Implementation fidelity of the national malaria control program in Burkina Faso

Abstract

Background: Every year 40,000 people die of malaria in Burkina Faso. In 2010, the Burkinabè authorities implemented a national malaria control program that provides for the distribution of mosquito nets and the home-based treatment of children with fever by community health workers. The objective of this study was to measure the implementation fidelity of this program.

Methods: We conducted a case study in two comparable districts (Kaya and Zorgho). Data were collected one year after the program's implementation through field observations (10 weeks), documentary analysis, and individual interviews with stakeholders (n = 48) working at different levels of the program. The analysis framework looked at the fidelity of (i) the intervention's content, (ii) its coverage, and (iii) its schedule.

Results: The program's implementation was relatively faithful to what was originally planned and was comparable in the two districts. It encountered certain obstacles in terms of the provision of supplies. Coverage fidelity was better in Kaya than in Zorgho, where many community health workers (CHW) experienced problems with the restocking of artemisinin-based combination therapy and with remuneration for periods of training. In both districts, the community was rarely involved in the process of selecting CHWs. The components affected by scheduling all experienced successive implementation delays that pushed nets distribution and the initial provision of artemisinin-based combination therapies to the CHWs past the 2010 malaria season.

Conclusions: The activities intended by the program were mostly implemented with good fidelity. However, the implementation was plagued by delays that probably postponed the expected beneficial effects.

Figure 1. The MEILUP’s intervention theory and causal chain of events.

Figure 2. Comparison of the content fidelity of the LLIN component in the two districts.

Notes: I = implemented as intended; I/M = implemented or modified; M = modified; N = not implemented; Z = Zorgho; K = Kaya. Source: survey data.

Figure 3. Comparison of the content fidelity of the HMM component in the two districts.

Notes: I = implemented as intended; I/M = implemented or modified; M = modified; A = added; N = not implemented; Z = Zorgho; K = Kaya. Source: survey data.