Accessibility and utilisation of delivery care within a Skilled Care Initiative in rural Burkina Faso
Article first published online: 10 JUN 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Tropical Medicine & International Health
Special Issue: An Evaluation of Skilled Care at Delivery in Burkina Faso
Volume 13, Issue Supplement s1, pages 44–52, July 2008
How to Cite
Hounton, S., Chapman, G., Menten, J., De Brouwere, V., Ensor, T., Sombié, I., Meda, N. and Ronsmans, C. (2008), Accessibility and utilisation of delivery care within a Skilled Care Initiative in rural Burkina Faso. Tropical Medicine & International Health, 13: 44–52. doi: 10.1111/j.1365-3156.2008.02086.x
- Issue published online: 10 JUN 2008
- Article first published online: 10 JUN 2008
- skilled care Initiative;
- health care access;
- health care utilisation;
- delivery care;
- Burkina Faso
Objectives The Skilled Care Initiative (SCI) was a comprehensive skilled attendance at delivery strategy implemented by the Ministry of Health and Family Care International in Ouargaye district (Burkina Faso) from 2002 to 2005. We aimed to evaluate the relationships between accessibility, functioning of health centres and utilisation of delivery care in the SCI intervention district (Ouargaye) and compare this with another district (Diapaga).
Methods Data were collected on staffing, equipment, water and energy supply for all health centres and a functionality index for health centres were constructed. A household census was carried out in 2006 to assess assets of all household members, and document pregnancies lasting more than 6 months between 2001 and 2005, with place of delivery and delivery attendant. Utilisation of delivery care was defined as birth in a health institution or birth by Caesarean section. Analyses included univariate and multivariate logistic regression.
Results Distance to health facility, education and asset ownership were major determinants of delivery care utilisation, but no association was found between the functioning of health centres (as measured by infrastructure, energy supply and equipment) and institutional birth rates or births by Caesarean section. The proportion of births in an institution increased more substantially in the SCI district over time but no changes were seen in Caesarean section rates.
Conclusion The SCI has increased uptake of institutional deliveries but there is little evidence that it has increased access to emergency obstetric care, at least in terms of uptake of Caesarean sections. Its success is contingent on large-scale coverage and 24-h availability of referral for life saving drugs, skilled personnel and surgery for pregnant women.