The Perception of Health Workers and Stakeholders Involved in the Process of Selecting Indigent in Burkina Faso

Background: Indigent selected for their health care is complex and poses enormous challenges. The actors involved have an influence on health actions and their perception is decisive for better care for the indigent. Little evidence exists on these perceptions and this paper has captured this. Methods: A case study involved 163 participants with a questionnaire and an interview guide. The quantitative responses were classified according to a measurement scale, proportions and overall indices of perception (Ip) and satisfaction (CSAT) were calculated. The relationship between variables was investigated using chi-square. Thematic analysis was used with qualitative data. The study met ethical requirements. Results: The participants had a positive perception of the selection: Ip = 0.77, but a minority (1/5) were dissatisfied with the selection. The perception of selection did not differ significantly depending on the experience of the actors. For the vast majority, the definition of indigent was satisfactory (CSAT = 91.4). The selection was done in a top down fashion and steps such as setting up committees, informing stakeholders, had shortcomings which negatively impacted the effectiveness of the selection. The needs of the participants included transparency in the indigent select process, matching the tools for selecting the indigent to the context, strengthening of local action, deconstruction of prejudices in terms of the indigent, power of actors to act, and importance for health services to reach out to the indigent. Conclusion: Considering the perception of the actors as well as their needs will improve the selection for effective care of the indigent.

Analysis of Indigents Selection by the Community: A Construction Inequality

Burkina Faso conducted a community selection of the indigent in eight health districts. The selection targeted 15% to 20% indigent per district. This study analyzed the data of this selection from the databases of the Ministry of Health. Descriptive analysis and time series modeling were performed. Indigents were predominantly female, heads of household were mostly elderly, and the average age of household members ranged from 21.9 to 29.8 years. The households were small. Indigents were mostly uneducated and employed. They all belonged to a given religious denomination, Muslims were the most numerous. The majority of the indigents were married and almost a quarter of them were widows. About 2% to 17% of indigents were selected depending on the district. Forecasts showed both an increase and a decrease in the use of health care by indigents. The study recommends considering the poverty level specific to each district when selecting, strengthening education policies targeting the indigent, improving the socio-health conditions of the indigent including specific actions considering age, sex and marital status, and the formulation of an employment policy targeting the indigent. Analyzes of the relationship between poverty and religion may allow the exploitation of religious capital for the benefit of the indigent.