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Annex 2.4 Page 2 of 6

(nutritional anemias, Vitamin A deficiency, endemic goiter, etc.). PEM strłkes 50% of infants from 6 months to 3 years, 35.5% of women of child-bearing age and 40% of pregnant women.

5.    With respect to the health coverage provided by the country's infrastructure facilities, the situation remains precarious owing to the qualitative and quantitative inadeąuacy of basie health services, notwithstanding the slight improvement recorded in the last six years. In 1993, Burkina Faso had 840 health stations (ali categories combined), compared with 569 in 1985, equivalent to an average inerease of 7% a year. These health stations are organized in the form of a pyramid comprising: (i) the Health and Social Development Centers (CSPSs), which form the bottom tier, each CSPS serving a population of about 10,000 inhabitants within an average radius of 10 km; (ii) the Medical Centers, with or without surgical units (CMs and CMAs), which represent the first linę of referral for the CSPSs and which each serve an average population of 180,000 inhabitants; (iii) the Regional Hospitai Centers (CHRs), of which there are ten (10), represent the second linę of referral; and (iv) the two National Hospitai Centers (CHNs), located at Ouagadougou and Bobo-Dioulasso, which form the apex of the pyramid.

6.    The number of medical and paramedical Staff rosę tirom 3,281 in 1985 to 4,338 in 1993, an inerease of 9.4% a year. Ratios of health personnel to population remain well below WHO guidelines. Access to basie health care thus remains very limited, especially in rural areas: only 51% of city dwellers and 48% of the rural population have access to health facilities. A study carried out in March 1993 (SAFER) revealed that there are 612 full-scale and equipped CSPSs, but that 30 of them are completely shut down for lack of personnel. By the same token, certain Professional categories appear to be morę heavily concentrated in urban areas: 60% of all doctors and midwives are located in the two provinces of Kadiogo and Houet, together with 38% of government-certified nurses and 28% of birth attendants. In response to this situation, the Ministry of Health has established minimum staffing norms and initiated a redeployment process to shift morę Staff into the outlying health facilities (CSPSs, CMAs).

7.    It must be stressed, however, that even existing, adequately staffed facilities are still underutilized, particularly in rural areas. For example, recent studies carried out in certain rural areas of the country reveal that, in cases of slight and serious illnesses, only 10% and 14% (respectively) of sufferers consult the health services. Most are treated without resort to modern health facilities. This situation is reiated to the distance to health facilities, deficiencies in the organization of health activhies in the health centers, the inadequacy of efforts to inform and educate the population groups, the high cost of health care, and the lack of drugs within the health facilities themselves.

8.    The resulting picture is one of substandard health service performance. Coverage as regards prenatal consultations, for instance, remains very poor, although some modest improvements have been recorded (39.5% in 1991 against 20% in 1985). The proportion of assisted childbirths, although rising (33% in 1990 against 21% in 1985), is still at levels that cali for major efforts to be madę. As regards consultations for infants, fewer than 20% of babies benefit from them, while only about 40% of all children from birth to 12 months had been fully yaccinated under the Expanded Programme of Immunization (EPI) in 1991. In the family planning area, activities have expanded somewhat in just a few years (for example, the prevalence of contraceptive use rosę from 0.3% in 1985 to 8.2% in 1990), but the large number of unwanted pregnancies, clandestine abortions and abandoned infants is becoming an increasingly worrisome