Burkina Faso

Background

Photo: Toby Madden / MMV

Malaria remains a major public health problem in Burkina Faso. According to the annual national health statistics (SNIS), malaria accounted for 38% of consultations, 63% of hospitalizations, and 18% of deaths in health facilities in 2022. Pregnant women and children under 5 are the most vulnerable groups. From a socioeconomic point of view, malaria constitutes a real obstacle to sustainable human development due to its impact on life expectancy, children’s education, productivity, family and national savings.

Several factors contribute to the persistence of malaria in Burkina Faso, including low levels of access to sanitation, declining antimalarial drugs and resistance of vectors to insecticides, and unfavourable attitudes and practices among the population.

During the last decade, Burkina Faso has made the control of malaria a major national priority through demonstrated political will and subscription to global initiatives to combat malaria such as the HBHI approach, the “Zero malaria, I’m committed” initiative, and the initiative for the malaria elimination in the Sahel (SaME).  

To reflect its political will and commitment to accelerate progress in the fight against malaria, the Government established the PNLP in 2022 as the Permanent Secretary for Malaria Elimination by 2030 (SP/Palu). The SP/Palu guides control efforts through strategic plans developed per the National Health Development Plan.

The major interventions carried out are among others: · Universal coverage with LLINs (one for every two people). In 2022–2023, more than 14 million new generation LLINs (PBO, IG2) were distributed in 68 out of 70 districts. · Free seasonal malaria chemoprevention (SMC) campaign for children aged 3–59 months during the transmission season. In 2022, 4.1 million children (94%) benefited from SMC. · In 2016, Burkina Faso adopted a free healthcare policy for children under 5 and pregnant women, explaining the relatively low related mortality.  

SMC implementation areas in Burkina Faso in 2020

Photo: NMCP of Burkina Faso
Burkina Faso # of children targeted # of children reached Coverage
Cycle 1 870913 921313 106%
Cycle 2 4074994 4227478 104%
Cycle 3 4176404 4398248 105%
Cycle 4 4295129 4498912 105%
Cycle 5 4405326 4557932 103%
Children receiving at least 4 cycles 4227478 3,916,450 93%

Data from the NMCP of Burkina Faso

Coverage and compliance monitoring for the 2020 SMC season

Monitoring for coverage

  • Daily data collection and transmission by structure :

- health facility level: summary of data from field teams
- District level: data entry for each field team in the SMC input column 
- DRS level: summary of district data in the SMC input column 
- Central level: reconciliation of the data from the regions with the data of districts;

  • Supervision and rapid survey
  • Supervision is carried out by teams at all levels (CSPS, Districts, Regions, Central).
  • The different teams check the effectiveness of the campaign implementation and coverage of all areas.
  • Independent monitoring is done in the form of a household survey carried out in each district. This makes it possible to ensure that the various concessions have been effectively visited by the DC and that the targeted children have had the drugs.

Monitoring for compliance

  • Adherence to treatment is assessed through the rapid survey and household survey:
  • The rapid survey is carried out from the 2nd day of each visit by the teams of supervision of each level (CSPS, district, regional and central) in 10 concessions of the locality. This makes it possible to check the taking of the drugs of the 2nd and 3rd day.
  • The household survey is carried out by independent monitors after the 1st and the fourth pass. It makes it possible to check the taking of medicines at home by the children for the different passages through the filling of cards, the presence of empty platelets
  • In the 23 DS supported by MC, this monitoring (LQAS survey) is performed 3 times after each cycle.
  • In 2020, 10 experienced districts 3 outlets supervised by distributors community. If done well, it solves the problem of compliance by mothers.

Monitoring of efficacy

  • The effectiveness of SMC is assessed through routine data and surveys:
    - routine data collected and entered weekly or monthly, making it possible to follow the evolution of malaria cases and deaths in time
  • Prevalence surveys make it possible to locate the level of the prevalence of malaria in the country through population data in community

Successes and challenges for the 2020 SMC season

Successes

  • Quantification of inputs (SP+AQ) taking into account targets per pass;
    • Consideration of children entering during the campaign;
    • Adjustment of platelets, taking into account shifts from the 3-11 month age group to the 12-59 month age group between rounds;
  • Micro plan by structure (PNLP, DRS, DS) based on a resource quantification file (human, material);
    • Optimal harmonization of campaign activities in all DS and DRS;
    • Signature of agreements between each structure and the support partners;
    • Accountability of each structure in the conduct of activities;
  • Consensual annual review of SMC tools taking into account adaptations to the current context;
    • Consideration of new data on COVID both in training modules and in tools for supervision, survey, data collection, supply, communication…;
    • Availability of harmonized and consensual tools in all districts;
  • Development of a COVID contingency plan;
    • Consideration of the adaptation of SMC strategies to the COVID context (training, meetings, drug administration, supervision, communication, community surveys, etc.);
    • Securing the implementation of the campaign in the COVID context (protection of actors and populations);

Actions taken

  • Consensual annual review of SMC tools taking into account the adaptations to the context of the moment;
  • Take into account new data on COVID-19 both in the training modules and in supervision tools, survey, data collection, supply, communication;
  • Availability of harmonized and consensual tools in all districts;
  • Development of a COVID-19 contingency plan;
  • Taking into account the adaptation of SMC strategies to the COVID-19 context (training, meetings, medication administration, supervision, communication, community surveys, etc.);
  • Securing the implementation of the campaign in the COVID context (protection of actors and populations)

Challenges

  • Internally Displaced Populations (IDPs);
  • Effective administration of doses to children in areas under permanent threat from armed men;
  • Coordination of the effective implementation of the campaign in areas where health facilities are closed.

Solution proposed / put in place

  • Consideration of internally displaced populations in the planning and implementation of the campaign;
  • Development of strategies for adapting the implementation of the campaign in the context of insecurity.

Research priorities for 2020

  • Boost the impact of SMC through screening and simultaneous processing of displaced children in Burkina Faso
  • Evaluation of a combined strategy SMC + supplementation of Plumpy’DozTM and Vitamin A coupled with zinc for the prevention of malaria and malnutrition in Burkina Faso
  • Improving SMC coverage by identifying and taking into account the determinants of low performance in Burkina Faso.
  • Increase in the coverage of Intermittent Preventive Treatment using Sulfadoxine-Pyrimethamine in pregnant women through the SMC channel

Partners

  • CRSN
  • Centre national de recherche et de formation en paludisme de Nanoro