of all actors in the development of the health system, the introduction of emergency care, the subsidization of benefits for the mother and the child, have improved the efficiency and use of health services. burkina joined the international partnership for health and related initiatives (ihp +) in may 2010, which aims to increase resources and efforts for health, as well as the effectiveness of aid in the sector. the financing system of the health sector is mainly based on a tripod consisting of the state budget, external inputs (bilateral and multilateral) and cost recovery of health care and services to users (households). the offer of care is organized around public and private structures. the public sub-sector of care with three levels that provide primary, secondary and tertiary care. approval of modern medicines (specialty and generic), traditional pharmacopoeial drugs, medical consumables and medical biology reagents is assigned to the drug regulatory directorate (drp). for each marketing authorization (ma) application, a related dossier is evaluated by experts. in 2010, burkina faso revised its national health policy and developed a national health development plan covering the period 2011 to 2020. burkina faso increased its health care workforce between 2006 and 2010, but not sufficiently to meet the population's growing needs. burkina faso suffers from a severe lack of qualified health workers at all levels including support staff. there is less than 1 (0.45) physician per 10,000 people, 3.57 nurses per 10,000 people, and 2.39 midwives per 10,000 (burkina faso ministry of health, statistical yearbook 2010). health status major death risks the top ten causes of death includes : lower respiratory infections 14% malaria 10% diarrheal disease 6% stroke 6% preterm birth complications 4% ischaemic heart disease 4% meningitis 4% birth asphyxia & birth trauma 4% road injury 3% hiv/aids 3% malaria malaria remains a major public health issue and is endemic throughout burkina faso: according to the ministry of health, malaria accounts for 43 percent of consultations with a health provider and 22 percent of deaths. the duration of the rainy season in burkina faso varies across the country with corresponding variances in seasonal malaria transmission based on geographic zones. the principal vectors of malaria in burkina faso include three members of the anopheles gambiae complex: anopheles gambiae s.s., anopheles coluzii, and anopheles arabienesis. in 90 percent of cases, plasmodium falciparum is responsible for serious and fatal forms of malaria. insecticide resistance is increasing every year, and the resistance of anopheles gambiae to insecticides including ddt and pyrethroid classes is evident in many parts of the country. burkina faso's malaria control approach includes three components: improvements in tracking of human illness, parasite surveillance, and effective resource delivery. significant efforts have been made to stabilize the antimalarial commodity situation. the government of burkina faso recently recruited and trained 17,000 community health workers to support malaria prevention and other health activities, with malaria testing and treatment available in some areas of the country. the increased availability of rapid diagnostic tests, artemisinin-based combination therapies, and injectable artesunate has helped improve malaria case management in health facilities. other endemic diseases the health situation in burkina faso, despite a certain improvement, is still dominated by high morbidity and mortality due to endemic epidemics. the epidemiological profile of the country is marked by the persistence of a high disease burden due to endemic epidemics including hiv infection and by the progressive increase in the burden of noncommunicable diseases. besides malaria, the major diseases of public health importance are acute respiratory infections, malnutrition, diarrheal diseases, hiv, aids, stis, tuberculosis, leprosy and neglected tropical diseases (river blindness) . in addition, burkina faso is regularly confronted with epidemic outbreaks (cerebrospinal meningitis, measles, poliomyelitis). important prevention efforts by vaccination are made. noncommunicable diseases are increasing. they include, among others, cardiovascular diseases, mental disorders and diseases, metabolic diseases such as diabetes, malnutrition and other nutritional deficiencies, cancers, genetic diseases and injuries due to road accidents. however, the data collected by the national health information system do not make it possible to assess the extent of these diseases. some of them are currently the subject of special programs to better control them. the health of vulnerable groups is influenced by these communicable and noncommunicable diseases and remains characterised by high morbidity and mortality. a recent dengue fever outbreak in 2017 have killed 18 patients along with 9029 cases. cases are currently reported in all the 13 health regions of the country, with 60.8% of cases reported in the central region, particularly in the city of ouagadougou. after this, who has recommended timely and adequate management of these cases. who recommends that countries should consider the introduction of the dengue vaccine cyd-tdv only in geographic settings (national or subnational) where epidemiological data indicate a high burden of disease. maternal and child healthcare child health though improving recently, is still a major problem in burkina faso. the country appears at 134th place out of 137 countries ranked in the child development index. the country has seen large reductions in its neonatal, infant, and under-5 mortality rates between 2003 and 2010. neonatal mortality dropped from 33 to 28 deaths per 1,000 live births, infant mortality dropped from 81 to 65 deaths per 1,000 live births, and under-5 mortality dropped from 184 to 129 deaths per 1,000 live births (insd and icf international 2012).these reductions are likely due, in part, to increased access to and utilisation of health services for children under 5 and obstetric services, although issues with the health system remain. the national nutrition policy lists malaria, neonatal conditions, acute respiratory infections, and diarrhea as major causes of infant and neonatal mortality and asserts that malnutrition is the underlying cause of 35 percent of infant and child deaths. at age 6, 38% of children had caries, with prevalence higher in urban than rural areas. at age 12, the mean dmft was 0.7 with prevalence significantly higher among urban than rural children. other issues faced by children in burkina faso are : only 41% of births are attended by trained medical personnel. the nutritional status of children under age five is deteriorating. malnutrition is especially concentrated in the northern regions that border niger. more than 44 per cent of children suffer delayed or stunted growth. burkina faso is one of only 12 countries where guinea worm has not yet been eradicated. hiv/aids continues to spread among young people. an estimated 120,000 children have been orphaned by hiv/aids. school enrolment rates are very low, especially among girls. almost two thirds of teens and young adults under age 24 are unemployed. many girls are still subjected to genital mutilation, a practice that causes lifelong damage. women marry at a young age, have an average of 6 children, and lack control over their fertility, household decision making, and time. women have less access to land, capital, and farming inputs, which limits their productive capacity and undermines their ability to achieve or adequately support household food security. only 23 percent of women and 36 percent of men are literate. among urban women, 52 percent are literate, compared to 11 percent of rural women burkina faso's population of more than 20 million persons experiences a high rate of maternal mortality with an average of 341 maternal deaths per 100,000 live births. the lifetime maternal risk of death is still 1 in 44. it is estimated that the majority (80 percent) of these deaths are preventable and 50 percent occur within the first 24 hours after delivery often due to obstetrical complications such as haemorrhage and eclampsia. certain factors such as shortages of blood also contribute to the overall burden of maternal deaths occurring in health facilities. to reduce maternal mortality and improve the timely notification of maternal deaths, the burkina faso ministry of health (moh), in january 2012, introduced the national maternal death surveillance and response (mdsr) system and guidelines.