Paper long abstract:

In Burkina Faso basic health services are progressively being decentralised to municipalities after the local elections of the 23 of March 2006. However, contrary to expectations, decentralisation in many African countries has not lead to improvements in basic service delivery. This raises the question whether Burkina can fare better. This research identifies some of the conditions that could assist municipalities to build performing health services at local level. These conditions will not be easily met.

The research studied the operation of basic health services using the framework of accountability relationships developed by the World Bank. Within this framework the authors analysed the nature of the relationship between three key actors ('policy maker', 'service provider' and 'service users') in terms of its effect on service delivery. Taking into account the foreseen developments of the decentralisation process in Burkina Faso, combined with the experience of more 'advanced' sub Saharan countries, we assess the potential strengths and weaknesses of the organisation of basic health service. Finally, we present some arrangements to restore the disrupted mechanisms of accountability between the actors. These measurements build on opportunities which are today existent, although somewhat hidden.

On the one hand, decentralisation will lead to some obvious improvements like shortening the long (electoral) route of accountability and improving the checks & balances between policy maker and service provider. On the other hand, Burkina risks a system of unbalanced accountability, growing clientelism (informalization) and lack of redistribution of the earmarked national budget towards local administration. If no corrective arrangements are taken, the poorest patients risk to pay the price.

Research team:

Aline Congo

Karim Zone

Bertram van der Wal

Jean Marc Sika

SNV Advisors