Background: The Service Availability and Readiness Assessment (SARA) surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso.
Methods: Data on malaria-related visits and associated deaths in under 5-year-old children were extracted from the national Health Management Information System (HMIS) in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA), applied to the selected indicators, was used to construct a composite facility readiness score based on multiple factorial axes. Geostatistical models were employed to characterise the geographical distribution of facility malaria readiness. The analysis was carried out separately for 112 medical centres (“health facility order 1”; HF1) and 546 dispensaries (HF2).
Results: The composite readiness score explained 30% and 53% of the original indicators for HF1 and HF2, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval (BCI): 0.19-0.91) lower in the high readiness group of HF2, compared to the low readiness group. HF1 readiness was not related to malaria mortality.
Conclusion: Performant health services in resource-constrained settings are associated with lower malaria mortality rates. To accelerate progress towards malaria elimination in low-resource settings, appropriate funding should be made available to strengthen health systems.