# Analysis of evolution of the policy framework and governance mechanisms and their influence on the institutionalisation process of integrated community case management in Burkina Faso between 2010 and 2024: a scoping review

## TL;DR

This paper reviews how policy and governance changes influenced the adoption of community health programs in Burkina Faso from 2010 to 2024.

## Contribution

The study provides a scoping review of iCCM institutionalisation in Burkina Faso, highlighting the role of policy, governance, and stakeholder power dynamics.

## Key findings

- Political transitions and partner ambitions strengthened commitment to iCCM but limited its integration into public health policy.
- Insufficient political commitment and fragmented governance hindered full institutionalisation of iCCM.
- Lack of a robust regulatory framework and community involvement limited local ownership and implementation.

## Abstract

Integrated Community Case Management (iCCM) has been implemented in Burkina Faso for several years. In view of the insufficient reduction in infant mortality due to multiple factors, strengthening its institutionalisation was recommended in 2019 after Addis Abeba conference. We conducted this study to understand how changes in the policy framework, governance of the system, and power relations between stakeholders have shaped the institutionalisation of iCCM from 2010 to 2024 in Burkina Faso.

A documentary analysis using the READ approach (Review, Extract, Analyse, Distil) was used to select the documents. After identifying the relevant documents relating to the institutionalisation of iCCM in Burkina Faso (2010–2024) through double validation by two researchers, we used a grid to extract data, which was analysed to identify interactions between three key areas (policy framework development, governance and financing, exercise of power between actors and community involvement) with a view to institutionalisation in Burkina Faso.

Starting with a weak political framework in 2010, the pressures of political transitions (2015 and 2022), the ambitions of partners (combating diseases such as HIV/AIDS and malnutrition and achieving development goals), combined with pressures from the social, health and security crisis and research findings, ultimately strengthened political commitment to iCCM. The dominance of partners’ power linked to funding facilitated its integration into national health priorities, but limited its transformation into public health policy and its integration into the healthcare chain. Insufficient political commitment to iCCM and the absence of a rigorous regulatory framework for its funding limited the mobilisation of internal financial resources. These challenges were exacerbated by fragmented governance with low community involvement, which impacted implementation and limited ownership and local resolution of certain difficulties.

The institutionalisation of iCCM in Burkina Faso has been partial. It has been hampered by partial commitment, a lack of a robust regulatory framework for its financing, fragmented governance and vertical management.