Burkina Faso

Country Profile

Jhpiego in Burkina Faso

Quick Facts
Estimated total
population:1
17.0 million
Maternal mortality ratio:2
560/100,000 live births
Infant mortality rate:2
91/1,000 live births
Under-five mortality rate:2
166/1,000 live births
Total fertility rate:1
5.8
Contraceptive prevalence:1
13% (modern methods)
17% (all methods)
HIV prevalence:3
1.2%
Births with skilled
provider:2
54%
Sources:
1
Population Reference Bureau 2011
World Population Data Sheet;
2
UNICEF Information by Country
Program;
3
UNAIDS Report on the Global AIDS
Epidemic 2010.

Background
Burkina Faso, an arid, landlocked country in West Africa, is one of the poorest and
least developed countries in the world. With more than 80% of the population
relying on subsistence agriculture, ongoing drought, poor soil, lack of adequate
infrastructure and a low literacy rate have all adversely impacted the populations
health status. As a result, Burkina Fasos rates of maternal, neonatal and infant
mortality are among the highest in Africa, and low use of contraception has led to
one of the highest fertility rates in West Africa. In addition, malaria is endemic,
placing pregnant women and young children at particular risk.
Jhpiego has actively collaborated with the Ministry of Health (MOH) in Burkina
Faso since 1996, initially through two projects funded by the U.S. Agency for
International Development (USAID): 1) supporting family planning service
providers under the Sant Familiale et Prvention du SIDA (Family Health and
AIDS) Project, and 2) introducing lifesaving postabortion care (PAC) services under
the Training in Reproductive Health Project. From 1999 to 2004 under the
Maternal and Neonatal Health (MNH) Program, Jhpiego partnered with
international and national organizations to develop a model delivery system in
Koupla District aimed at increasing the use of skilled providers during pregnancy,
childbirth and the postpartum period. In addition, Jhpiego partnered with
Georgetown Universitys Institute for Reproductive Health from 2002 to 2004 on a
pilot study testing the feasibility and acceptability of introducing the Standard Days
Method (SDM)1 into family planning services at three clinics. From 2001 to 2005,
under the MNH and ACCESS Programs, Jhpiego collaborated with the U.S.
Centers for Disease Control and Prevention (CDC) and the Burkinab National
Center for Research and Training in Malaria on a pilot program to introduce
intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxinepyrimethamine (SP), which contributed to national policy change. From 2005 to
2006, Jhpiego continued through ACCESS to scale up training of service providers
in focused antenatal care and malaria in pregnancy in one region. Currently, Jhpiego
is implementing three programs in Burkina Faso in the areas of: 1) the prevention of
mother-to-child transmission of HIV (PMTCT), 2) the prevention and treatment of
malaria in pregnancy, and 3) cervical cancer screening and prevention.

SDM is a simple, effective, low-cost, natural method to prevent or plan pregnancy that uses a string of color-coded beads
called CycleBeads to track menstrual cycles and identify periods when pregnancy is most likely.
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Current Program Highlights

Prevention of Mother-to-Child Transmission of HIV

In November 2006, the MOH awarded Jhpiego a five-year
project to increase PMTCT coverage and improve the quality
of PMTCT services at 408 facilities in four out of the
countrys 13 health regions. The projects strategy is to
implement the PMTCT-Plus approach to increase
coverage and quality of maternal and neonatal health
services. In 2009, follow-up visits to support quality
improvement at intervention sites were supplemented
by the introduction of the Jhpiego-developed
Standards-Based Management and Recognition (SBM-R)
approach to improving performance and quality of health services.
In partnership with the MOHs Direction de la Sant de la Famille
(Department of Family Health, or DSF), Jhpiego is responsible for building
the capacity of providers through training and follow-up, putting into place the
SBM-R approach for continuous quality improvement and helping estimate the
needs for testing kits and drugs.

Malaria in Pregnancy
Since October 2009, USAID has funded the Maternal and Child Health Integrated
Program (MCHIP) to support the prevention and treatment of malaria, including
diagnosis by rapid diagnostic tests at peripheral-level health facilities without labs
for microscopy. This nationwide program targets the general population, with a
particular focus on those who are the most vulnerable through: 1) malaria in
pregnancy services, particularly prevention (IPTp and long-lasting insecticidetreated bed nets) and treatment; and 2) malaria prevention and treatment for
children under five years old. Building on past program experiences in malaria in
pregnancy, Jhpiegos approach includes improving provider and supervisor skills in
preventing, diagnosing and treating malaria in pregnancy nationally.
Under this program, Jhpiego is responsible for: 1) training and follow-up/
mentoring of providers and supervisors, 2) advocacy and support for updating
an integrated training and supervision package and national guidelines,
3) development of job aids for providers, 4) communications targeting clients to
increase demand for health services, and 5) support to health professional
schools to review and update pre-service training curricula for midwives/nurses
and other health cadres in charge of malaria interventions.

Cervical Cancer Prevention

Provider at clinic.

In 2010, the Izumi Foundation awarded Jhpiego a two-year project for the
prevention of cervical cancer in Burkina Faso. The project aims to reinforce
cervical cancer prevention activities, improve womens access to early detection
and treatment of precancerous cervical lesions and prevent needless deaths from
cervical cancer. This project is based on the single visit approach, which uses
visual inspection of the cervix after applying acetic acid (vinegar) to the cervix
and, if indicated, treatment of precancerous lesions by cryotherapy during the
same visit. Providing all of these services in one visit reduces the proportion of
women lost to follow-up.

The projects principal objectives are to: 1) increase government awareness and
strengthen political commitment and support for the development of national,
comprehensive cervical cancer prevention strategies, policies and guidelines;
2) strengthen local human and institutional capacities and ensure high-quality
service delivery through supportive supervision and monitoring and evaluation;
and 3) generate demand for available services through community awareness and
education. Services are being implemented at the two main/university teaching
hospitals in the two largest cities, namely the Yalgado Ouedraogo University
Teaching Hospital in Ouagadougou, and the Souro Sanon University Teaching
Hospital in Bobo-Dioulasso.

Key Accomplishments
Under current programs:

As a result of Jhpiegos work in PMTCT, 305,209 women received

counseling and testing for HIV between 2007 and 2011. Out of the 6,546
women who tested HIV-positive, 5,695 (or 87%) received appropriate case
management for PMTCT.

The percentage of health centers providing PMTCT services in 15 project

districts increased from 16% in 2007 to 95% in 2011, and the percentage of
antenatal clients at these sites who agreed to be tested for HIV increased
from 47% in 2007 to 81% in 2011.

Under MCHIP, 59,257 women received treatment for malaria in pregnancy

between January and December 2010. A total of 1,095 providers coming
from 20 health districts in nine out of the 13 regions were trained in malaria
in pregnancy; in addition, 165 trainers/supervisors from 63 districts and
regional and national levels were also trained and conduct supervision visits
in the health districts.

Under the cervical cancer prevention program, 3,068 women have been
screened for cervical cancer using the single visit approach, and three
national trainers and 24 service providers were trained in cervical cancer
screening using this approach.

Under past programs:

Under MNH, antenatal care visits to the 13 model health facilities in Koupla
district increased substantially. According to a 2004 survey, 44% of women
who gave birth in the previous 12 months had four antenatal care visits,
compared to 21% in 2001. Deliveries with skilled providers also rose during
that period, from 39% to 58%. These increases were due to improvements in
service quality, better supervision, increased competence of service providers
and community awareness efforts.

Also under MNH, a pilot study in Koupla determined the feasibility of

delivering IPTp using SP during antenatal visits to prevent malaria in
pregnancy. A follow-up survey revealed that IPTp with SP led to a
reduction in maternal anemia, peripheral parasitemia and placental
parasitemia. As a result of this and other studies carried out in the West
African region, Burkina Faso officially adopted a country-wide malaria in
pregnancy policy in February 2005 that includes IPTp and insecticidetreated bed nets provided through focused antenatal care.

Under ACCESS, Jhpiego supported the training of providers in focused

antenatal care and malaria in pregnancy, reaching 80% of facilities in the
Centre-Ouest region, which serves a population of 3.8 million.

As a result of the PAC work, these services are available at 11 hospitals and
23 health centers, and PAC has been integrated into the national service
delivery guidelines for reproductive health and into national curricula used
to train doctors and midwives.

The SDM pilot program showed that the SDM method is acceptable to
Burkinab couples and feasible to introduce into existing family planning
services. In light of these findings, the MOH decided to expand the
availability of the SDM to other health care facilities throughout the
country and include it in their national reproductive health norms.

Partners and Donors

Current donors include the MOH of Burkina Faso, USAID and the Izumi
Foundation.

New mom with baby.

Current partners include the MOH (DSF, National Malaria Control

Program), the Ministry of Superior Education and Scientific Research, the
university teaching hospitals, the Permanent Secretariat of the National
Council for the Control of HIV/AIDS and Sexually Transmitted Infections,
John Snow Inc./DELIVER and Abbott.

References
Bicaba, A, et al. 2005. The Acceptability and Feasibility of Introducing the
Standard Days Method of Family Planning in Reproductive Health Clinics in
Burkina Faso, West Africa: Final Report. Jhpiego, Baltimore, MD.
Jhpiego. 2004. The Maternal and Neonatal Health Program in Burkina Faso
19992004. Baltimore, MD.
Jhpiego. 2010. Projet dextension interne de services PTME dans 15 districts sanitaires
du Burkina Faso, Rapport annuel dactivits: 2009. Ouagadougou, Burkina Faso.
Joint United Nations Programme on HIV/AIDS (UNAIDS). 2010. UNAIDS
Report on the Global AIDS Epidemic 2010.
Population Reference Bureau. 2011 World Population Data Sheet. Washington,
D.C.
United Nations Childrens Fund (UNICEF). Information by Country Program.
At: http://www.unicef.org/infobycountry/burkinafaso_statistics.html.