Authors: Issa Kaboré, Orokia Sory, Charlemagne Tapsoba, Yamba Kafando, Joël Arthur Kiendrébéogo

Following the adoption of decentralization as the preferred method of territorial administration under the Constitution of 2nd June 1991, Burkina Faso introduced the General Code of Territorial Authorities in 2004, which defines eleven (11) areas of authority to be transferred to territorial authorities. With regard to the health sector, the transfer took place in 2010 and covers two areas of authority: (i) Construction, standardization and rehabilitation of basic health facilities; (ii) Coverage of recurrent costs of basic health facilities, including (a) Fuel for medical evacuations, (ii) Gas for the cold chain, (iii) Other sources of energy, (iv) Office supplies, (v) Maintenance equipment and products, (vi) Protective equipment, (vii) Small medical and technical equipment, (viii) Specific printed material, (ix) Medicines and medical consumables, (x) Vehicle maintenance, (xi) Maintenance and repair of buildings.

From 2010 to 2020, a total sum of 49,796,980,605 CFA francs (about US$90 million) has been transferred to local authorities to fund these two areas of responsibility. Between 2017 and 2020, the local authorities used transferred resources to build and develop infrastructures, including 63 health centres, 167 maternity units, 328 housing units, 338 latrines, 119 boreholes, 127 pharmaceutical depots and 191 incinerators, all at a cost of 13 528 920 897 CFA francs (about US$24 million). At the same time, many basic health facilities were upgraded. A decade after the effective transfer of powers and resources by the Ministry of Health to local authorities, this report takes stock of the achievements and difficulties in the implementation of the transfer of powers and identifies prospects for improving the process.

Noble goals at the beginning…

The objective of the transfer of authority and resources from the Ministry of Health to local and regional authorities is to provide accessible health services that are adapted to the needs of the local population. This measure is intended to give local elected leaders, who are in direct contact with the community, the opportunity to effectively identify the priority health infrastructure and equipment needs of their localities, to enable fair and effective investment of the allocated resources. The measure also makes it possible to evaluate in real time the needs of health facilities in terms of equipment and consumables and to purchase them in order to avoid stock-outs that could compromise the quality of care offered to the people.

The transfer of authority to local and regional authorities also aims at increasing people’s participation in decisions affecting their health and reducing barriers in the implementation of certain investments. Indeed, it is not uncommon for local communities to contest the choice of a site for the construction of a health facility, or to refuse to go to a health facility because they were not involved in the choice of the site, which is sometimes a sacred site. Since the local elected leaders come from the same area and have a good understanding of the socio-cultural realities at the community level, it is possible to anticipate these contestations and therefore find a way of reducing their occurrence. Similarly, involving the public in the implementation would secure the investments more and encourage good will to support community-based actions. Such support could, for example, take the form of community work, in-kind or cash contributions for the construction of infrastructure and or for the acquisition of medical equipment and consumables. For example, in several localities within the country, local communities are constructing and equipping health facilities in support of local authorities.

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