Masters Degree. (360G-Wellcome-083245_Z_07_Z)

Rationing decisions in health care in Burkina Faso The health system in Burkina Faso has been extensively restructure since 1990. One important dimension of this is the introduction of referral system that reflects conventional international practice: primary care at a district level, secondary care at a regional level and tertiary care in a single national hospital, with a progressive increase in the degree of specialization and complexity of the medical work involved. It is important not to identify these tiers with their equivalents in more developed countries: Burkina Faso is one of the poorest countries in the world (204/232 in the CIA World Factbook) with GDP of about $1,200 per head and life expectancy at birth of less than 50 years. There is a growing problem with HIV/AIDS and a high risk of infectious disease. As with a number of other poor countries, then, the health system has added a fourth tier, providing state-funded referrals to health facilities outside the country where local services are unable to cope. Eligibility for international referral is defined and guaranteed in law, although not matched by the availability of resources to fund referrals in every case. A committee of doctors has been set up in the national tertiary centre to determine which patients should actually be referred for treatment outside the country. This study will concentrate on the workings of the review committee. It will look at the two main issues: the response of the members to the constraints on traditional medical autonomy represented by the legal definitions of eligibility for health care in another country, and the basis on which committee members adjudicate between the competing claims of different patients who satisfy the criteria in a situation where resources are insufficient to offer the treatment to all of them. Although both of these are familiar issues to both social scientists and bioethicists, they have been little studied in the context of the poorest countries, where the challenges may be more sharply posed.