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2.31 In the absence of an effective means for treating dracunculiasis, eradication must be based upon: (i) public awareness campaigns about the disease; (ii) education on ways to avoid its transmission, particularly with cloth drinking water filters; (iii) case containment and case reporting by village health workers (VHW). The plan relies on strong and sustainable supervision of the VHW by CSPS health workers who, in tura, should be trained and supervised by the District health team.

2.32 Epidemiological services within Burkina, particularly at the central level, are extremely weak. Such services are essential to maintainlng control of endemic diseases. The Department of Preventive Medicine (DMP), which includes the Service of Epidemiology, is scattered around Ouagadougou over seven facilities which are institutionally weak and without proper Computer equipment. The resurgence of various diseases such as malaria, schistosomiasis, trypanosomiasis, and, foremost, the emergence of AIDS, have highlighted the need for strong epidemiological surveillance and control services. Moreover, the organizational structure of the DMP has been based on a rangę of national "vertical" disease programs with little coordination or integration of activities.

E. Goyemmenfs Strategy

2.33 Health Seryices. The key objectives of the Goverament's current health services strategy as set out in the Government's "Letter of Sector Policy" (Annex 2.4), which was finałized during negotiations and submitted to IDA as a condition for Board presentadon, are: (a) strengthening the health care pyramid by promoting decentralization, integrating verdcal programs, and improving capacity at Ute central and regional levels to enhance management of human, materiał and financial resources; (b) improving the supply and minimizing the cost of essential drugs; and (c) encouraging increased accountability and cost recovery mechanisms throughout the health system in linę with the UNICEF/WHO-sponsored Bamako Inidadve which has been endorsed by the Government.

2.34    A key element of the Government's health senrices strategy is the strengthening of health services at the peripheral level through creating "Health Districts" centered around CMAs (Details are in Annex 3.1). District health authorities will supervise and control primary health care acdvides-through the CSPS-at the community level and through surgical referral facilities (CMA) at the district level.

2.35    The CSPS are supposed to follow a "Minimum Package" approach, l.e. curative consultations, immunizations, recommendations about appropriate food intake, pre-natal consultation, dealing with chronic sicknesses, family planning, etc. The CMAs are expected to deal with cases reąuiring hospitalization, referral consultations, and urgent medical/surgical cases. In addition to the basie surgical cases, the CMAs are also expected to handle complicated births and simpler labo rato ry tests.

2.36    Under the second Five Year Plan (1991-95), the Goverament set out the following objectives: (i) establishing health districts throughout the country with an average population density of approximatdy 200,000; (ii) providing all districts without a regional hospital (CHR) with an upgraded CMA; (iii) involving locally elected community members in decision maklng and management of the CSPS and CMAs; (iv) establishing primary care facilities in urban centers to draw primary care out of the hospitals; and (v) improving the supply of essential drugs and establishing local cost-recovery.