Références bibliographiques

Carabali Mabel, Pérez Dennis, Degroote Stephanie, Reyes Alicia, Kaufman Jay S. et Ridde Valery (2020) « Towards a better integration of social sciences in arbovirus research and decision-making: an experience from scientific collaboration between Cuban and Quebec institutions », Global Health Promotion (août 14), p. 175797592094385. DOI : 10.1177/1757975920943859. http://journals.sagepub.com/doi/10.1177/1757975920943859.

Résumé : In 2017, the Institute of Tropical Medicine Pedro Kourí, University of Montreal Public Health Research Institute, and McGill University joined efforts to provide scenarios for scientific exchange and knowledge dissemination about the social science contribution on arboviral research. This commentary describes the scientific collaboration between Cuban and Canadian (Quebec) institutions, illustrating the need and opportunities to facilitate research and effective decision-making processes for arboviral prevention and control, going beyond traditional biomedical aspects. We organized a set of scientific activities within three international events conducted in Cuba between 2017 and 2018. Given the collaborating institutions’ expertise and the knowledge gaps in arboviral research, we selected three main thematic areas: social determinants and equity, community-based interventions and use of evidence for decision-making. The partnership shows that interdisciplinary collaboration and the use and integration of quantitative and qualitative methods from the social sciences is essential to face the current challenges in arbovirus research.

Carillon Séverine, Gosselin Anne, Coulibaly Karna, Ridde Valery et Desgrées du Loû Annabel (2020) « Immigrants facing Covid 19 containment in France : An ordinary hardship of disaffiliation », Journal of Migration and Health, 1-2, p. 100032. DOI : 10.1016/j.jmh.2020.100032. https://linkinghub.elsevier.com/retrieve/pii/S2666623520300325.

Résumé : In order to limit the spread of the SARS-CoV-2 virus, the majority of governments have introduced population containment. Certain population groups, including immigrants in precarious situations, are experiencing the impact of this measure in a brutal manner. This article is based on accounts of containment experiences collected by telephone within the framework of a pre-existing intervention research carried out among immigrants to France from Sub-Saharan Africa who are in a precarious situation. It highlights certain social effects of containment and the logics at work in the precarious situations. This research shows how this a priori unprecedented situation affects individual capacities to act and generates a ‘disaffiliation process’ causing individuals to shift towards ‘social non-existence’, repeating lived experiences and exacerbating pre-existing logics. The ordeal of containment proves to be an ordinary experience for these individuals.

Cloos Patrick, Ndao Elhadji Malick, Aho Josephine, Benoît Magalie, Fillol Amandine, Munoz-Bertrand Maria, Ouimet Marie-Jo, Hanley Jill et Ridde Valéry (2020) « The negative self-perceived health of migrants with precarious status in Montreal, Canada: A cross-sectional study », éd. par Luisa N. Borrell, PLOS ONE, 15 (4) (avril 9), p. e0231327. DOI : 10.1371/journal.pone.0231327. https://dx.plos.org/10.1371/journal.pone.0231327.

Résumé : Background Knowledge about the health impacts of the absence of health insurance for migrants with precarious status (MPS) in Canada is scarce. MPS refer to immigrants with authorized but temporary legal status (i.e. temporary foreign workers, visitors, international students) and/or unauthorized status (out of legal status, i.e. undocumented). This is the first large empirical study that examines the social determinants of self-perceived health of MPS who are uninsured and residing in Montreal. Methods and findings Between June 2016 and September 2017, we performed a cross-sectional survey of uninsured migrants in Montreal, Quebec. Migrants without health insurance (18+) were sampled through venue-based recruitment, snowball strategy and media announcements. A questionnaire focusing on sociodemographic, socioeconomic and psychosocial characteristics, social determinants, health needs and access to health care, and health self-perception was administered to 806 individuals: 54.1% were recruited in urban spaces and 45.9% in a health clinic. 53.9% were categorized as having temporary legal status in Canada and 46% were without authorized status. Regions of birth were: Asia (5.2%), Caribbean (13.8%), Europe (7.3%), Latin America (35.8%), Middle East (21%), Sub-Saharan Africa (15.8%) and the United States (1.1%). The median age was 37 years (range:18–87). The proportion of respondents reporting negative (bad/fair) self-perception of health was 44.8%: 36.1% among migrants with authorized legal status and 54.4% among those with unauthorized status (statistically significant difference; p<0.001). Factors associated with negative self-perceived health were assessed using logistic regression. Those who were more likely to perceive their health as negative were those: with no diploma/primary/secondary education (age-adjusted odds ratio [AOR]: 2.49 [95% CI 1.53–4.07, p<0.001] or with a college diploma (AOR: 2.41 [95% CI 1.38–4.20, p = 0.002); whose family income met their needs not at all/a little (AOR: 6.22 [95% CI 1.62–23.85], p = 0.008) or met their needs fairly (AOR: 4.70 [95% CI 1.21–18.27], p = 0.025); with no one whom they could ask for money (AOR: 1.60 [95% CI 1.05–2.46], p = 0.03); with perception of racism (AOR: 1.58 [95% CI 1.01–2.48], p = 0.045); with a feeling of psychological distress (AOR: 2.17 [95% CI 1.36–3.45], p = 0.001); with unmet health care needs (AOR: 3.45 [95% CI 2.05–5.82], p<0.001); or with a health issue in the past 12 months (AOR: 3.44 [95% CI 1.79–6.61], p<0.001). Some variables that are associated with negative self-perceived health varied according to gender: region of birth, lower formal education, having a family income that does not meet needs perfectly /very well, insalubrious housing, not knowing someone who could be asked for money, and having ever received a medical diagnosis. Conclusions In our study, almost half of immigrants without health insurance perceived their health as negative, much higher than reports of negative self-perceived health in previous Canadian studies (8.5% among recent immigrants, 19.8% among long-term immigrants, and 10.6% among Canadian-born). Our study also suggests a high rate of unmet health care needs among migrants with precarious status, a situation that is correlated with poor self-perceived health. There is a need to put social policies in place to secure access to resources, health care and social services for all migrants, with or without authorized status.

Coulibaly Abdourahmane, Gautier Lara, Zitti Tony et Ridde Valéry (2020) « Implementing performance-based financing in peripheral health centres in Mali: what can we learn from it? », Health Research Policy and Systems, 18 (1). DOI : 10.1186/s12961-020-00566-0. https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020-00566-0.

Résumé : IntroductionNumerous sub-Saharan African countries have experimented with performance-based financing (PBF) with the goal of improving health system performance. To date, few articles have examined the implementation of this type of complex intervention in Francophone West Africa. This qualitative research aims to understand the process of implementing a PBF pilot project in Mali's Koulikoro region.MethodWe conducted a contrasted multiple case study of performance in 12 community health centres in three districts. We collected 161 semi-structured interviews, 69 informal interviews and 96 non-participant observation sessions. Data collection and analysis were guided by the Consolidated Framework for Implementation Research adapted to the research topic and local context.ResultsOur analysis revealed that the internal context of the PBF implementation played a key role in the process. High-performing centres exercised leadership and commitment more strongly than low-performing ones. These two characteristics were associated with taking initiatives to promote PBF implementation and strengthening team spirit. Information regarding the intervention was best appropriated by qualified health professionals. However, the limited duration of the implementation did not allow for the emergence of networks or champions. The enthusiasm initially generated by PBF quickly dissipated, mainly due to delays in the implementation schedule and the payment modalities.ConclusionPBF is a complex intervention in which many actors intervene in diverse contexts. The initial level of performance and the internal and external contexts of primary healthcare facilities influence the implementation of PBF. Future work in this area would benefit from an interdisciplinary approach combining public health and anthropology to better understand such an intervention. The deductive-inductive approach must be the stepping-stone of such a methodological approach.

Coulibaly Karna, Gosselin Anne, Ravalihasy Andrainolo, Carillon Séverine, Ridde Valéry, Derche Nicolas, Mbiribindi Romain, Desgrées du Loû Annabel et Makasi Study Group and the (2020) « Atteindre les populations exposées à l’infection VIH en France : apport de l’approche communautaire développant « l’aller-vers » » (poster), présenté à , Faculté de Médecine Sorbonne Universités, Paris, France. https://transversalmag.fr/ressources/documents/1/8d53143-1144-JSS2020_Programme_VF_1.PDF.

Dagenais Christian, Hébert Catherine et Ridde Valéry (2020) Video As An Effective Knowledge Transfer Tool to Increase Awareness Among Health Workers and Better Manage Dengue Fever Cases., Preprint, In Review. https://www.researchsquare.com/article/rs-105416/v1.

Résumé : Abstract Background context. For a patient with dengue fever, a wrong diagnosis can be fatal. Very few Burkinabé health workers are properly trained to diagnose and treat cases of dengue fever. Recent outbreaks of dengue fever in Burkina Faso, which is also carrying a significant malaria burden, have made updating health workers’ knowledge an urgent matter. Method. Following a trial to determine the most appropriate format, a video was specially developed as a knowledge translation tool to update health workers’ knowledge. We posted a training video online for front-line medical staff. In four months, it was viewed by 2,993 people. We conducted a qualitative evaluation using the theory of planned behaviour. Twenty interviews were conducted with health professionals who had viewed the video. A content analysis was performed. Results. The use of the knowledge contained in the video was mainly influenced by the fact that its format was adapted to the target audience, that it presented specific and concise information, that it conveyed a relevant message in everyday language, and that the context was one of urgency. Conclusion. The development of video as a knowledge translation tool is an effective and efficient way to update health workers’ knowledge and influence their practices. Users received the video enthusiastically because of the epidemic context.

Dagenais Christian et Ridde Valéry (2020) « Le transfert des connaissances scientifiques, « c’est bien, mais c’est pas encore arrivé… » », Revue francophone de recherche sur le transfert et l’utilisation des connaissances (août 12), p. Vol. 4 No 1 (2020). DOI : 10.18166/TUC.2020.4.1.16. https://revue-tuc.ca/index.php/accueil/article/view/16.

Résumé : Éditorial du numéro 1, volume 4 de la Revue Tuc, Revue francophone de recherche sur le transfert et l’utilisation des connaissances.

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Dumont Alexandre, Betrán Ana Pilar, Kaboré Charles, de Loenzien Myriam, Lumbiganon Pisake, Bohren Meghan A., Mac Quoc Nhu Hung, Opiyo Newton, Carroli Guillermo, Annerstedt Kristi Sidney, Ridde Valery, Escuriet Ramón, Robson Michael, Hanson Claudia et The QUALI-DEC research group (2020) « Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial », Implementation Science, 15 (1) (décembre). DOI : 10.1186/s13012-020-01029-4. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-01029-4.

Résumé : Background While cesarean sections (CSs) are a life-saving intervention, an increasing number are performed without medical reasons in low- and middle-income countries (LMICs). Unnecessary CS diverts scarce resources and thereby reduces access to healthcare for women in need. Argentina, Burkina Faso, Thailand, and Vietnam are committed to reducing unnecessary CS, but many individual and organizational factors in healthcare facilities obstruct this aim. Nonclinical interventions can overcome these barriers by helping providers improve their practices and supporting women’s decision-making regarding childbirth. Existing evidence has shown only a modest effect of single interventions on reducing CS rates, arguably because of the failure to design multifaceted interventions effectively tailored to the context. The aim of this study is to design, adapt, and test a multifaceted intervention for the appropriate use of CS in Argentina, Burkina Faso, Thailand, and Vietnam. Methods We designed an intervention (QUALIty DECision-making—QUALI-DEC) with four components: (1) opinion leaders at heathcare facilities to improve adherence to best practices among clinicians, (2) CS audits and feedback to help providers identify potentially avoidable CS, (3) a decision analysis tool to help women make an informed decision on the mode of birth, and (4) companionship to support women during labor. QUALI-DEC will be implemented and evaluated in 32 hospitals (8 sites per country) using a pragmatic hybrid effectiveness-implementation design to test our implementation strategy, and information regarding its impact on relevant maternal and perinatal outcomes will be gathered. The implementation strategy will involve the participation of women, healthcare professionals, and organizations and account for the local environment, needs, resources, and social factors in each country. Discussion There is urgent need for interventions and implementation strategies to optimize the use of CS while improving health outcomes and satisfaction in LMICs. This can only be achieved by engaging all stakeholders involved in the decision-making process surrounding birth and addressing their needs and concerns. The study will generate robust evidence about the effectiveness and the impact of this multifaceted intervention. It will also assess the acceptability and scalability of the intervention and the capacity for empowerment among women and providers alike.

Fillol Amandine et Ridde Valéry (2020) « Gouvernance globale et utilisation des connaissances pour l’action: », Revue francophone de recherche sur le transfert et l’utilisation des connaissances, 4 (2) (décembre 1). DOI : 10.18166/tuc.2020.4.2.15. https://revue-tuc.ca/index.php/accueil/article/view/15.

Mots-clés : action collective, connaissances explicites, gouvernance globale, Interdisciplinarité.

Gautier Lara, De Allegri Manuela et Ridde Valéry (2020) « Transnational Networks’ Contribution to Health Policy Diffusion: A Mixed Method Study of the PerformanceBased Financing Community of Practice in Africa », International Journal of Health Policy and Management (avril 27). DOI : 10.34172/ijhpm.2020.57. https://www.ijhpm.com/article_3796.html.

Résumé : Background: Transnational networks such as Communities of Practice (CoPs) are flourishing, yet their role in diffusing health systems reforms has been seldom investigated. Over the past decade, performance-based financing (PBF) has rapidly spread in Africa. This study explores how, through the PBF Community of Practice’s attributes, structure, and strategies, PBF diffusion was fostered in sub-Saharan Africa (SSA). Methods: Informed by the diffusion entrepreneurs’ (DEs) framework dimensions, we used a mixed methods convergent design to investigate how the attributes, structure, and strategies of this community fostered the diffusion of PBF. The quantitative strand of work included firstly a semantic discourse analysis of textual data extracted from CoP’s online discussion forum (n=1346 posts). Secondly, the relational data extracted from these 1346 forum posts was examined using social network analysis (SNA). We confronted these quantitative results with a thematic analysis of qualitative interviews (n=40) and data extracted from the CoP’s key documentation (n=17). Results: CoP members’ attributes included: representation systems anchored in clinical and economic sciences, strong expectations that the CoP would boost professional visibility and career, and significant health systems knowledge and social resources. The CoP’s core group, dominated by high-income country (HIC) members, critically matched PBF principles to major health systems issues in Africa. The broad consensus in online PBF thematic discussions created a strong sense of community, a breeding ground for emulation among CoP members. The CoP also sought to produce and promote experiential knowledge exchanges about PBF amongst African practitioners. Findings from network analyses showed that the promoted Africa-driven community was led by HIC members, although their prominence tended to decrease with time. Conclusion: This empirical research highlighted some of the constituting features, structure, and strategies of policy networks in influencing health policy diffusion. Despite good intentions to disrupt the established governance landscape, influential actors coming from HICs continued to drive the framing, and shaped health systems policy experimentation, emulation, and learning in African countries. Beyond mere knowledge exchange platforms, CoP can act as meaningful transnational policy networks pursuing the diffusion of health systems reforms, such as PBF. Keywords: Transnational Policy Networks, Communities of Practice, Social Network Analysis, Semantic Analysis, Performance-Based Financing, Sub-Saharan Africa

Gosselin Anne, Coulibaly Karna, Ravalihasy Andrainolo, Carillon Séverine, Ridde Valéry, Derche Nicolas, Mbiribindi Romain et Desgrees du Loû Annabel (2020) « Finding the missing link: when community-based outreach in public space is key to engage migrants in health prevention programmes in Paris, France », J Epidemiol Community Health (avril 28). DOI : 10.1136/jech-2019-213394. https://jech.bmj.com/content/early/2020/04/29/jech-2019-213394.

Résumé : Background One of the classic challenges for prevention programmes is reaching the populations they serve. In France, a substantial number of African migrants living with HIV acquired their infection after migrating. The aim of this paper is to better understand the characteristics of the population reached by a community-based outreach approach. Methods We compared sociodemographic characteristics across three different groups in the Paris greater area: (1) the general African migrant population (Population census), (2) the African migrant population using either the regular healthcare system or the system for vulnerable populations (PARCOURS Survey) and (3) the African migrant population reached through a community-based mobile unit (Afrique Avenir). Comparisons were conducted according to sex, age, region of origin, duration of residence and occupational and legal statuses using χ2 tests. Results The migrants reached by the mobile unit were mostly men (69%), 52% of whom were younger than 35 years old. They more often lived in precarious situations than did the general sub-Saharan population (49% vs 35% were unemployed, respectively, p<0.001) and the ones accessing the regular healthcare system. Fewer of them lived in precarious situations than did migrants seeking healthcare consultations for vulnerable populations (42% in the mobile unit vs 54% in healthcare consultations were undocumented, p<0.028). Conclusion Our study shows that the outreach approach can constitute a missing link in the prevention chain among sub-Saharan African migrants, reaching a group that differs from the general migrant population and from the migrant population in healthcare services—not only the newly arrived migrants who live in more precarious situations but also those who have been in France for several years and are still affected by social hardship.

Mots-clés : community-based organisations, HIV/aids, migrants, outreach, prevention.

Hébert Catherine, Dagenais Christian, Mc Sween-Cadieux Esther et Ridde Valéry (2020) « Video as a public health knowledge transfer tool in Burkina Faso: A mixed evaluation comparing three narrative genres », éd. par Mary Hayden, PLOS Neglected Tropical Diseases, 14 (6) (juin 10), p. e0008305. DOI : 10.1371/journal.pntd.0008305. https://dx.plos.org/10.1371/journal.pntd.0008305.

Résumé : Background The dengue virus is endemic in many low- and middle-income countries. In Burkina Faso, the proportion of fevers that could be due to dengue is growing. In 2013, a dengue epidemic spread there, followed by other seasonal outbreaks. Dengue is often confused with malaria, and health workers are not trained to distinguish between them. Three training videos using different narrative genres were tested with nursing students from two institutions in Ouagadougou: journalistic, dramatic and animated video. The study aimed to determine if video is an effective knowledge transfer tool, if narrative genre plays a role in knowledge acquisition, and which narrative elements are the most appreciated. Methodology A mixed method research design was used. The relative effectiveness of the videos was verified through a quasi-experimental quantitative component with a comparison group and post-test measurements. A qualitative component identified participants’ perceptions regarding the three videos. Data were drawn from a knowledge test (n = 482), three focus groups with health professionals’ students (n = 46), and individual interviews with health professionals (n = 10). Descriptive statistics and single-factor variance analysis were produced. A thematic analysis was used to analyse qualitative data. Principal findings Results showed that all three videos led to significant rates of knowledge improvement when compared with the comparison group (p <0.05): 12.31% for the journalistic video, 20.58% for the dramatic video, and 18.91% for the animated video. The dramatic and animated videos produced a significantly higher increase in knowledge than did the journalistic video (with respectively 8.27% (p = 0.003) and 6.59% (p = 0.029) and can be considered equivalent with a difference of 1.68% (p = 0.895). Thematic analysis also revealed that these two videos were considered to be better knowledge transfer tools. Four key aspects are important to consider for a video to be effective: 1) transmitting information in a narrative form, 2) choosing good communicators, 3) creating a visual instrument that reinforces the message and 4) adapting the message to the local context. Conclusions Video has proven to be an effective and appreciated knowledge transfer and training tool for health professionals, but the narrative genre of the videos can influence knowledge acquisition. The production of other videos should be considered for training or updating health professionals and their narrative genre taken into consideration. The actual context of constant circulation of new diseases, such as COVID-19, reaffirms the need to train health professionals.

Kadio Kadidiatou, Louart Sarah, Dabiré Solange, Kafando Yamba, Somé Paul-André et Ridde Valéry (2020) « L’accès aux services de santé au Burkina Faso : une revue de l’interaction entre les capacités des individus et les caractéristiques du système de santé », Ramres, Série Sciences Humaines, 14 (juin), p. 13-42.

Mots-clés : ⛔ No DOI found.

Lara Gautier, Tosun Jale, De Allegri Manuela et Ridde Valéry (2020) « Comment les entrepreneurs de la diffusion propagent-ils leurs politiques ? », Revue francophone de recherche sur le transfert et l’utilisation des connaissances (septembre 1), p. Vol. 4 No 1 (2020). DOI : 10.18166/TUC.2020.4.1.17. https://revue-tuc.ca/index.php/accueil/article/view/17.

Résumé : La diffusion des innovations politiques entre les pays suscite un intérêt croissant. La recherche sur la diffusion des politiques se caractérise par des modèles explicatifs cohérents qui évaluent l’importance des mécanismes de diffusion. La présente étude adopte une perspective différente des études sur la diffusion et fait progresser la littérature sur les politiques publiques en introduisant le concept d’entrepreneurs de la diffusion. Ces entrepreneurs représentent des (groupes d’) individus, des réseaux et des organisations qui font la promotion d’une certaine innovation en matière de politiques, en vue d’exercer une influence. Premièrement, en nous inspirant de la littérature sur la diffusion et en la reliant aux études sur la diffusion des politiques dans des contextes polycentriques, nous introduisons des catégories analytiques pour étudier les principales caractéristiques et actions des entrepreneurs de la diffusion. Deuxièmement, pour illustrer la valeur analytique du concept, nous analysons la littérature sur les entrepreneurs de la diffusion du financement basé sur la performance (FBP) dans le domaine de la santé en Afrique subsaharienne. Nous montrons comment et pourquoi cette innovation politique récemment diffusée offre une opportunité unique pour démontrer notre notion conceptuelle : dans le domaine du FBP, un groupe d’entrepreneurs de la diffusion fortement dévoués se sont efforcés d’induire la diffusion de cette politique. Plus précisément, nous explorons comment les caractéristiques des entrepreneurs de diffusion du FBP et leurs actions affectent les résultats des processus de diffusion. Enfin, nous réfléchissons sur la pertinence de nos propositions conceptuelles et offrons quelques considérations pratiques pour guider les recherches futures.

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Louart Sarah, Bonnet Emmanuel et Ridde Valery (2020) « Is patient navigation a solution to the problem of "leaving no one behind"? A scoping review of evidence from low-income countries », Health Policy and Planning (novembre 19). DOI : 10.1093/heapol/czaa093.

Résumé : Patient navigation interventions, which are designed to enable patients excluded from health systems to overcome the barriers they face in accessing care, have multiplied in high-income countries since the 1990s. However, in low-income countries (LICs), indigents are generally excluded from health policies despite the international paradigm of universal health coverage (UHC). Fee exemption interventions have demonstrated their limits and it is now necessary to act on other dimensions of access to healthcare. However, there is a lack of knowledge about the interventions implemented in LICs to support the indigents throughout their care pathway. The aim of this paper is to synthesize what is known about patient navigation interventions to facilitate access to modern health systems for vulnerable populations in LICs. We therefore conducted a scoping review to identify all patient navigation interventions in LICs. We found 60 articles employing a total of 48 interventions. Most of these interventions targeted traditional beneficiaries such as people living with HIV, pregnant women and children. We utilized the framework developed by Levesque et al. (Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12:18) to analyse the interventions. All acted on the ability to perceive, 34 interventions on the ability to reach, 30 on the ability to engage, 8 on the ability to pay and 6 on the ability to seek. Evaluations of these interventions were encouraging, as they often appeared to lead to improved health indicators and service utilization rates and reduced attrition in care. However, no intervention specifically targeted indigents and very few evaluations differentiated the impact of the intervention on the poorest populations. It is therefore necessary to test navigation interventions to enable those who are worst off to overcome the barriers they face. It is a major ethical issue that health policies leave no one behind and that UHC does not benefit everyone except the poorest. Keywords: Patient navigation; access to health care; indigents; scoping review.

Mbow Ndeye Bineta, Senghor Ibrahima, Ridde Valéry et Faye Adama (2020) « The resilience of two professionalized departmental health insurance units during the COVID-19 pandemic in Senegal », Journal of Global Health, 10 (2) (décembre), p. 1-6. DOI : 10.7189/jogh.10.020394.

Meda Ivlabèhiré Bertrand, Kouanda Seni, Dumont Alexandre et Ridde Valéry (2020) « Effect of a prospective payment method for health facilities on direct medical expenditures in a low-resource setting: a paired pre-post study », Health Policy and Planning, 35 (7) (août 1), p. 775-783. DOI : 10.1093/heapol/czaa039. https://academic.oup.com/heapol/article/35/7/775/5851553.

Résumé : Almost all sub-Saharan countries have adopted cost-reduction policies to facilitate access to health care. However, several studies underline the reimbursement delays experienced by health facilities, which lead to deficient implementation of these policies. In April 2016, for its free care policy, Burkina Faso shifted from fee-for-service (FFS) paid retrospectively to FFS paid prospectively. This study tested the hypothesis that this new method of payment would be associated with an increase in direct medical expenditures (expenses covered by the policies) associated with deliveries. This paired pre-post study used data from two cross-sectional national surveys. Observations were paired according to the health facility and the type of delivery. We used a combined approach (state and household perspectives) to capture all direct medical expenses (delivery fees, drugs and supplies costs, paraclinical exam costs and hospitalization fees). A Wilcoxon signed-rank test was used to test the hypothesis that the 2016 distribution of direct medical expenditures was greater than that for 2014. A total of 279 pairs of normal deliveries, 66 dystocia deliveries and 48 caesareans were analysed. The direct medical expenditure medians were USD 4.97 [interquartile range (IQR): 4.30-6.02], 22.10 [IQR: 15.59-29.32] and 103.58 [IQR: 85.13-113.88] in 2014 vs USD 5.55 [IQR: 4.55-6.88], 23.90 [IQR: 17.55-48.81] and 141.54 [IQR: 104.10-172.02] in 2016 for normal, dystocia and caesarean deliveries, respectively. Except for dystocia (P=0.128) and medical centres (P=0.240), the 2016 direct medical expenditures were higher than the 2014 expenses, regardless of the type of delivery and level of care. The 2016 expenditures were higher than the 2014 expenditures, regardless of the components considered. In the context of cost-reduction policies in sub-Saharan countries, greater attention must be paid to the provider payment method and cost-control measures because these elements may generate an increase in medical expenditures, which threatens the sustainability of these policies.

Nguyen Hoa Thi, Torbica Aleksandra, Brenner Stephan, Kiendrébéogo Joël Arthur, Tapsoba Ludovic, Ridde Valéry et De Allegri Manuela (2020) « Economic Evaluation of User-Fee Exemption Policies for Maternal Healthcare in Burkina Faso: Evidence From a Cost-Effectiveness Analysis », Value in Health, 23 (3) (mars), p. 300-308. DOI : 10.1016/j.jval.2019.10.007. https://linkinghub.elsevier.com/retrieve/pii/S1098301519351794.

Résumé : Objectives The reduction and removal of user fees for essential care services have recently become a key instrument to advance universal health coverage in sub-Saharan Africa, but no evidence exists on its cost-effectiveness. We aimed to address this gap by estimating the cost-effectiveness of 2 user-fee exemption interventions in Burkina Faso between 2007 and 2015: the national 80% user-fee reduction policy for delivery care services and the user-fee removal pilot (ie, the complete [100%] user-fee removal for delivery care) in the Sahel region. Methods We built a single decision tree to evaluate the cost-effectiveness of the 2 study interventions and the baseline. The decision tree was populated with an own impact evaluation and the best available epidemiological evidence. Results Relative to the baseline, both the national 80% user-fee reduction policy and the user-fee removal pilot are highly cost-effective, with incremental cost-effectiveness ratios of $210.22 and $252.51 per disability-adjusted life-year averted, respectively. Relative to the national 80% user-fee reduction policy, the user-fee removal pilot entails an incremental cost-effectiveness ratio of $309.74 per disability-adjusted life-year averted. Conclusions Our study suggests that it is worthwhile for Burkina Faso to move from an 80% reduction to the complete removal of user fees for delivery care. Local analyses should be done to identify whether it is worthwhile to implement user-fee exemptions in other sub-Saharan African countries.

Ouedraogo Wendkouni, Biau Sandrine, Bonnet Emmanuel et Ridde Valery (2020) « Scoping review protocol on the use of telephone in the implementation of citizen participation in the processes of developing health system strengthening reforms/policies in Sub-Saharan Africa (participation in decision-making) v1 (protocols.io.bky7kxzn) ». DOI : 10.17504/protocols.io.bky7kxzn. https://www.protocols.io/view/scoping-review-protocol-on-the-use-of-telephone-in-bky7kxzn.

Paul Elisabeth, Brown Garrett W et Ridde Valery (2020) « COVID-19: time for paradigm shift in the nexus between local, national and global health », BMJ Global Health, 5 (4) (avril), p. e002622. DOI : 10.1136/bmjgh-2020-002622. http://gh.bmj.com/lookup/doi/10.1136/bmjgh-2020-002622.

Paul Elisabeth, Brown Garrett W., Ensor Tim, Ooms Gorik, van de Pas Remco et Ridde Valéry (2020) « We shouldn’t count chickens before they hatch: results-based financing and the challenges of cost-effectiveness analysis », Critical Public Health (janvier 3), p. 1-6. DOI : 10.1080/09581596.2019.1707774. https://www.tandfonline.com/doi/full/10.1080/09581596.2019.1707774.

Résumé : Results-based financing (RBF) is subject to fierce debate and the evidence-base on its cost effectiveness is scarce. To our knowledge, only one cost-effectiveness study of RBF in a lower-middle income country has been published in a peer reviewed journal. That study – in Zambia – concludes that RBF is cost-effective, which was then uncritically repeated in an editorial accompanying its release. Here we would like to warn against readily accepting the conclusion of the cost-effectiveness study of RBF in Zambia, because its conclusions are not straightforward and could be dangerously misleading, especially for those readers unfamiliar with health economics. After outlining the results from the Zambia’s RBF cost-effectiveness study, we point to important methodological issues related to cost-effectiveness analysis, showing how key assumptions produce particular results. We then reflect on how cost-effectiveness is different from efficiency and affordability – which is important, since cost-effectiveness studies often have considerable influence on national health financing strategies and policy priorities. Finally, we provide an alternative reading of the evidence on RBF in Zambia. Namely, when examined from an efficiency point of view, the study actually demonstrates that RBF is less efficient than the simpler alternative of providing more resources to health facilities, unconditioned on performance, which will be of most interest to a government with tight budget constraints. As a result, existing claims that RBF is cost-effective are overstated, requiring further and more nuanced examination with more adequate research methods.

Paul Elisabeth, Brown Garrett W., Kalk Andreas, Van Damme Wim, Ridde Valery et Sturmberg Joachim (2020) « “When My Information Changes, I Alter My Conclusions.” What Can We Learn From the Failures to Adaptively Respond to the SARS-CoV-2 Pandemic and the Under Preparedness of Health Systems to Manage COVID-19? », International Journal of Health Policy and Management. DOI : 10.34172/ijhpm.2020.240. https://www.ijhpm.com/article_3972.html.

Mots-clés : COVID-19, Evidence-Based Policy, Health Policies, Public Health, SARS-CoV-2, Systemic Approach.

Paul Elisabeth, Brown Garrett W. et Ridde Valéry (2020) « Misunderstandings and ambiguities in strategic purchasing in low‐ and middle‐income countries », The International Journal of Health Planning and Management (juillet 16), p. hpm.3019. DOI : 10.1002/hpm.3019. https://onlinelibrary.wiley.com/doi/abs/10.1002/hpm.3019.

Résumé : Strategic purchasing is branded as an approach that is necessary for progress towards universal health coverage. While we agree that publicly purchased health services should respond to society's needs and patient expectations, and thus generally endorse strategic purchasing, here we would like to explore two emerging concerns within current discussions in low‐ and middle‐income countries. First, there exists a great deal of misunderstanding and conceptual unclarity, within practitioner groups, around the concept of strategic purchasing and what instruments it incorporates. Second, there is a growing trend to regularly fuse strategic purchasing into a performance‐based financing (PBF) discourse in ways that increasingly blur their distinctive properties and policy orientations, while perhaps too easily obfuscating potential tensions. We believe the discourse on strategic purchasing would benefit from better conceptual clarity by dissociating and prioritising its two objectives, namely: priority should be given to needs‐based allocation of resources, while rewarding performance is a subsequent concern. We argue there is a need for a more thoroughgoing conceptual and empirical re‐examination of strategic purchasing's priorities, its link with PBF, as well as for a wider evidence‐base on what strategic purchasing tools exist and which are most appropriate for diverse contexts.

Paul Elisabeth et Ridde Valéry (2020) « Évaluer les effets des différentes mesures de lutte contre le Covid-19, mission impossible ? », The Conversation, avril 5. https://theconversation.com/evaluer-les-effets-des-differentes-mesures-de-lutte-contre-le-covid-19-mission-impossible-135060.

Pérez Myriam Cielo, Chandra Dinesh, Koné Georges, Singh Rohit, Ridde Valery, Sylvestre Marie-Pierre, Seth Aaditeshwar et Johri Mira (2020) « Implementation fidelity and acceptability of an intervention to improve vaccination uptake and child health in rural India: a mixed methods evaluation of a pilot cluster randomized controlled trial », Implementation Science Communications, 1 (1) (décembre), p. 88. DOI : 10.1186/s43058-020-00077-7. https://implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-020-00077-7.

Résumé : The Tika Vaani intervention, an initiative to improve basic health knowledge and empower beneficiaries to improve vaccination uptake and child health for underserved rural populations in India, was assessed in a pilot cluster randomized trial. The intervention was delivered through two strategies: mHealth (using mobile phones to send vaccination reminders and audio-based messages) and community mobilization (face-to-face meetings) in rural Indian villages from January to September 2018. We assessed acceptability and implementation fidelity to determine whether the intervention delivered in the pilot trial can be implemented at a larger scale. Methods We adapted the Conceptual Framework for implementation fidelity to assess acceptability and fidelity of the pilot interventions using a mixed methods design. Quantitative data sources include a structured checklist, household surveys, and mobile phone call patterns. Qualitative data came from field observations, intervention records, semi-structured interviews and focus groups with project recipients and implementers. Quantitative analyses assessed whether activities were implemented as planned, using descriptive statistics to describe participant characteristics and the percentage distribution of activities. Qualitative data were analyzed using content analysis and in the light of the implementation fidelity model to explore moderating factors and to determine how well the intervention was received. Results Findings demonstrated high (86.7%) implementation fidelity. A total of 94% of the target population benefited from the intervention by participating in a face-to-face group meeting or via mobile phone. The participants felt that the strategies were useful means for obtaining information. The clarity of the intervention theory, the motivation, and commitment of the implementers as well as the periodic meetings of the supervisors largely explain the high level of fidelity obtained. Geographic distance, access to a mobile phone, level of education, and gender norms are contextual factors that contributed to heterogeneity in participation. Conclusions Although the intervention was evaluated in the context of a randomized trial that could explain the high level of fidelity obtained, this evaluation provides confirmatory evidence that the results of the study reflect the underlying theory. The mobile platform coupled with community mobilization was well-received by the participants and could be a useful way to improve health knowledge and change behavior.

Pérez Myriam Cielo, Singh Rohit, Chandra Dinesh, Ridde Valéry, Seth Aaditeshwar et Johri Mira (2020) « Development of an mHealth Behavior Change Communication Strategy: A case-study from rural Uttar Pradesh in India » (présenté à COMPASS '20: ACM SIGCAS Conference on Computing and Sustainable Societies), in Proceedings of the 3rd ACM SIGCAS Conference on Computing and Sustainable Societies, Ecuador : ACM, p. 274-278. ISBN : 978-1-4503-7129-2. DOI : 10.1145/3378393.3402505. https://dl.acm.org/doi/10.1145/3378393.3402505.

Rajan Dheepa, Koch Kira, Rohrer Katja, Bajnoczki Csongor, Socha Anna, Voss Maike, Nicod Marjolaine, Ridde Valery et Koonin Justin (2020) « Governance of the Covid-19 response: a call for more inclusive and transparent decision-making », BMJ Global Health, 5 (5) (mai), p. e002655. DOI : 10.1136/bmjgh-2020-002655. http://gh.bmj.com/lookup/doi/10.1136/bmjgh-2020-002655.

Résumé : Not all countries make their Covid-19 task force membership list public—the available information varies by country. There is currently a predominance of politicians, virologists and epidemiologists in the Covid-19 response at the country level. Experts on non-Covid-19 health, social and societal consequences of Covid-19 response measures are, for the most part, not included in Covid-19 decision-making bodies. There is little transparency regarding whom decision-making bodies are consulting as their source of advice and information. From the available data on Covid-19 decision-making entities, female representation is particularly paltry. In addition, civil society is hardly involved in national government decision-making nor its response efforts, barring some exceptions. We need to be more inclusive and multidisciplinary: the Covid-19 crisis is not simply a health problem but a societal one—it impacts every single person in society one way or another. Decision makers need to address more systematically the suffering from mental illness exacerbations, domestic violence, child abuse, child development delays, chronic diseases and so on, during lockdown.

Ravit Marion, Ravalihasy Andrainolo, Audibert Martine, Ridde Valéry, Bonnet Emmanuel, Raffalli Bertille, Roy Flore-Apolline, N’Landu Anais et Dumont Alexandre (2020) « The impact of the obstetrical risk insurance scheme in Mauritania on maternal healthcare utilization: a propensity score matching analysis », Health Policy and Planning, 35 (4) (janvier 31). DOI : 10.1093/heapol/czz150. https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz150/5718854.

Résumé : In Mauritania, obstetrical risk insurance (ORI) has been progressively implemented at the health district level since 2002 and was available in 25% of public healthcare facilities in 2015. The ORI scheme is based on pre-payment scheme principles and focuses on increasing the quality of and access to both maternal and perinatal healthcare. Compared with many community-based health insurance schemes, the ORI scheme is original because it is not based on risk pooling. For a pre-payment of 16–18 USD, women are covered during their pregnancy for antenatal care, skilled delivery, emergency obstetrical care [including caesarean section (C-section) and transfer] and a postnatal visit. The objective of this study is to evaluate the impact of ORI enrolment on maternal and child health services using data from the Multiple Indicator Cluster Survey (MICS) conducted in 2015. A total of 4172 women who delivered within the last 2 years before the interview were analysed. The effect of ORI enrolment on the outcomes was estimated using a propensity score matching estimation method. Fifty-eight per cent of the studied women were aware of ORI, and among these women, more than two-thirds were enrolled. ORI had a beneficial effect among the enrolled women by increasing the probability of having at least one prenatal visit by 13%, the probability of having four or more visits by 11% and the probability of giving birth at a healthcare facility by 15%. However, we found no effect on postnatal care (PNC), C-section rates or neonatal mortality. This study provides evidence that a voluntary pre-payment scheme focusing on pregnant women improves healthcare services utilization during pregnancy and delivery. However, no effect was found on PNC or neonatal mortality. Some efforts should be exerted to improve communication and accessibility to ORI. Maternal health, neonatal mortality, pre-payment scheme, universal health coverage, Mauritania, Sub-Saharan Africa Topic: pregnancycesarean sectionhealth care facilityinsurancemauritaniamotherspostnatal careobstetricsprenatal careneonatal mortalityhealth care usemalnutrition-inflammation-cachexia syndrome

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Ridde Valéry, Aho Joséphine, Ndao Elhadji Malick, Benoit Magalie, Hanley Jill, Lagrange Solène, Fillol Amandine, Raynault Marie-France et Cloos Patrick (2020) « Unmet healthcare needs among migrants without medical insurance in Montreal, Canada », Global Public Health (mai 27), p. 1-14. DOI : 10.1080/17441692.2020.1771396. https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1771396.

Résumé : While access to healthcare for permanent residents in Canada is well known, this is not the case for migrants without healthcare coverage. This is the first large-scale study that examines the unmet healthcare needs of migrants without healthcare coverage in Montreal. 806 participants were recruited: 436 in the community and 370 at the NGO clinic. Proportions of individuals reporting unmet healthcare needs were similar (68.4% vs. 69.8%).The main reason invoked for these unmet needs was lacking money (80.6%). Situations of not working or studying, not having had enough food in the past 12 months, not having a medical prescription to get medication and having had a workplace injury were all significantly associated with higher odds of having unmet healthcare needs. Unmet healthcare needs were more frequent among migrants without healthcare coverage than among recent immigrants or the citizens with health healthcare coverage (69%, 26%, 16%). Canada must take measures to enable these individuals to have access to healthcare according to their needs in order to reduce the risk of worsening their health status, something that may have an impact on the healthcare system and population health. The Government of Quebec announced that all individuals without any healthcare coverage will have access to COVID-19 related health care. We hope that this right, the application of which is not yet obvious, can continue after the pandemic for all health care.

Note

Ridde Valéry et Ba Mame-Penda (2020) « La pandémie du Covid-19 vue d'Afrique », Article Opinion Commentaire (AOC), avril 26. https://aoc.media/analyse/2020/04/26/la-pandemie-du-covid-19-vue-dafrique/.

Résumé : Si la situation sanitaire en Afrique inquiète de plus en plus, il est difficile d’en avoir une vision claire. Comment les différents pays du continent réagissent-ils à la pandémie ? Quels enseignements ont-ils tiré de l’épidémie d’Ebola ? Les systèmes sanitaires africains sont souvent défaillants et le risque d’une sous-estimation des cas patent, mais la solidarité à toutes les échelles du continent dessine l’espoir du moindre mal.

Ridde Valéry, Dabiré Solange et Dagenais Christian (2020) « L’utilisation de la recherche par les ONG : un appel à actions et à réflexions », Alternatives Humanitaires, 13 (mars 18), p. 86-101. http://alternatives-humanitaires.org/wp-content/uploads/2020/03/AH_N13_5_Innovations_Ridde_VFR.pdf.

Résumé : Les auteurs rappellent l’importance de tenir compte des résultats de recherche pour les interventions des ONG et montrent les défis techniques et politiques que cela pose. Ils suggèrent plusieurs démarches favorables à la prise en compte des recherches, tout en expliquant que l’on manque encore de connaissances et d’actions à ce propos. Ainsi, ce texte brosse un portrait succinct de l’état de la question pour suggérer la participation en 2021 à un possible dossier d’Alternatives Humanitaires centré sur le transfert des connaissances par les ONG.

Mots-clés : ⛔ No DOI found.

Ridde Valéry, Pérez Dennis et Robert Emilie (2020) « Using implementation science theories and frameworks in global health », BMJ Global Health, 5 (4) (avril), p. e002269. DOI : 10.1136/bmjgh-2019-002269. http://gh.bmj.com/lookup/doi/10.1136/bmjgh-2019-002269.

Résumé : In global health, researchers and decision makers, many of whom have medical, epidemiology or biostatistics background, are increasingly interested in evaluating the implementation of health interventions. Implementation science, particularly for the study of public policies, has existed since at least the 1930s. This science makes compelling use of explicit theories and analytic frameworks that ensure research quality and rigour. Our objective is to inform researchers and decision makers who are not familiar with this research branch about these theories and analytic frameworks. We define four models of causation used in implementation science: intervention theory, frameworks, middle-range theory and grand theory. We then explain how scientists apply these models for three main implementation studies: fidelity assessment, process evaluation and complex evaluation. For each study, we provide concrete examples from research in Cuba and Africa to better understand the implementation of health interventions in global health context. Global health researchers and decision makers with a quantitative background will not become implementation scientists after reading this article. However, we believe they will be more aware of the need for rigorous implementation evaluations of global health interventions, alongside impact evaluations, and in collaboration with social scientists.

Robert Emilie, Rajan Dheepa, Koch Kira, Muggleworth Weaver Alyssa, Porignon Denis et Ridde Valery (2020) « Policy dialogue as a collaborative tool for multistakeholder health governance: a scoping study », BMJ Global Health, 4 (Suppl 7) (avril), p. e002161. DOI : 10.1136/bmjgh-2019-002161. http://gh.bmj.com/lookup/doi/10.1136/bmjgh-2019-002161.

Résumé : Introduction Health system governance is the cornerstone of performant, equitable and sustainable health systems aiming towards universal health coverage. Global health actors have increasingly been using policy dialogue (PD) as a governance tool to engage with both state and non-state stakeholders. Despite attempts to frame PD practices, it remains a catch-all term for both health systems professionals and researchers. Method We conducted a scoping study on PD. We identified 25 articles published in English between 1985 and 2017 and 10 grey literature publications. The analysis was guided by the following questions: (1) How do the authors define PD? (2) What do we learn about PD practices and implementation factors? (3) What are the specificities of PD in low-income and middle-income countries? Results The analysis highlighted three definitions of policy dialogue: a knowledge exchange and translation platform, a mode of governance and an instrument for negotiating international development aid. Success factors include the participants’ continued and sustained engagement throughout all the relevant stages, their ability to make a constructive contribution to the discussions while being truly representative of their organisation and their high interest and stake in the subject. Prerequisites to ensuring that participants remained engaged were a clear process, a shared understanding of the goals at all levels of the PD and a PD approach consistent with the PD objective. In the context of development aid, the main challenges lie in the balance of power between stakeholders, the organisational or technical capacity of recipient country stakeholders to drive or contribute effectively to the PD processes and the increasingly technocratic nature of PD. Conclusion PD requires a high level of collaborative governance expertise and needs constant, although not necessarily high, financial support. These conditions are crucial to make it a real driver of health system reform in countries’ paths towards universal health coverage.

Robert Emilie et Ridde Valéry (2020) Dealing With Complexity and Heterogeneity in a Collaborative Realist Multiple Case Study in Low- and Middle-Income Countries, 1 Oliver's Yard, 55 City Road, London EC1Y 1SP United Kingdom : SAGE Publications Ltd. ISBN : 978-1-5297-3230-6. https://methods.sagepub.com/case/complexity-heterogeneity-collaborative-realist-low-middle-income-countries.

Résumé : A qualitative realist evaluation research was conducted in six African countries to understand a complex and multifaceted World Health Organization program that provides technical and financial support to Ministries of Health in low- and middle-income countries. This support aims to foster the institutionalization of policy dialogue as a collaborative governance device, the purpose of which is the advancement of universal health coverage. This case study illustrates the realist and collaborative approach used in this multi-country research. It highlights the methodological and pedagogical challenges we faced and for which we propose recommendations. We specifically present our collaborative approach with both our research collaborators and our World Health Organization colleagues, the step of co-construction of the intervention theory, and the three successive stages of data analysis. This case is for readers who have a basic understanding of the realist approach, case study, and evaluation. Readers who are not familiar with these methods are encouraged to first refer to the recommended readings.

Rudasingwa Martin, Yeboah Edmund, Allegri de Manuela, Bonnet Emmanuel, Ridde Valéry, Somé Paul-André, Muula Adamson, Chitha Bona Mukoshya et Mphuka Chrispin (2020) Estimating the distributional incidence of healthcare spending on maternal health services in Sub-Saharan Africa: Benefit Incidence Analysis in Burkina Faso, Malawi, and Zambia. (AFD Research paper No. 141), Paris : AFD. https://www.afd.fr/en/ressources/estimating-distributional-incidence-healthcare-spending-maternal-health-services-sub-saharan-africa-benefit-incidence-analysis-burkina-faso-malawi-and-zambia.

Résumé : L'amélioration de l'accès aux services de santé maternelle est une préoccupation politique essentielle, en particulier en Afrique subsaharienne (ASS) où les taux de mortalité maternelle restent très élevés, en particulier parmi les segments les plus pauvres de la société. Par conséquent, à la suite de l'appel mondial à réduire la mortalité maternelle inscrit dans l'Objectif de développement durable 3, de multiples interventions ont été conçues et mises en œuvre dans les pays d'Afrique subsaharienne pour favoriser les progrès vers la couverture sanitaire universelle (CSU) des services de santé maternelle, y compris l'assistance qualifiée à l'accouchement. Alors que les preuves de l'impact de ces interventions sur l'accès à l'utilisation des services se multiplient, les preuves de l'incidence distributive de l'investissement financier qu'elles impliquent sont encore limitées. Cet article vise à combler ce manque de connaissances en effectuant une analyse quasi-longitudinale de l'incidence des bénéfices pour évaluer l'égalité des dépenses de santé publiques et globales pour les services de santé maternelle dans trois pays d'Afrique subsaharienne: le Burkina Faso, le Malawi et la Zambie. L'étude s'est appuyée sur des données sur l'utilisation des soins de santé tirées de différentes enquêtes auprès des ménages au niveau national (y compris l'enquête démographique et sur la santé, l'enquête sur le financement basé sur les performances et l'enquête sur la santé et les dépenses des ménages en Zambie) et les données sur les dépenses de santé tirées des comptes nationaux de la santé. Les résultats démontrent une égalité croissante des dépenses de santé au fil du temps, mais aussi une hétérogénéité persistante considérable de l'incidence distributionnelle entre les provinces / régions / districts. Ces résultats suggèrent que la mise en œuvre de réformes spécifiques à la CSU ciblant les soins maternels a été efficace pour accroître l'égalité dans les dépenses de santé, ce qui signifie que davantage de ressources financières ont atteint les segments les plus pauvres de la société, mais n'était pas encore suffisante pour éliminer les différences entre les provinces / régions / districts. Des recherches supplémentaires sont nécessaires pour étudier les sources des disparités régionales et identifier des stratégies pour les surmonter.

Samb Oumar Mallé, Essombe Christiane et Ridde Valery (2020) « Meeting the challenges posed by per diem in development projects in southern countries: a scoping review », Globalization and Health, 16 (1). DOI : 10.1186/s12992-020-00571-6. https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00571-6.

Résumé : This study presents the results of a review whose goal is to generate knowledge on the possible levers of action concerning per diem practices in southern countries in order to propose reforms to the existing schemes. Methodology A synthesis of available knowledge was performed using scoping review methodology: a literature search was conducted using several databases (Medline, Cinahl, Embase, PubMed, Google Scholar, ProQuest) and grey literature. A total of 26 documents were included in the review. Furthermore, interviews were conducted with the authors of the selected articles to determine whether the proposed recommendations had been implemented and to identify any outcomes. Results For the most part, the results of this review are recommendations supporting per diem reform. In terms of strategy, the recommendations call for a redefinition of per diems by limiting their appeal. Issued recommendations include reducing daily allowance rates, paying per diem only in exchange for actual work, increasing control mechanisms or harmonizing rates across organizations. In terms of operations, the recommendations call for the implementation of concrete actions to reduce instances of abuse, including not paying advances or introducing reasonable flat-rate per diem. That said, the authors contacted stated that few per diem reforms had been implemented as a result of the issued recommendations. Conclusion The results of the study clearly identify possible levers of action. Such levers could make up the groundwork for further reflection on context and country-specific reforms that are carried out using a dynamic, participatory and consensual approach.

Seppey Mathieu, Ridde Valéry et Somé Paul-André (2020) « Scaling-Up Performance-Based Financing in Burkina Faso: From PBF to User Fees Exemption Strategic Purchasing », Int J Health Policy Manag, p. 1-13. DOI : 10.34172/ijhpm.2020.209.

Sia D., Dondbzanga B.D.G., Carabali M., Bonnet Emmanuel, Enok Bonong P.R. et Ridde Valery (2020) « Effect of a free healthcare policy on health services utilization for non‐malarial febrile illness by children under five years in Burkina Faso: an interrupted time series analysis », Tropical Medicine & International Health (juillet 19), p. tmi.13468. DOI : 10.1111/tmi.13468. https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.13468.

Résumé : Objective To assess the effect of a free healthcare policy for children under five years old implemented in Burkina Faso since April 2016, on the use of healthcare of non‐malarial febrile illnesses (NMFI). Methods To assess the immediate and long‐term effect of the free healthcare policy in place, we conducted an interrupted time series analysis of routinely collected data on febrile illnesses from three urban primary health centers of Ouagadougou between January 1, 2015 and December 31, 2016. Results Of the 39,046 febrile cases reported in the study period, 17,017 NMFI were included in the study. Compared to the period before the intervention, we observed an immediate, non‐statistically significant increase of 7% in the number of NMFI (IRR=1.07; 95% CI= 0.75, 1.51). Compared to the trend that would have been expected in absence of the intervention, the results showed a small but sustained increase of 6% in the trend of monthly number of NMFI during the intervention period (IRR= 1.06; 95%CI= 1.01, 1.12). Conclusion Our study highlighted an increase in the uptake of health care services, specifically for NMFI by children under five years of age, after the implementation of a free care policy. This analysis contributes to informing decision‐makers on the need to strengthen the capacities of health care centers and to anticipate the challenges of the sustainability of this policy.

Sieleunou Isidore, De Allegri Manuela, Roland Enok Bonong Pascal, Ouédraogo Samiratou et Ridde Valéry (2020) « Does performance-based financing curb stock-outs of essential medicines? Results from a randomised controlled trial in Cameroon », Tropical Medicine & International Health (mai 23). DOI : 10.1111/tmi.13447. http://doi.wiley.com/10.1111/tmi.13447.

Résumé : Objectif En 2011, le gouvernement du Cameroun a lancé son programme de financement basé sur la performance (FBP). Notre étude a examiné les effets de l'intervention PBF sur la disponibilité des médicaments essentiels (EM). Les méthodes Essai de contrôle randomisé par lequel le PBF et trois groupes de comparaison distincts ont été randomisés dans un total de 205 établissements de santé dans trois régions. Les données de base ont été collectées entre mars et mai 2012 et les données finales 36 mois plus tard. Nous avons défini la disponibilité de plusieurs groupes EM en évaluant les ruptures de stock pendant au moins un jour au cours des 30 jours précédant la date de l'enquête et en estimant les changements attribuables au FBP à l'aide d'une série de modèles de régression de différence en différence, ajustés pour le niveau de l'établissement concerné co-varie. Les données ont été analysées stratifiées par région et zone pour évaluer l'hétérogénéité de l'effet. Résultats Nos estimations suggèrent que l'intervention PBF n'a eu aucun effet sur les ruptures de stock de médicaments de soins prénatals (p = 0,160), les vaccins (p = 0,396), la gestion intégrée des médicaments contre les maladies infantiles (p = 0,681) et les médicaments du travail et d'accouchement (p = 0,589). Cependant, l'intervention a été associée à une réduction significative de 34% des ruptures de stock de médicaments de planification familiale (p = 0,028). Nous avons observé une hétérogénéité des effets entre les régions et les zones, avec des diminutions significatives des ruptures de stock de produits de planification familiale dans la région du Nord-Ouest (p = 0,065) et dans les zones rurales (p = 0,043). Conclusions L'intervention du PBF au Cameroun a eu des effets limités sur la réduction des ruptures de stock des EM. Ces mauvais résultats étaient probablement la conséquence d'un échec partiel de la mise en œuvre, allant de l'interruption et de l'arrêt des services à l'autonomie limitée des installations dans la gestion de la prise de décision et au retard considérable dans le paiement de la performance.

Sombié Issa, Degroote Stéphanie, Somé Paul André et Ridde Valéry (2020) « Analysis of the implementation of a community-based intervention to control dengue fever in Burkina Faso », Implementation Science, 15 (1) (mai 14), p. 32. DOI : 10.1186/s13012-020-00989-x. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-00989-x.

Résumé : Background A community-based dengue fever intervention was implemented in Burkina Faso in 2017. The results achieved vary from one area to another. The objective of this article is to analyze the implementation of this intervention, to better understand the process, and to explain the contextual elements of performance variations in implementation. Methodology The research was conducted in the former sector 22 of the city of Ouagadougou. We adapted the Consolidated Framework for Implementation Research (CFIR) to take into account the realities of the context and the intervention. The data collected from the participants directly involved in the implementation using three techniques: document consultation, individual interview, and focus group. Results Two dimensions of CFIR emerge from the results as having had a positive influence on the implementation: (i) the characteristics of the intervention and (ii) the processes of the intervention implementation. The majority of the CFIR constructions were considered to have had a positive effect on implementation. The quality and strength of the evidence received the highest score. The dimension of the external context had a negative influence on the implementation of the intervention. Conclusion The objective of the study was to analyze the influence of contextual elements on the implementation process of a community-based dengue fever intervention. We used the CFIR framework already used by many studies for implementation analysis. Although it was not possible to test this framework in its entirety, it is useful for the analysis of the implementation. Its use is simple and does not require any special skills from users. Usability is indeed an essential criterion for the relevance of using an analytical framework in implementation science.

Touré Laurence et Ridde Valery (2020) « The emergence of the national medical assistance scheme for the poorest in Mali », Global Public Health. DOI : 10.1080/17441692.2020.1855459.

Résumé : Background : Universal health coverage (UHC) is now high up the international agenda. There are still major needs to be met in West Africa, particularly in Mali, where providing health care for the poorest remains a big challenge. The majority of the region’s countries are currently seeking to define the content of their compulsory, contribution-based medical insurance system. However, very few countries apart from Mali have decided to, in parallel, develop a solution for poorest that is not based on contributions. Methods : This qualitative research article examines the historical process that has permitted the emergence of this ground-breaking public policy. Results : The research shows that the process has been very long, chaotic and sometimes suspended for long periods. One of the biggest challenges has been that of intersectoriality and the social construction of the groups to be targeted by this public policy (the poorest), as institutional tensions have evolved in accordance with the political issues linked to social protection. Eventually, the medical assistance scheme for the poorest (RAMED) saw the light of day in 2011, funded entirely by the government. Conclusions : RAMED emergence would appear to be attributable not so much to any new concern for the poorest in society but rather to a desire to give the social protection policy engaged in a guarantee of universality. The RAMED nonetheless remains an innovation within French-speaking West Africa.

Note

Zinszer Kate, Caprara Andrea, Lima Antonio, Degroote Stéphanie, Zahreddine Monica, Abreu Kellyanne, Carabali Mabel, Charland Katia, Dantas Mayana Azevedo, Wellington José, Parra Beatriz, Fournet Florence, Bonnet Emmanuel, Pérez Denis, Robert Emilie, Dagenais Christian, Benmarhnia Tarik, Andersson Neil et Ridde Valéry (2020) « Sustainable, healthy cities: protocol of a mixed methods evaluation of a cluster randomized controlled trial for Aedes control in Brazil using a community mobilization approach », Trials, 21 (1) (décembre). DOI : 10.21203/rs.2.9928/v3. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3714-8.

Résumé : BACKGROUND: Dengue is increasing in its global presence with an estimated 4 billion people at-risk of infection in at least 128 countries. Despite the promising results of EcoHealth and community mobilization approaches to Aedes reduction, more evidence of their efficacy on reducing dengue risk is needed. The principal research question is to determine if interventions based upon community mobilization reduce the risk of dengue virus infection among children 3 to 9 years old compared to usual dengue control practice in Fortaleza, Brazil. METHODS: The present study will follow a pragmatic cluster randomized controlled trial (cRCT) design with randomization at the census tract level with equal allocation to the two arms. In each arm, there will be 34 clusters of 86 children between 3 to 9 years old for an expected total of 5848 children enrolled in the study, assuming a risk reduction of 29.5% based upon findings from a previous multi-site cRCT. The primary outcomes are rates of anti-dengue Immunoglobulin G (IgG) seroconversion and adult female Aedes density. The intervention is based upon a participatory health research approach, Socializing Evidence for Participatory Action (SEPA), where the research evidence is used to foster community engagement and ownership of the health issue and solution. Following allocation, intervention communities will develop and implement their own solutions that will likely include a wide variety of collective events and media approaches. Data collection activities over a period of 3 years include household visits for blood collection, household surveys, and entomological surveys; and qualitative activities including focus groups, in-depth interviews, and document analysis to evaluate the process, acceptability, fidelity, and sustainability of the intervention. Study participants will be aware of their assignment and all research staff will be blinded although the intervention assignment will likely be revealed to field staff through interaction with participants. DISCUSSION: The results of our study will provide evidence on community mobilization as an intervention for dengue control. We anticipate that if community mobilization is effective in Fortaleza, the results of this study will help develop evidence-based vector control programs in Brazil, and also in other countries struggling with Aedes-transmitted diseases. KEYWORDS: Aedes mosquitos; Brazil; Cluster randomized controlled trial; Community empowerment; Community-based intervention; Dengue; Mixed methods; Vector control

Zombré David, Allegri Manuela De et Ridde Valéry (2020) « No effects of pilot performance-based intervention implementation and withdrawal on the coverage of maternal and child health services in the Koulikoro region, Mali: an interrupted time series analysis », Health Policy and Planning, 35 (4) (janvier 31), p. 379-387. DOI : 10.1093/heapol/czaa001. https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czaa001/5718845.

Résumé : Performance-based financing (PBF) has been promoted and increasingly implemented across low- and middle-income countries to increase the utilization and quality of primary health care. However, the evidence of the impact of PBF is mixed and varies substantially across settings. Thus, further rigorous investigation is needed to be able to draw broader conclusions about the effects of this health financing reform. We examined the effects of the implementation and subsequent withdrawal of the PBF pilot programme in the Koulikoro region of Mali on a range of relevant maternal and child health indicators targeted by the programme. We relied on a control interrupted time series design to examine the trend in maternal and child health service utilization rates prior to the PBF intervention, during its implementation and after its withdrawal in 26 intervention health centres. The results for these 26 intervention centres were compared with those for 95 control health centres, with an observation window that covered 27 quarters. Using a mixed-effects negative binomial model combined with a linear spline regression model and covariates adjustment, we found that neither the introduction nor the withdrawal of the pilot PBF programme bore a significant impact in the trend of maternal and child health service use indicators in the Koulikoro region of Mali. The absence of significant effects in the health facilities could be explained by the context, by the weaknesses in the intervention design and by the causal hypothesis and implementation. Further inquiry is required in order to provide policymakers and practitioners with vital information about the lack of effects detected by our quantitative analysis. © The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. KEYWORDS: Mali; Performance-based financing; health services coverage; interrupted time series; policy evaluation

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