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Burkina Faso Case

This case study explores Burkina Faso's readiness to implement a Sector-Wide Approach (SWAp) in health financing. With a population of 11.3 million and challenging health metrics, including a high infant mortality rate and low adult literacy, the paper assesses key indicators such as economic conditions, government commitment, and the health system's performance. Strategies for donor coordination and management capacity improvement are discussed, alongside potential advantages and disadvantages of adopting a SWAp. Recommendations are offered on advancing health sector reform for better outcomes.

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Burkina Faso Case

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  1. Burkina Faso Case Is Burkina Faso ready for a SWAP?

  2. Indicator Data Population 11.3 million Population growth rate 2.4 % per annum Total fertility rate 6.6 per woman 15-49 Infant mortality rate 94 per 1000 live births Maternal mortality ratio 556 per 100,000 live births Urban population 16 % Adult literacy rate 19 % Life expectancy at birth 52 years Burkina Faso: basic indicators

  3. Indicator Data Income per capita $240 Per capita health expenditure $10 Health expenditure as % of GDP 4 % Average household spending on health $63 per year Drugs as percent of health spending 88 % B F: economic indicators

  4. Health system performance issues • Over-centralized resources leading to: • Technical inefficiency—low value for money • Poor allocative efficiency—spending money on the wrong things • High costs to patients (who spend a lot for drugs) • Poor quality of care—poor performance by health workers at poor facilities

  5. Reform initiatives • New role for ministry of health in setting norms, planning, special programs • District health team approach, with community management committee implication • New approaches to resource management, including block grants to districts • General contracting of civil servants with performance evaluation

  6. Enabling factor Assessment Macroeconomic conditions Government allocations to health sector Management capacity--MOH Government openness to SWAp Donor coordination Prospects for harmonization of donor procedures Interest in basket funding SWAp readiness Criteria

  7. Discussion questions • Based on your reading of the case (or knowledge of BF), comment the criteria of readiness in the previous slide? How to do you assess these criteria? • Would a SWAp enable BF to improve the management capacity of its MOH, or would weak existing capacity defeat a SWAp? • Would a SWAp contribute to efforts to improve the performance of BF’s health system? • Are donors ready for a SWAp? • Would you recommend that BF move to a sector-wide program?

  8. Take 45 min for discussion

  9. Discussion questions • Based on your reading of the case (or knowledge of BF), comment the criteria of readiness in the previous slide? How to do you assess these criteria? • Would a SWAp enable BF to improve the management capacity of its MOH, or would weak existing capacity defeat a SWAp? • Would a SWAp contribute to efforts to improve the performance of BF’s health system? • Are donors ready for a SWAp? • Would you recommend that BF move to a sector-wide program?

  10. Burkina Faso Case Could Burkina Faso engage a SWAp process ?

  11. Central ideas • Government, Donors and other groups of civil society are involved in a new type of partnership • Management and coordination of aid is shared equally by stakeholders on both sides  Government in the Driver-seat

  12. Advantages • More efficient use of funds for development purposes • More control by the Government over the development agenda • Better donor coordination & reduce administrative burden for the Govnt • Flexibility to design strategies corresponding to local conditions • Consistency between policy and dvpt goals by all stakeholders • Long term approach to development

  13. Disadvantages • Greater influence of the donors in deciding Government policy & high level decision • Difficult in attributing results to particular donor • Less opportunity for innovative approaches from multiplicity of development agencies • Less control of how funds are used

  14. Here is what Burkina has Int’l NGO E U UNDP DONOR Community? A D B W Bank Af D B WHO UNICEF UNFPA BILATERALS

  15. Here is what Burkina wants Int’l NGOs E U UNDP HEALTH SWAp A D B W Bank Af D B WHO UNICEF UNFPA BILATERALS

  16. Here is what Burkina needs to do Preconditions • Commitment of Burkina government • Burkina ownership in SWAp process • Capacity of the MoH • Clear and consistent strategies • Transparent budgeting and accounting system • Policies and strategies remain consistent

  17. How strong is the commitment ? • An agency must be designated or created to guide SWAp process in the country • The agency is endowed with authority to implement the course of action for the SWAp, • An adequate budget must be appropriated to enable the agency to carry out its mandate.

  18. How to strengthen Ownership? • National consultations • Clear overall vision: role of the state in the sector endorsed by the Head of State • Sector strategy endorsed by MoH and Legislature • Core of influential officials sharing relevant donor perspectives • Ministry of Finance support: spending programmes realistically matched to the Budget available

  19. How strong is ownership ? Strong Government Leadership Government change Agents seeking Alliance Donor Leadership

  20. Finally…… • Mechanism that gives back control of health development programs to Burkina government • Focusing on the long-term policy & strategy decisions in the Health Sector • An approach rather than a blueprint • Ownership and Timing apropriate • Building discipline and trust from both sides: Government and donors

  21. Burkina building carefully a Health SWAp ?

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