An exploratory analysis of the regionalization policy for the recruitment of health workers in Burkina Faso

Background: Health personnel retention in remote areas is a key health systems issue wordwide. To deal with this issue, since 2002 the government of Burkina Faso has implemented a staff retention policy, the regionalized health personnel recruitment policy, aimed at front-line workers such as nurses, midwives, and birth attendants. This study aimed to describe the policy's development, formulation, and implementation process for the regionalization of health worker recruitment in Burkina Faso. Methods: We conducted a qualitative study. The unit of analysis is a single case study with several levels of analysis. This study was conducted in three remote areas in Burkina Faso for the implementation portion, and at the central level for the development portion. Indepth interviews were conducted with Ministry of Health officials in charge of human resources, regional directors, regional human resource managers, district chief medical officers, and health workers at primary health centres. In total, 46 indepth interviews were conducted (February 3 - March 16, 2011). Results Development: The idea for this policy emerged after finding a highly uneven distribution of health personnel across urban and rural areas, the availability of a large number of health officers in the labour market, and the opportunity given to the Ministry of Health by the government to recruit personnel through a specific budget allocation. Formulation: The formulation consisted of a call for job applications from the Ministry of Health, which indicates the number of available posts by region. The respondents interviewed unanimously acknowledged the lack of documents governing the status of this new personnel category. Implementation: During the initial years of implementation (2002-2003), this policy was limited to recruiting health workers for the regions with no possibility of transfer. The possibility of job-for-job exchange was then approved for a certain time, then cancelled. Starting in 2005, a departure condition was added. Now, regionalized health workers can leave the regions after undergoing a competitive selection process. Conclusion: The policy was characterized by the absence of written directives and by targeting only one category of personnel. Moreover, there was no associated incentive-financial or otherwise-which poses the question of long-term viability.