Assessment of MCH services in the district of Solenzo, Burkina Faso. III. Effectiveness of MCH services in detecting of and caring for mothers and children at risk.

A time and motion study was carried out in all five professional MCH-facilities in the study area. The chain of decision making process--from (i) collecting information, (ii) interpreting it as indicating risk to (iii) action--was followed while taking care not to interfere with it. At each step specific shortcomings were identified: a great number of commonly accepted risk factors was not looked for (e.g. outcome of previous pregnancies in a woman in labour). On the other hand, information indicating risk was collected, but not recognized as such (e.g. weight loss). The most striking feature of both under fives' (UFC), antenatal clinics (ANC) and maternity care was the consistent lack of any action taken as a consequence of a recognized risk factor. The possible underlying causes for the poor functioning of the risk approach in the studied peripheral services are discussed: (i) implementation failure, (ii) inappropriateness of cut-off points for risk definition leading to an unmanageably great proportion of risk clients, and (iii) a conceptual problem, i.e. the reluctance of the auxiliary staff as well as the patients to act on the basis of risk prediction, i.e. something that has not yet happened.