ArticleConflict and health2025
The evolution of facility-based deliveries at primary healthcare centres during an insecurity and conflict crisis in Burkina Faso: a geospatial analysis.
Article in Conflict and health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Abstract
backgroundAccess to healthcare in Burkina Faso, particularly obstetric care, is severely reduced by nearby armed conflict. However, systematic assessments of the spatial distribution of facility-based delivery rates and their evolution, as well as how they relate to conflict intensity, facility characteristics, and geo-spatial determinants, are absent.
methodsWe analysed spatial and temporal shifts in facility-based deliveries in Burkina Faso's primary healthcare centers in relation to conflict. Using spatial analyses, we examined how conflict-related deaths influenced delivery patterns, considering variations by facility type and pre-conflict service volume. We obtained monthly healthcare facility data (2016-2021) from Burkina Faso's Health Management Information System (HMIS) and conflict event data from the Uppsala Conflict Data Program (UCDP). The study covered all primary healthcare centers in conflict-affected northern and eastern districts (> 10 UCDP conflict deaths, 2016-2021) and neighboring southern districts: 854 CSPSs (Centres de Santé et de Promotion Sociale) and 53 CMs (Centres Médicaux).
resultsThe study identified geographical variations in facility-based delivery rates, notably from 2018-2019, with spatial clusters of lower rates becoming predominant in northern areas and higher rates doubling along southern routes and cities. This shift coincided spatially and timely with conflict escalation. In conflict hotspots, the average monthly rate of facility-based deliveries decreased over time, irrespective of pre-conflict service volume. However, CM facilities showed an upward trend, contrasting CSPS facilities. Outside conflict hotspots, facilities with exceptional pre-conflict service volume showed similar upward trends, while low- and high-volume facilities showed moderate increases. CM consistently maintained higher facility-based delivery rates over time than CSPS facilities.
conclusionThis research provides crucial insights for strengthening Burkina Faso's health system resilience to conflict by spatially identifying how facility characteristics and geo-spatial determinants shape healthcare disruptions. Mapping these elements at a fine scale enables adaptive policy interventions and dynamic resource allocation based on evolving conflict dynamics, enhancing obstetric care during conflict. By integrating the applied geospatial methods into national health systems, we can enhance responsiveness, enabling targeted and timely interventions, as well as efficient and flexible resource distribution (e.g., funding, personnel, and medical supplies). This also supports improved healthcare demand forecasting, ultimately ensuring a more proactive, data-driven, and conflict-sensitive approach to maternal health policy planning in crisis response.
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