8144188917

3

which will not lead to ocular complications. Ivermectin is cocsidered to be an invaluable tool in preventing widespread recurrcnce of the disease.

2.8 Although the incidence of trypanosomiasis (sleeping sickness) has been reduced to relatively Iow levels-200 cases have been reported in the last five years—its epidemiologica! characteristics can result in explosive outbreaks if the disease goes undetected for long periods. The danger of trypanosomiasis "imports" is serious, especialiy through immigrants settling on lands cleared from onchocerciasis. Dracunculiasis (Guinea worm disease) is also considered a significant heałth problem in Burkina Faso. Although not life-threatening, the worms cause wounds which, if not cared for properly, will become infected. A nationwide survey in 1990 found morę than 42,000 cases, spread throughout the country. Tbis temporarily disabling illness causes substantial economic losses-estimated by the Organisation de coordlnation et de coopiration pour la lutte coture les grandes endśmles (OCCGE) to include US$3 million per annum in lost agricultural production-due to the afflicted being unable to work the fields or attend school.

2.9 The Ministry of Public Health and Social/Family Action (MSASF) is responsible for formulating health policies and providing most national health services. The public health care system in Burkina Faso is pyramidal in shape, with about 600 health centers (Centres de santł et promotion sociale - CSPS), as well as 130 dispenseries and 21 matemities, at the base, extending upwards through about 67 medical centers (Centres mćdicawc - CM) spread throughout all of the country's 30 provinces, nine regional hospitals, and two national hospitals. In addition, primary health posts were established between 1985 and 1987, in all of the country's 7,000 villages, staffed by village health workers and traditional birth attendants. Local communities select and support these staff while the MSASF provides training and supenrision. The program, however, does not work well sińce less than 2,000 of these health posts are estimated to be currently operational.

2.10    At the provincial level, health services are coordinated by the Provincial Directorate of Health (DPS), headed by a medical officer. Responsibility for the national health budget, procurement, personnel management, and training is at the central MSASF level. The Ministry's headąuarters recently underwent a reorganization, the major feature being the establishment of a Public Health General Directorate responsible for a Directorate of Family Health (DSF) and a Directorate of Preventive Medicine (DMP). The DSF coordinates all nutrition programs, family planning, and the Expanded Program of Immunization. The DMP coordinates transmissible disease programs, mental health, dental health, and sanitation programs. It has also assiuned responsibility for maintaining the achievements of OCP in conjunction with control of other diseases (devolution). The new Ministry structure is morę appropriate than the previous organization in supporting decentralized and integrated health services. An organigram of the current MSASF is provided in Annex 2.2.

2.11    The District Health System. The MSASF is reorganizing basie health services through the establishment of health districts, the new basie operational unit for health care delivcry. The districts will consist of a medical center (CM) upgraded to provide emergency operations (Centre mćdlcal avec antenne chirurglcale - CMA), serving a population of about 180,000, and all health centers (CSPS), usually 15-20, within its zonę of responsibility. The health district does not always correspond to an existing political-administrative structure (province). There are 30 provinces throughout the country, and some larger provinces will have two or even three districts.