Table 2 Research methodsto evaluate the obstetric care subsidy policy in Burkina Faso, FemHealth project 2011–2013
Specific objective | Data | Timespan | Target population | Sample size |
|---|---|---|---|---|
Method/data collection | ||||
1. To determine if the introduction of the policy was followed by an increase of health services use, including facility-based delivery and caesarean section, and if the policy increased equity of access to health care | ||||
Secondary data analysis of: -Routine data on health service deliveries and caesareans collected through annual health statistics reports published by the Ministry of Health; -Four Demographic & Health Survey datasetscombined to provide delivery-based trends in obstetric care over the period 1988–2010. The analysis focused on whether women delivered within a health facility and by caesarean. Sampling weights and clustering were taken into account in the analysis | MoH routine data: 1992, 1998, and 2000 to 2010; DHS data: 1993, 1998–99, 2003, 2010 | 1988–2010 (no data for 2004) | Routine data: national coverage DHS: Women of reproductive age (15–49 years) with at least one live birth in the five years preceding the survey | Routine data: national coverage DHS: 36,836 women |
2. To analyze the costs incurred by the households during childbirth and collect the perception of people on the quality of services | ||||
Structured household interviews with women who had just delivered or their relatives, on average 7 days after discharge. Interviews were performed by 9 experienced trained interviewers. All completed questionnaires were checked by a researcher before being sent for data entry. | Collected information included the socio-demographic characteristics of the women, the delivery events, the costs supported by the household as well as pre-referral costs, and women’s opinion about the health services they received. | From May to November 2012 | Sampled women included: -All deliveries with near-miss complications or by Caesarean; -All deliveries with stillbirth, neonatal mortality or perinatal death under 7 days after birth occurring before discharge; -All deliveries with instrumental delivery or twins; - A sample of women with uncomplicated delivery which sub-sample size was indexed on that of the women with near-miss complication: half recruited in the hospitals and the remaining in health centers (one health center sampled per district) | A total of 1609 household interviews: 361, 165, 281, 235, 302, 265 in Banfora, Bogandé, Gaoua, Houndé, Orodara, and Yako, respectively, including 51, 52, 34, 41, 48, and 37from the six health centres |
3. To evaluate the effects of the policy on the health system at district level (including both targeted and non-targeted health services), to examine potential changes induced by the introduction of the policy on the work patterns and motivation of health workers, and to assess the financing, financial effects on facilities and sustainability of the policy | ||||
Data extraction from hospital registers and reports | Health District routine data and hospital register | Data extraction from 2005 to 2011 | OPD clinics and Admission in the different unit (surgery, medicine, pediatric, OB/GYN), lengthof stay, lethality rate, human resources, | Outpatient and In Patient data of 6 hospitals |
Semi-structured interviews with district key informants (health workers in maternity ward, block, peripheral health centres, administrators, and beneficiaries). Selected participants profile related to their involvement in the policy care provision in local health system and other community representatives and beneficiaries. Interviews were conducted by two experienced socio-anthropologists | Semi-structured interviews | From May to November 2012 | Institutional leaders, administrators, health workers in maternity and surgical wards, beneficiaries (district and regional hospitals); staff head of units and community representatives (peripheral health centres) | 57 semi-structured interviews |
Structured interviews with health workers randomly sampled in all categories working in the hospital maternity, block or pediatrics wards (physicians, midwives, nurses, etc.), with the number of interviews per district weighted according to the size of the population of health workers in each district (number ranging from 16 in Bogandé to 29 in Orodara); interviews conducted by a sociologist. | Structured interviews | From October to December 2012 | District health workers in maternity ward, block, peripheral health centres, administrators, and beneficiaries | 130 structured interviews |
Structured analysis of secondary financial data from national, district and facility levels | Extraction of financial data into spreadsheet | March- August 2012 | Financial information systems at national level, in six study districts and selected facilities (13 in total). | National level, six districts, 1 university hospital, 2 regional hospitals, 4 district hospitals and 6 health centres. |
4. To document the effect of the policy on severe maternal and neonatal morbidity and on quality of care | ||||
Data extraction from the hospital medical records of the women (the same as for the household interviews above, but no extraction for women sampled in peripheral health centres) Data extraction performed by three trained health workers per hospital (including two in the maternity ward and one in pediatrics), using a standardized template. All completed extraction templates were checked by a researcher before being sent for data entry. | Medical records of the women and their babies | From May to November 2012 | Data extraction for: -all womenwith near-miss with complications or C-section; -all women with stillbirth, neonatal mortality or perinatal death under 7 days after birth occurring before discharge; -all women with instrumental delivery or twins; -sample of women with uncomplicated delivery (sample size indexed on that of the women with near-miss complication): half recruited in the hospitals and the remaining in health centers (one health center sampled per district) - all women with maternal death. | 1752 mothers and 182 infants. |