Presentation by Loubna Belaid (Université de Montréal). Global Health Workshop: Methods For Implementation Science in Global Health. http://www.equitesante.org/implementation-science-methods-in-global-health/

1. The potential of the case study method to
understand the heterogeneity of effects of a
health policy
METHODS FOR IMPLEMENTATION SCIENCE
IN GLOBAL HEALTH
April, 20th. 2017
McGill University
Workshop co-organised by REALISME Chair and McGill of Global Health Programs
Loubna Belaid

2. Context
• In Burkina Faso, 47% of the population live below the poverty line, poor MNCH
outcomes (INDES, 2012)
• In 2006, Emergency obstetric neonatal care (EmoNc Policy): Increase the coverage
of facility–based deliveries by reducing the costs of complicated and
uncomplicated chidlbrith in health facilities
• Effects of EmoNc policy: Increase of the coverage of facility-based deliveries
(from 38% in 2003 to 66% in 2010) but disparities were observed within the
regions, the districts and the primary health care facilities
• Djibo district located in the Sahel region, the coverage of facility-based deliveries
was 55% against 66% at the national level

3. Objectives of the study
• To assess the implementation of the EmoNc policy in 6 health facilities in Djibo
district
• To understand the variation in coverage of facility-based deliveries by identifying
the influence of contextual factors

4. Methods
• Study design: Multiple contrasted case study. Case: Health care facilities (n=6)
• Contrasted cases: (1) Immediate effect, (2) delayed effect (3) no effect after the implementation of EmoNc policy
• Methods of data collection: In-depth interviews (women, health providers, health managers), FGD
(communities), document analysis and observation in the 6 health facilities
• Fieldwork for 4 months (November 2010- February 2011)
• Analysis : QDA Miner software , “Explaining building strategy”
• Inter and intra cases analysis
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5. Results
Implementation was homogenous in the 6 health facilities
Immediate effect
• Creation of additionnal strategies to promote facility -based
deliveries: funded fuel, recruitement of women in villages
• The arrival of female of health providers
• Positive perception of quality of care and strong relation of trust
Delayed effect
• The arrival of a new health team
• The application of a penalty fee for home births
No effect
• No activities to promote facility-based deliveries
• Poor quality of care , informal and illegal payements
• Conflicts between health teams and communities
The importance of
health provider’s
leadership

6. Lessons learned for
implementation
science in global
health
Case study design is a
potential method to
understand how the effects
of a policy are produced
Strengths
• Strong method to understand the influence of context on
the implementation (processes) and effects of health
policy
• Study design refines the interpretation of the data by
taking into account negative cases
• Potential method to enhance the internal (triangulation)
and external (multiple cases: logic of replication) validity
of the research
Limits
• Time and budget consumming
• Too much data to analyse !

7. To go further
1. Belaid L, Ridde V. Contextual factors as a key to understanding the heterogeneity of
effects of a maternal health policy in Burkina Faso Health Policy and Planning. 2014;29(2):1-13.
2. Belaid L, Bodson O, Ridde V, Samb O, Turcotte-Tremblay A-M. Innovations qualitatives
dans l'évaluation des interventions en santé In: Kivits J, Balard F, Fournier C, Winance M, editors.
Les recherches qualitatives en santé Collection U Paris Armand Collin 2016.
3. Yin R, Ridde V. Théorie et pratiques des études de cas en évaluation Yin R, Ridde V,
editors. Montréal: Presses de l'Université de Montréal 2012.
4. Yin R. Case study research: Design and methods. 5 ed. Thousand Oaks, California Sage
Publications; 2013
5. Yin RK. Validity and generalization in future case study evaluations. Evaluation. 2013;19.
6. Lagarde M, Barroy H, Palmer N. Assessing the effects of removing user fees in Zambia
and Niger. Journal of health services research & policy. 2012;17(1):30-6.

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