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EQUITY GAUGE PROFILES: OUAGADOUGOU, BURKINA FASO

Research & Monitoring
Advocacy & Public Participation
Community Involvement
Key People & Partners
Photos
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Introduction to Ouagadougou:

The situation in Ouagadougou is especially problematic. Since 1950, the city has experienced the most rapid population growth in all of Africa, at over 7 percent per annum. Its population of 263 thousand as recently as 1980 is projected to exceed 2.5 million by 2015. As a result of poverty, food insecurity, and high fertility in rural areas, a mass exodus to the city is in its initial phase.

The Demographic and Health Surveys (1993, 1998) and other sources provide only average statistics on health indices for all of Ouagadougou. These averages (e.g. the 1998 DHS estimated the under-five mortality rate as 133 per 1000 in Ouagadougou compared to 120 in smaller towns and 235 in rural areas of Burkina Faso) mask the health situation of Ouagadougou's poorest neighborhoods.

Burkina Faso Gauge Website

Summary:

In the next quarter-century, the majority of world population growth will take place in urban areas of developing countries. An increasing proportion of Africans live in overcrowded slums and shantytowns where health outcomes may resemble those found in inaccessible rural communities. Yet resources for further investment in urban health are severely constrained.

A partnership of organizations based in Ouagadougou, Burkina Faso is conducting a controlled trial to measure the impact of a low cost community health intervention on infant and child mortality and other health indicators in target urban communities.

To assess the impact of this intervention on health outcomes, the Initiative is establishing a Demographic Surveillance System, which visits each household in the focus urban zones every 3 months to obtain information about births, deaths and migration. This information is combined with findings from periodic surveys to assess trends in health practices and other intermediate indicators.

Apart from documenting the impact of the intervention on health outcomes, the Initiative develops, implements and documents the effectiveness of strategies that address several problems characteristic of many urban settings: a) how to mobilize heterogeneous and often divided urban neighbourhoods for effective health promotion; b) how to make the most cost-effective use of outreach in an urban setting; c) how to strengthen the quality and accessibility of popular private health services; d) without major additional investments, how to make best use of the large number of existing public health facilities and staff to provide key, life saving services; and e) how to provide for demographic surveillance of a mobile urban population.

The Initiative has the potential to provide an important research and action platform for evidence-based recommendations to address the health needs of the urban poor in Sub-Saharan Africa.

Measure inequalities in health, education, and housing and document the processes that influence them in Ouaga to document the level of disadvantage and health outcomes. Comparisons will be made among geographically small populations, between households of different SES, religion, ethnic groups, and between different types of household members (fostered/non-fostered children, boys/girls, etc.).

Primary data collection, we well as the design and implementation of an integrated, real time data collection and analysis system that allows longitudinal demographic information to be combined with panel surveys, focus groups, and in-depth interviews. The surveys are integrated, and include demographic information on individuals collected every three months as well as supplementary panel surveys on education, housing, health, migration, etc.

To date, the computer program for information management has been completed and tested in the field, and analysis of the information has been successfully used for a pilot intervention on malnutrition.

The team has the human resources and technical expertise to collect the data (primary or secondary). The base-line demographic information collection requires 15 days per zone, per researcher, every three months. The Gauge has 15 data collectors, 2 supervisors, 1 statistician (who also works in the field), and 1 programmer to undertake this work. For the nutrition panel study, the Gauge had 6 interviewers and 2 controllers to cover 650 households.

Highlight to government planners, bilateral donors, and the public that levels of health among the disadvantaged group in Ouaga are comparable to, if not worse than, the situation in many rural settings currently targeted for aid. Provide evidence-based urban health policy recommendations and strategies to the government and international aid decision makers.

Data collection: Interestingly, initial reaction suggests that the monitoring, using the pocket PCs, serves as a form of generating public participation and interest in the project and project issues because of its novelty.

Fact sheets: Dissemination of over a dozen fact sheets on equity in relation to the three sector areas (health, education, and housing) to a hundred workshop participants and partners (research institutes, ministries, local Government, NGOs, the press, radio and national television.

Workshop: Discussions with local stakeholders have shown that the term "equity in health" is sometimes used but that the concept's definition and programmatic implications need to be clarified before the stakeholders can fully contribute to the initiative (i.e. in its intervention and advocacy components). Stakeholders in Health and the local Government are therefore the first targets of our health advocacy efforts. Additionally, there is a need to demonstrate the importance of the concept in relation to rural/urban differences, and why local comparisons are useful.

The intervention strategies that will be tested will be tailored to the needs of the urban poor population, taking into account their survival strategies, financial resources, and context of decision-making at the household/family level.

Goals for community empowerment first include understanding the context of urban communities and networks in Ouagadougou, and then learning how to work with them and mobilize them around activities. Also, there is a need to strengthen concepts of community and population health within the public. The specific intervention strategies being developed by the Gauge are intended to directly support community empowerment.

Health:

  • Prevention and home management of malaria: Social marketing and education on the use of insecticide-impregnated bed nets and chloroquine management.
  • Maternal and child health: Pilot activities, working at the Health District Level, to integrate outreach activities from local clinics.
  • Childhood survival and nutrition: Integrated approaches, including a focus on diarrhea.
  • AIDS awareness: Among adolescents/young adults. The intervention will be based on research results regarding risk behaviors and attitudes
  • Increase standards of expectations for health access and quality (also employing concepts of human rights), to support increased use by the poor of formal providers, and to improve quality of health care services (patient/provider interface; cost of drugs).

Education: The education component includes a population based approach to education, longitudinal (to identify needs), and is school based. The Gauge will probably be advocating and working with the Ministry of Education later to build partnerships. Also doing qualitative studies on barriers to education. Survey to visit all the local schools, public and private. UERD received funding to create a GIS on education in Ouaga that has been used to analyze the spatial disparities in education and in health. It is currently implementing a study on the links between health and education among the urban poor at the household level (impact of disease on children's schooling, and strategies used to maintain educational objectives). It is also studying disparities between fostered and non-fostered children in the households.

Housing: Housing is the least developed component of the Gauge. For the moment, it is used as an indicator of socioeconomic status. Houses are followed longitudinally, so changes in habitat and ownership are followed.

Key People:

  • Banza Baya: PhD, demographer; expertise in Public Health and child mortality.
  • Christine Ouedraogo: PhD, sociologist; expertise in gender and childcare.
  • Bob Pond: MD; volunteer public health physician.
  • Hubert Dabire: PhD, demographer; expertise in migration.
  • Younoussi Zourkkaleini: 2-year Mellon Foundation Fellow, will be analyzing the
    Urban Migration and Assimilation database.
  • Mark Pilon: PhD, economist and demographer; specialist in family and schooling issues
    in West Africa.
  • René Dala: MSc in Demography, also Statistician and Epidemiologist.
  • Mamadou Niang: Computer programmer.
  • Abdramane Soura: Statistician.
  • Idrissa Ouili: Statistician.

Key Partners:

Photos:


The Burkina Faso Gauge Team


An informal zone in Ouagadougou

A relatively well-off neighbourhood

Malnutrition intervention in an informal zone

Demonstration of field data collection using the pocket PC

A Gauge sponsored community
outreach clinic for malnutrition.

Documents of Interest: