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Home » Burkina Faso » Glossary
Glossary
» Bamako Initiative
» Female Circumcision
» CM - Centre Médical
» CSPS - Centre de Santé et de Promotion Sociale
» Dispensaire
» HIV - Prevalence
» Infectious Diseases
» Maternity Ward
» PSP - Poste de Santé Primaire
» Demographic Pressure
Bamako Initiative
Bamako, the capital of Mali in West Africa, was venue for a WHO (World Health Organisation) conference in 1988. Delegates were searching for a solution to the looming financial crisis of healthcare institutions in developing countries. Result of this endeavour was the Bamako Initiative, a programme targeting a stronger involvement of affected populations into the financial support of healthcare institutions.
Burkina Faso started to implement the Bamako recommendations through the establishment of Comités de Gestion or Management Committees for rural PHC institutions such as CSPS or CM. The Committees are elected by the population. Its task include setting prices for treatments and drugs and the supervision of the proper functioning of the institution and in particular its pharmaceutical depot. Accountability to the community is thereby ensured.
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Female Circumcision
Female genital mutilation or excision is a still widely practised custom across the African continent and is particularly widespread in West Africa. According to a recent UNO study, an estimated 72% of women in Burkina Faso have been circumcised. During the procedure, clitoris and sometimes the inner labia of young girls are cut out, often under appalling hygienic conditions such as by using broken glass or razor blades. The resulting wounds generally heal badly if at all, and are often a lifelong source of infections.
Many still believe that a women who has not been circumcised will have difficulties finding a husband. Mothers therefore often force their daughters to be circumcised. Men usually have little if any awareness of the problem and detailed knowledge of the operation or its consequences generally lack completely.
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CM - Centre Médical
Medical Centres are hospital in larger towns, covering a population of 20-30,000. Most centres - similar to the lower layer of CSPS - consist of a Dispensaire and a maternity ward (Maternité), albeit usually in a larger layout. In addition, many CM have an attached operating theatre, a so-called Antenne Chirurgicale.
Usually situated in District Centres, CM are often attached to the national power grid and sometimes have an ambulance, to transport severe cases.
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CSPS - Centre de Santé et de Promotion Sociale
Bush hospitals or CSPS usually consist of a general medical unit - the dispensary or Dispensaire - and a maternity ward or Maternité. Staff is trained and paid by the state and usually consist of a barefoot doctor or paramedic, a midwife, a pharmacist and up to five assistants.
Full integration of both general medical and obstetric activities is paramount as the maternity ward cross-subsidises the dispensary: expenses of material intensive interventions such as treating wounds with dressings are compensated by labour intensive services performed by the midwife and her assistants. Solitary dispensaries are therefore rare, as such a facility can hardly be sustainable.
CSPS generally are the highest level of medical care available in most rural areas of Burkina Faso and usually cover a population of c. 8-15,000. A government programme states that every Burkinabč shall have access to a CSPS within 10.5km (7 miles). This has so far been realised in 18 of the country's 30 provinces.
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Dispensaire
Dispensaries are the general medical units of CSPS, the medium layer of rural PHC institutions in Burkina Faso. A dispensary is headed by a barefoot doctor or paramedic, who also has overall responsibility of the CSPS.
In addition to the paramedic, a dispensary usually has three to five nurses or aides and a pharmacist who sells drugs and medical materials such as dressings to patients at regulated prices. Almost all conditions are treated in a dispensary, only severe cases are referred to the next level, the Medical Centres or CM. In a 1995 study the Ministry of health counted 760 dispensaries, of which 132 operated without an attached maternity ward.
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HIV - Prevalence
Estimates of HIV prevalence in Burkina Faso vary between 5 and up to 30 percent, depending on the population group. In a recent study, UNAIDS estimates that between 6.4 and 7.2 percent of adults in Burkina are HIV positive - the third highest level in West Africa. Whatever the real prevalence rate, since the early Nineties HIV/AIDS has rapidly become an increasingly urgent problem. However, Burkina Faso is far from the catastrophic situation in Botswana, Uganda or South Africa, but co-ordinated sensitisation campaigns and educational measures are almost lacking completely. Experts believe that the rate of new infections is far from
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Infectious Diseases
In contrast to the industrialised world, the main cause for mortality in Africa are infectious diseases. In addition to well known conditions such as cholera, yellow fever, malaria or typhus, the continent suffers from numerous other obscure infections, but also those that have been long eradicated in the West such as polio or leprosy.
A combination of many smaller, singularly banal, infections and malnutrition however is the most frequent condition and often fatal. For the last decade, HIV/AIDS has become an increasing problem and claimed many victims.
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Maternity Ward
Maternity wards or Maternités are obstetric units and - together with a dispensary - form a CSPS or rural health centre. The maternity ward is managed by a midwife. In addition to deliveries and the corresponding ante- and postnatal exams, the obstetric staff frequently carries out sensitisation and awareness building campaigns covering topics such as HIV prevention and family planning. In collaboration with their colleagues of the dispensary, staff carry out immunisation campaigns. The Ministry of Health counted 664 maternity wards in Burkina Faso in 1995, of which 16 were without a corresponding dispensary.
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PSP - Poste de Santé Primaire
Health posts or PSP are the most basic rural healthcare institution. Based on the programme '10,000 villages - 10,000 PSP' the government of Burkina Faso tried to establish a health post in every village during the Eighties. Between 1984 and 1987 a total of 6,495 posts were established, of which only a handful are still operative. The model based on volunteers was not sustainable and the posts quickly suffered from lacking materials and drugs. During the modernisation of the country in recent years, only the state sponsored CSPS have survived. The provision of healthcare services to the rural population however has suffered as a result: A CSPS should ideally cover a perimeter of 10.5km. Only 18 of the country's 30 provinces have a sufficiently dense network of institutions to meet this figure.
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Demographic Pressure
According to the UN Population Fund UNFPA, population density in Burkina Faso averages 38 inhabitants per square kilometre, about 20% lower than the corresponding figure for Austria. This average however hides a considerable bias towards urban areas: population density ranges from 11 inhabitants per sq.km in the East of the country to 122 in the centre.
The population of currently c. 12 million grows by 2.7% annually - this means a doubling of the population in 2030, not considering the effect of the HIV/AIDS pandemic. Every women in Burkina gives birth to 6.8 children - a figure directly correlated to the high child mortality of 105 in 1000 live births.
All those factors suggest a serious aggravation of the current situation in the near future. In addition, migration will further increase demographic pressure on the centre while the periphery will become increasingly depopulated.
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