How community-based health workers fulfil their roles in epidemic disease surveillance: a case study from Burkina Faso.

Background: In 2016, Burkina Faso adopted a new community-based model for disease surveillance, appointing two community-based health workers (CBHWs) per village. The CBHWs play a crucial yet under-researched role in Burkina Faso's health system. This study aimed to analyze the factors influencing their practices in relation to their official roles in epidemic disease surveillance.

Methods: Conducted in the Dandé Health District in southwestern Burkina Faso, this qualitative study collected data through semi-structured interviews with 15 CBHWs and 25 health professionals, supplemented by observations of the CBHWs' working conditions. Data analysis employed a qualitative content analysis.

Results: Analysis showed major challenges in the current community health strategy, particularly in capacity building and the working conditions of CBHWs (e.g., lack of monthly report sheets and financial incentives). Recognition from the community was the key motivation for volunteering as a CBHW in Dandé Health District where rural populations are under great financial pressure. Consequently, financial incentives (monthly remuneration and extra incentives) and non-financial rewards in terms of status and prestige, play a crucial role in sustaining volunteer enegagment and effectiveness.

Conclusions: This study underscores the necessity of establishing a clear policy on compensation and protection for CBHWs to motivate and optimize their work. Such policies are essential for enhancing their contribution to a robust national community surveillance system, ultimately improving public health outcomes in Burkina Faso.