AN ACTION RESEARCH PROJECT PROVIDING A TOLL-FREE NUMBER USING AN INTERACTIVE VOICE SERVER FOR HEALTH SERVICES USERS AND PROFESSIONALS TO IMPROVE HEALTH SYSTEM GOVERNANCE IN BURKINA FASO Ridde V., Bonnet E. Dagenais C. Queuille L., Traore Z. Sanon P. Lechat L. Somé P-A. May 25, 2016 equitesante.org

CONTEXT Equitesante.org 2 Democratization of Mhealth in LMIC Low reactivity of health system in LMIC and Burkina Faso Exploratory research in Burkina – Scoping review, Indian experimentation, interviews and workshops Burkina Faso Health Policies Orientations : Promotion of democracy and improvement of active citizenship Improve the good governance and ICT potential for development Improve the health service and governance

ACTION RESEARCH Equitesante.org 3 Action research approach, reflexivity and partnership Toll free number with Interactive Voice Response (IVR) Health staff and patients Improve the governance, health services and health system responsiveness Research objective : to experiment and evaluate the technical, social and instrumental relevance of an automatic toll free number with 2 different technologies

CONCEPT 11 sectors in the capital ( hab., < 100 health centre) PFT = Toll free number + IVR multilingual + web Information and communication activities Equitesante.org 4  DIOULA  FRENCH  MOORÉ POPULATION + « AS » AIRTEL ONATEL TELECEL TELMOB (ARCE) TOLL FREE NUMBER (ONATEL) ANONYMUS AND FREE CALL INTERACTIVE VOICE RESPONSE DATA BASE Zone d’intervention

INTERVENTION Equitesante.org 5 Ph1 : health system performance, health system delivery, financial access Ph2 : 2 MCQ : health staff and health users PHASE 1 (PH1) 1 CLOSE QUESTION + 1 OPEN QUESTION KEYBORD TOUCH + MESSAGE RECORDING (2 MINUTES) 3 MONTHS PHASE 2 (Ph2) MULTIPLE CHOICE QUESTIONS + 1 OPEN QUESTION KEYBORD TOUCH (2 - 5 minutes) 3 MONTHS CONTENT ANALYSIS

RELEVANCE EVALUATION Equitesante.org 6 TECHNOLOGIC : A technical solution adapted ? SOCIAL/CONTEXT : Adapted to the social context ? INSTRUMENTAL : Useful data to improve HS respons. ? DATA COLLECTED : 2364 messages recorded (Ph1) 1328 questionnaires filled (Ph2) 247 questionnaires (Ph1) 44 interviews (Ph2)

TECHNOLOGIC Equitesante.org 7 Phase 1 (Ph1)Phase 2 (Ph2) 124 DAYS154 days (49 non functional) 9966 CALL3911 CALL 578 CALL/WEEK (M.)261 CALL/WEEK (M.) DURATION : 44 s (M.)DURATION : 1’45s AUDIBLES MESSAGES (less noisy than expected) AUTOMATIC DATA COLLECTION -FINANCIAL AND MATERIAL RESOURCES -ENERGY CUT, BAD QUALITY OF PHONE OPERATORS AND INTERNET

INSTRUMENTAL Equitesante.org 8 PHASE 1 (Ph1)PHASE 2 (Ph2) USERS > STAFF USERS (68%) > H Staff (Under 5 Y. or public health facilities adults) Infrastructures, welcome, HR, caring, payment, medical inputs Good satisfaction but not for payment for users and health services for staff Others topics : TEST, CLARIFICATION, WELCOME, SUGGESTIONS PERSONNAL HEALTH PROBLEM HEALHT INFORMATION NEEDS (HIV/AIDS, etc.) ORAL TRADITION VS CONTENT ANALYSIS FOR SCALING UP

SOCIAL Equitesante.org 9 PHASE 1 (PH1)PHASE 2 (PH2) CALL PICS : RADIO (990 in few hours) CALL PICS : RADIO (134 in 1 day) 49% RECORDED MESSAGES 48% QUIZ STARTED 1/3 VALID CONTENT 49% HAVE CHOSEN A LANGUAGE FINISH THE QUIZ : 30% OF USERS 15% FOR HEALTH STAFF LEARNING CURVES ? STAFF HAVE LESS TIME THAN USERS ? -NO HABITS TO DENONCE -MISTRUST ABOUT A NEW CONCEPT/SERVICE DIFFERENT FROM OTHER TOLL FREE NUMBER

CONCLUSION TECHNO ABILITY TO DEVELOP AND IMPLEMENT A TOLL FREE NUMBER WITH 2 TECHNOLOGIES SOCIAL GOOD INTEREST FROM USERS AND HEALTH STAFF USERS ARE MORE PATIENTS FROM PUBLIC HEALTH FACILITY MULTILINGUAL AND COMMUNICATIONS ARE KEY ECONOMIC CONTEXT IS CHALLENGING (ELECTRICITY, INTERNET, PHONE, ETC) INSTRUMENTAL DATA COLLECTED, VALID AND A GOOD POTENTIAL TO BE USED Equitesante.org 10

Merci de votre attention Nous remercions aussi le Ministère de la Santé, les différentes autorités sanitaires IGS, DRS, DS), FS, AS, OSC, etc.), les décideurs, techniciens, opérateurs, représentants Société civile, chercheurs, etc.), la population, etc.

CHALLENGES … Pertinence technologique o Nécessité de matériels ou d’une structure d’hébergement de la plateforme SVI adaptée pour pallier les défauts de fourniture en énergie o Besoin de proposer un service en plusieurs langues … Pertinence sociale o Importance des activités de communication/information o Besoin de recherche approfondie sur les raisons des erreurs de manipulation et d’abandon o Besoin de recherche sur une mise en service en milieu rural … Pertinence instrumentale o Charge de l’analyse de contenu des messages enregistrés non viable pour le passage à l’échelle du concept o Formulaire trop long Equitesante.org 12