousse (n=22)
Nouna (n=28)
Fluconazole Mebendazole Metrodinazole
20
Availability of Oxytocine, Paracetamol, sachets SRO,
DCA 2008
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Diapaga (n=26)
Ouargaye (n=25)
Bogodo (Sect. 30) (n=86)
Ouahigouya (n=98)
Djibo (n=31)
Sindou (n=28)
Diebougou (n=15)
Bobo (Sect.22) (n=95)
Leo (n=32)
Manga (n=33)
Kongoussi (n=36)
Bousse (n=22)
Nouna (n=28)
Oxytocine Paracétamol Sachets SRO
21
Availability of Coartem/ACT, Fansidar/SP, Quinine,
DCA 2008
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Diapaga (n=26)
Ouargaye (n=25)
Bogodo (Sect. 30) (n=86)
Ouahigouya (n=98)
Djibo (n=31)
Sindou (n=28)
Diebougou (n=15)
Bobo (Sect.22) (n=95)
Leo (n=32)
Manga (n=33)
Kongoussi (n=36)
Bousse (n=22)
Nouna (n=28)
Coartem/ACT Fansidar/SP Quinine
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Intermediate indicator 12 (MOH/DEP 2009). Percentage of health centres with a functional system for treating biomedical wastes. The DCA Facility census 2008 collects data on mechanisms of biomedical waste disposal in health facilities. (Information on sterilization mechanisms is also collected.)
Treatment of biomedical waste, sharps and infectious waste,
in 13 districts, DCA 2008
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Burn in
incinerator
Open burning Dump without
burning
Remove offsite Other/No sharps
Sharps Infectious wasten= 555 health facilities
23
Disposal mechanisms of infectious waste,
DCA 2008
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Diapaga (n=26)
Ouargaye (n=25)
Bogodo (Sect. 30) (n=86)
Ouahigouya (n=98)
Djibo (n=31)
Sindou (n=28)
Diebougou (n=15)
Bobo (Sect.22) (n=95)
Leo (n=32)
Manga (n=33)
Kongoussi (n=36)
Bousse (n=22)
Nouna (n=28)
Burn in incinerator
Open burning
Dump without burning
Remove offsite
Other/No sharps
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Intermediate indicator 27 (MOH/DEP 2009). Percentage of public health centers (CSPS, CMA, CHR) fulfilling minimal requirements for health personnel. The DCA Facility census 2008 collects information on the type of health personnel at each facility (full time and part time), their presence at time of interview, and specific training formations within the past two years. Information can be adjusted to present the nationally defined 'minimal requirements' for health personnel, and the percentage of facilities fulfilling the requirements.
Average number of full‐time health professionals per health facility,
in 13 districts, DCA 2008
0.0
0.5
1.0
1.5
2.0
2.5
Medical doctors Asst. medical officers Certified/registered
nurses
Certified/registered
midwives
All 4 health
professionals
n= 555 health facil ities
25
Average number of full‐time health professionals per health facility,
DCA 2008
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8
Diapaga (n=26)
Ouargaye (n=25)
Bogodo (Sect. 30) (n=86)
Ouahigouya (n=98)
Djibo (n=31)
Sindou (n=28)
Diebougou (n=15)
Bobo (Sect.22) (n=95)
Leo (n=32)
Manga (n=33)
Kongoussi (n=36)
Bousse (n=22)
Nouna (n=28)
Certified/registered midwives
Certified/registered nurses
Asst. medical officers
Medical doctors
26
Intermediate indicator 28 (MOH/DEP 2009). Ratio of various categories of health personnel per population.
Average number of health personnel per 10,000 inhabitants,
in 13 districts, DCA 2008
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Medical doctors Asst. medical officers Certified/registered
nurses
Certified/registered
midwives
All 4 health
professionals
n= 555 health facilities
Average number of health personnel per 10,000 inhabitants,
DCA 2008
0.0 1.0 2.0 3.0 4.0 5.0 6.0
Diapaga (n=26)
Ouargaye (n=25)
Bogodo (Sect. 30) (n=86)
Ouahigouya (n=98)
Djibo (n=31)
Sindou (n=28)
Diebougou (n=15)
Bobo (Sect.22) (n=95)
Leo (n=32)
Manga (n=33)
Kongoussi (n=36)
Bousse (n=22)
Nouna (n=28)Certified/registered midwives
Certified/registered nurses
Asst. medical officers
Medical doctors
27
Note: Base population 2006 projected with 3.2% average growth rate for 2000‐2005 (UN Population Division)
28
Annex D Documentation and references: Ministry of Economy and Development. 2004. Burkina Faso Poverty Reduction Strategy Paper. Copie pdf Ministry of the Economy and Finance/Bureau central du recensemen. Recensement général de la Population et de l'Habitation 2006: Résultats définitifs. July 2008. Copie pdf Ministry of the Economy and Finance/INSD and OECD. 2009. Programme statistique acceleré, Burkina Faso. Rapport de la première phase de la première étape: Archivage des données d'enquêtes et de recensements. Copie Word Ministry of Health/DEP. Annuaire Statistique Santé 2007. June 2008. Direction des Etudes et de la Planification. Ouagadougou. Copie pdf Ministry of Health/DEP/Secretariat technique. Canevas et guide d'élaboration des rapports de progrès des districts sanitaires. Jan. 2009. Copie pdf Ministry of Health/DEP. Indicateurs essentiels de système national d'information sanitaire: Manuel de reference. August 2007. Copie Word Ministry of Health/DEP. Tableau de Bord de la Santé 2007. Direction des Etudes et de la Planification. Ouagadougou. Copie pdf Ministry of Health/Plan National de développement sanitaire 2001‐2010. Rapport final: Evaluation à mi‐parcours du PNDS au Burkina Faso. Sept. 2005. Copie pdf Ministry of Health/Plan National de développement sanitaire 2001‐2010. Tranche 2006‐2010. March 2007. 2005. (Hard copy only) Rapport de Mission de la Delegation du Burkina Faso et des Partenaires a la Réunion Internationale de l'Equipe Inter‐Pays du secteur de la Santé a Lusaka (Zambie), MOH, March 2008 (Hard copy only) Ministry of Health/DEP. Rapport d'Activité Sanitaire Informatisé (RASI) Manuel de l'Utilisateur. Copie pdf Ministry of Health. 2008. Comptes Nationaux de la Santé 2006: Sous comptes VIH/SIDA, Tuberculose et Paludisme de 2003 à 2006. Copie pdf Reseau de metrologie sanitaire evaluation du système d'information sanitaire, Rapport du Burkina Faso. December 2008. [HMN Assessment final report, Burkina Faso Dec. 2008] Copie Word
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Annex E 2006 Burkina Faso Carte Sanitaire
2006 Burkina Faso Carte Sanitaire: Summary of Desk Review:
This summarizes a rapid desk review by Lemarchand and Greenwell, based on information provided about the 2006 Carte Sanitaire on a CD‐ROM. The objective was not to conduct an exhaustive review, rather to formulate recommendations for WHO as to how they might support the DGISS/MOH in updating the 2009 Carte Sanitaire. Content Themes 1. Demography
Population by region, admin district, density, by sex, by major age group, by pregnant women
14 demographic indicators, limited trend info. 2. Infrastructure
By 8 facility types, and name/owner
The number of facilities by type, by region and district
% of facilities with water, electricity, comm., sewage
14 international partners, by type 3. Partner interventions
Number of specific medical personnel, density and the norme, by region and district 4. Personnel
Number of personnel type by region, district, and density and target ('Niv. Atteinte de norme'), and by type of health center.
5. Health situation
15 National indicators and trend info
12 district indicators, no trend info
5 specific diseases, by district/region
Total state budget, national level, and percent for health, trend info 6. SES situation
14 national indicators, trend info where available Assessment: Overall the content for existing themes is pretty good. However, information on specific services, staff training, drugs, lab and equipment do not appear to be available. Also, most data are aggregated at the district/region level, and not analyzable by facility observations. There is not trend data, mostly 2004 data only, but the 2009 update should provide valuable comparison data for the major themes. Presentation There was not a copy of the final report on the cd. The Access database is user‐friendly. Automatically generated reports and maps are good. The maps are nicely presented.
30
Assessment: Nice presentation using an older version of ARCVIEW GIS. Database Data are in an Access database with about 40 relational tables. The database is not documented using international documentation and archiving standards to facilitate use from outside analysts. Assessment: A relational database such as Access is not feasible for further analysis because only discrete tables can be viewed or exported. The DHIS2 software should address this problem by providing a platform that has greater potential for providing data in a full dataset that is conducive to further analysis. Data quality Difficult to assess quality since data are not in one exportable data file. A more in‐depth assessment could compare a selection of common indicators (2008 GFE and 2006 Carte Sanitaire), such as available personnel, at the district level. TBD Mapping An examination of the 2006 Carte Sanitaire database revealed that for many facilities, if not most, GPS coordinates are not accurate. A comparison of facility coordinates for facilities in the 2008 GFE districts with those from the 2006 Carte Sanitaire/Health Mapper showed significant discrepancies. In Lebara district, for example, geographic coordinates for the same facilities deviated from 1‐1.3 km (Annex E1). The GF coordinates appear more accurate since it designated a facility located in a village, whereas coordinates from the other sources showed the same facility outside of the village in non‐inhabited areas (Annex E2 and E3). The reason for these discrepancies is that health facilities from the 2006 Carte Sanitaire are geo‐referenced using a variety of available mapping sources such as gazeteers and very few health facilities were geo‐referenced using GPS devices. For the 2008 GFE, the geographic coordinates were collected using a GPS device.
Recommendations for WHO support of the 2009 Carte Sanitaire update
1. GPS coordinates should be updated with precise measurements. To start, the coordinates could be updated with measurements from the GFE, new facilities, and facilities in non‐GFE districts would require a visit. 2. Technical assistance could be provided to assist in presentation of the updated information. For example, a WHO cartographer could work with DGISS on presenting maps using more recent software. 3. Technical assistance could be provided to assist with interpretation of 2004‐2009 trends, and potentially new baseline information. 3. Collaborate with the DHIS‐2 team and DGISS to program routine data collection of relevant facility indicators‐‐ as defined in the national strategic plan. 4. Documentation and archiving of annual data sets would greatly facilitate the dissemination and use of these data by outside analysts.
31
Annex E1. Comparing different GPS measures from different sources, for the same facilities (Note: the 2006 Carte Sanitaire probably relied on some earlier Health Mapper coordinates that were probably obtained from a secondary source such as a Gazeteer, rather than a GPS device)
32
Annex E2. Facility in Lebara district, two measurements (2008 GFE and 2006 Carte Sanitaire)
33
Annex E3. Another facility in Lebara district, two measurements (2008 GFE and 2006 Carte Sanitaire)