Decentralization and health resources transfer to local governments in Burkina Faso:A SWOT analysis among health care decision makers

Background and Aims: In line with the decentralization policy, in 2009, the central government of Burkina Faso issued a decree to transfer health resources to local governments for fulfilling their new responsibilities in health care provision. The first stage of this health care decentralization process involved the basic health care facilities, composed of primary health care facilities, maternities, dispensaries, maternal and child health centers, and essential drugs depots.This study seeks to explore the strengths, weaknesses, opportunities, and threats (SWOT) associated with the health resources transfer in Burkina Faso, from the perspective of decision makers.Methods: We used a qualitative research approach. We conducted 17 semistructured interviews with 17 representatives of key decision-making groups, in August to December 2017 in Burkina Faso. The participants included mayors of municipalities, health district managers, policy decision makers, and donors/partners. The data collected were subjected to a directed qualitative content analysis, and the SWOT framework was used to select themes and codes for the analysis.Results: The most cited strength was the improvement of local governance, which also creates the opportunity for an enhanced partnership and decentralized cooperation. As expected, however, the limited financial capacity of local governments is an important weakness. Furthermore, misuse of financial resources threatens the resources transfer. Recommendations to improve decentralization and health resources transfer included effective enforcement of decentralization's laws and policies, strengthening local governments' capacities, adequate funding, and evaluation of the resources transfer process.Conclusions: An analysis of the preconditions for a successful resources transfer is needed to provide guidance to policy.