Geography
Burkina Faso (literally means country of “Upright people”) is a francophone country located in the middle of West Africa. The country is land-locked surrounded by Cote d’Ivoire, Ghana, Benin and Togo in the South, by Mali in the north-west and by Niger in the North-eastern part as shown by figure 4. Burkina covers an area of 274 200 Km2 with a Sudanese savannah climate in the South-western part and an almost desert-like climate in the Northern part (Sahel). Its current population is estimated at 14.1 millions (Burkina Faso 2009) predominantly rural (81%), with a higher proportion of females (52%). The country got its formal independence from France in 1960 but still has strong links with this country both in economic, political and cultural aspects.
Today the country is organized into 13 administrative regions and 45 provinces.
Figure 4: Geographic location of Burkina in West Africa (a mainland country)
(Source: INSD, 2009 Report)
Economics
Burkina Faso is one of the poorest countries in the world (UNDP 2008) and was ranked at 173/179 in 2008 with more than 46% of its population living below the international poverty line of 1.25 US per day (The World Bank 2009). The country does not have any substantial natural resources like oil, gold, diamonds, forest or sea. Small gold mines are scattered around the Central Eastern part and a
manganese deposit is yet to be exploited in the Northern part of Burkina. The main resources of the country come from agriculture and livestock that represent 45% and 16% of the gross domestic product (GDP), respectively. The gross national income (GNI) per capita was estimated at 430 US in 2007 (UNICEF 2009). The life expectancy at birth was at 52 years in 2007 (UNICEF 2009).
Demography and health
The population annual growth rate was estimated at 3 per 1000 in 2007 with a crude birth rate of 44 per 1000 for the same year. The crude death rate in Burkina was at 15 per 1000 in 2007 (UNICEF 2009) as outlined in table 4.
Illiteracy is a great problem in the country with a total adult literacy just at 29% and a net primary school attendance rate of 47% (UNICEF 2009).
From the health perspective, only 72% of the population have access to safe drinking water with a lower proportion in rural areas (66%).
In terms of health indicators Burkina has very high rates of morbidity with a crude morbidity rate at 5.8% (Burkina Faso(b) 2008) and a high crude mortality of 15 per 1000 (Burkina Faso 2009), similar to many other low-income countries.
Child mortality and morbidity are certainly among the worst in this region of Africa.
Indeed the country stands at the sad rank of having the 7th highest under-five year mortality rate, estimated to be 191 per thousand live births in 2007 (UNICEF 2009).
In the same period, the infant mortality rate was 104 per thousand live births, and a neonatal mortality rate of 32 per thousand live births (UNICEF 2009).
Despite timid progress in the trends of child health, the situation is still alarming.
The main causes of child deaths are malaria, pneumonia, meningitis and diarrhoea.
Malnutrition is an underlying cause in more than 70% of the cases.
The country still continues to experience outbreaks of meningitis and measles almost every year and meningitis is responsible for 12% of the deaths among the under-five year olds.
The causes of morbidity are very similar with malaria representing the first reason (53%) for hospitalization in health facilities followed by acute respiratory infections (14%), meningitis (8%), diarrhoea (3%), malnutrition (2%) and other diseases like measles and HIV infection (Burkina Faso(a) 2008).
Among the under-five year olds, severe malaria is responsible for as many as 60% of the hospitalizations.
Despite large immunization coverage (99%) for most of the antigens, the infant mortality rate remains very high (104 per 1000 in 2007) raising a lot of questions about the reliability of this immunization coverage and the quality of the vaccines.
From the maternal health perspective, the situation is not brilliant with a maternal mortality ratio of over 484 per 100 000 live births (an adjusted rate at 700 in 2005), a low contraceptive use (17%) and a high home delivery rate (50%). The attendance of antenatal clinics seems acceptable with antenatal care coverage of 85% for one ANC visit (UNICEF 2009).
The broad reasons of maternal deaths include reduced access to health facilities, delay in reaching the health services, poverty and illiteracy, and lack of emergency obstetric care. The medical causes of maternal deaths are bleeding (haemorrhages), bacterial infections (sepsis), malarial anaemia, placental retention, and uterine rupture for higher multigravidae or long standing deliveries.
Malnutrition is another health challenge faced by Burkina Faso. The prevalence of low birth weight is at 16% with an exclusive breastfeeding rate of 19% at 3 months and 7% at 6 months (Burkina Faso 2004; UNICEF 2009). The prevalence of stunting among children under-five years was at 35% and that of wasted at 23% in 2007. The proportion of children from the same age group suffering from under-weight was at 32% for the same period and it was estimated that 73% of them got full supplementation of vitamin A (UNICEF 2009).
HIV infection has emerged in the late 1990s and has become a public health problem with an estimated prevalence of 7.1% in the general population in 1997. A strong involvement of the national health authorities has led to a substantial decrease of the HIV prevalence that was estimated at 1.6% in 2007 (UNICEF 2009) among the 15-49 years. The annual number of people living with HIV was roughly 130 000 in 2007, of which 10 000 were below 15 years (UNAIDS 2008).
Table 4: Summary of main health indicators of Burkina Faso from 1990 to 2007
Health indicators 1990 2003 2007
Crude death rate (/1000) 18 17 15
Under-5 year olds mortality rate (/1000) 206 197 191
Infant mortality rate (/1000) 112 103 104
Maternal mortality ratio (/100 000) 566 484 480
HIV-prevalence among 15-49 year olds (%) 7.1 2.7 1.6 Causes of hospitalisation among < 5 year olds (%)
Malaria 38 63 60
Acute respiratory infections 20 10 13
Meningitis 16 6 9
Diarrhoea 20 4 4
Malnutrition 6 3 2
Sources: MoH/BF, INSD/2009, SOWC/2009
Organization of the health system and the health care
The health system is organized within the 13 administrative regions and 63 health districts with at the top of the system, the Ministry of Health and its central directorates. The health care follows closely the health system organisation in a three-level infrastructure. The university hospitals (two in Ouagadougou and one in Bobo-Dioulasso) are the most well equipped with experts in health care and clinical practice; at the intermediate level, there are 13 regional referral hospitals and the peripheral health facilities is formed both by the health districts (63) and primary health care facilities (1268). Large immunization programme has been operating in the country since 1970. Immunization was an intensive activity during the
“revolutionary power” between 1983 and 1987 with massive “alpha commando”
campaigns involving the national army.
The country has also several vertical disease control programmes, established by the Ministry of Health in collaboration with partners like the WHO, European and American institutions, and regional African organs.
The most active of these programmes are the national HIV/AIDS control programme, the national malaria control programme, and the national tuberculosis control programme.
Burkina ratified the millennium development goals (MDG) convention in 2001.
The health policy is organized by the Ministry of Health and local communities are involved in some ways in the implementation of many health-related activities based on Alma-Ata and the Bamako initiative recommendations.