Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-22T14:22:32.009Z Has data issue: false hasContentIssue false
  • English
  • Français

Accelerated fragility: exploring the supply–demand nexus in health facilities in rural Burkina Faso

Published online by Cambridge University Press:  03 November 2020

Helle Samuelsen
Get access Rights & Permissions [Opens in a new window]

Abstract

In Burkina Faso, political turmoil, escalating insecurity and a looming pandemic challenge the population's trust in the state. This article contributes to the debates about state–citizen relationships in fragile countries by connecting local health-seeking practices with the global trends of datafication and a strong focus on the fight against malaria in this part of Africa. Drawing on long-term research engagement in Burkina Faso, I examine the health-seeking practices of rural citizens and look into diagnostic routines and reporting in two rural dispensaries. I show how the routinization of diagnostic procedures combined with a strong national and global political focus on the fight against malaria create what I term a ‘supply–demand nexus’ in which rural citizens selectively ask for the health services that they know the system can supply. I argue that the routinized diagnostic practices that mainly focus on malaria serve as a ‘technology of invisibility’ by not capturing other important diseases among the rural population. Finally, I ask whether the limited healthcare services in the current context of political insecurity, instability and a global pandemic spur a process of further fragilization of the social contract between rural citizens and the state.

Résumé

Résumé

Au Burkina Faso, l'agitation politique, la montée de l'insécurité et la menace d'une pandémie ébranlent la confiance de la population dans l’État. Cet article contribue aux débats sur les relations État-citoyen dans les pays fragiles en reliant des pratiques locales de recours aux soins aux tendances mondiales de mise en données et à la priorité donnée à la lutte contre le paludisme dans cette partie de l'Afrique. S'appuyant sur ses recherches à long terme au Burkina Faso, l'auteure examine les pratiques de recours aux soins des citoyens ruraux et étudie les routines et rapports diagnostiques dans deux dispensaires ruraux. L'auteure montre comment la routinisation des procédures diagnostiques, associée à la priorité politique nationale et mondiale donnée à la lutte contre le paludisme, crée ce qu'elle appelle un « lien offre-demande » dans lequel les citoyens ruraux réclament sélectivement des services de santé qu'ils savent pouvoir être fournis par le système. L'auteure soutient que les pratiques diagnostiques routinisées qui se concentrent essentiellement sur le paludisme servent de « technologie d'invisibilité » en ne capturant pas d'autres maladies importantes parmi la population rurale. Enfin, l'auteure pose la question de savoir si les services de soins de santé, limités dans le contexte actuel d'insécurité politique, d'instabilité et de pandémie mondiale, stimulent un processus de fragilisation accrue du contrat social entre les citoyens ruraux et l’État.

Type
Austere labour and fragile health
Information
Africa , Volume 90 , Issue 5 , November 2020 , pp. 934 - 951
Check for updates
Copyright
Copyright © International African Institute 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adams, V. (ed.) (2016) Metrics: what counts in global health. Durham NC and London: Duke University Press.Google Scholar
Adebanwi, W. (ed.) (forthcoming n.d.) Everyday State and Democracy in Africa: ethnographic encounters. Athens OH: Ohio University Press.Google Scholar
Adebanwi, W. and Obadare, E. (eds) (2010) Encountering the Nigerian State. New York NY: Palgrave Macmillan.CrossRefGoogle Scholar
Biehl, J. (2005) ‘Technologies of invisibility: politics of life and social inequality’ in Inda, J. X. (ed.), Anthropologies of Modernity: Foucault, governmentality, and life politics. Malden MA: Blackwell Publishing.Google Scholar
Brunsson, N. and Jacobsson, B. (2000) A World of Standards. Oxford: Oxford University Press.Google Scholar
Cueto, M. (2013) ‘A return to the magic bullet? Malaria and global health in the twenty-first century’ in Biehl, J. and Petryna, A. (eds), When People Come First: critical studies in global health. Princeton NJ and Oxford: Princeton University Press.Google Scholar
Das, V. and Poole, D. (2004) ‘Anthropology in the margins of the state’, PoLAR: Political and Legal Anthropology Review 30 (1): 140–4.Google Scholar
Erikson, S. (2016) ‘Metrics and market logics of global health’ in Adams, V. (ed.), Metrics: what counts in global health. Durham NC: Duke University Press.Google Scholar
Foucault, M. (2012) The Birth of the Clinic. Abingdon: Routledge.CrossRefGoogle Scholar
Gupta, A. (2012) Red Tape: bureaucracy, structural violence, and poverty in India. Durham NC and London: Duke University Press.Google Scholar
Hacking, I. and Hacking, T. (1990) The Taming of Chance. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Hagberg, S. (2019) ‘Performing tradition while doing politics: a comparative study of the dozos and koglweogos self-defense movements in Burkina Faso’, African Studies Review 62 (1): 173–93.CrossRefGoogle Scholar
Hagberg, S., Kibora, L., Ouattara, F. and Konkobo, A. (2015) ‘Au cœur de la révolution burkinabè’, Anthropologie et Developpement 42: 199–224.CrossRefGoogle Scholar
Hagberg, S., Kibora, L., Barry, S., Gnessi, S. and Konkobo, A. (2018) ‘Nothing Will Be as Before!’: anthropological perspectives on political practice and democratic culture in a new Burkina Faso. Uppsala: Uppsala University.Google Scholar
Hagberg, S., Kibora, L., Barry, S., Cissao, Y., Gnessi, S., Kaboré, A., Koné, B. and Zongo, M. (2019) Sécurité par le Bas: perceptions et perspectives citoyennes des défis sécurité au Burkina Faso. Uppsala Papers in Africa Studies. Uppsala: Uppsala University.Google Scholar
Harsch, E. (1998) ‘Burkina Faso in the winds of liberalisation’, Review of African Political Economy 25 (78): 625–41.CrossRefGoogle Scholar
Jerven, M. (2013) Poor Numbers: how we are misled by African development statistics and what to do about it. Ithaca NY: Cornell University Press.CrossRefGoogle Scholar
Kiemde, F. (2019) ‘Febrile diseases in young children in Burkina Faso: etiologies and the value of rapid diagnostic test in primary healthcare settings’. PhD thesis, University of Amsterdam.Google Scholar
Law, J. (2002) Aircraft Stories. Durham NC and London: Duke University Press.CrossRefGoogle Scholar
Livingston, J. (2012) Improvising Medicine: an African oncology ward in an emerging cancer epidemic. Durham NC and London: Duke University Press.Google Scholar
Lock, M. and Nguyen, V. K. (2010) An Anthropology of Biomedicine. Oxford: Wiley-Blackwell.Google Scholar
MacLean, L. M. (2011) ‘State retrenchment and the exercise of citizenship in Africa’, Comparative Political Studies 44 (9): 1238–66.CrossRefGoogle Scholar
Masquelier, A. (2001) ‘Behind the dispensary's prosperous façade: imagining the state in rural Niger’, Public Culture 13 (2): 267–91.CrossRefGoogle Scholar
Masquelier, A. (2012) ‘Public health or public threat? Polio eradication campaigns, Islamic revival, and the materialization of state power in Niger’ in Dilger, H., Kane, A. and Langwick, S. A. (eds), Medicine, Mobility, and Power in Global Africa. Bloomington IN: Indiana University Press.Google Scholar
Mbembe, A. J. (2016) ‘Africa in the new century’, Massachusetts Review 57 (1): 91.CrossRefGoogle Scholar
Melberg, A., Diallo, A. H., Ruano, A. L., Tylleskär, T. and Moland, K. M. (2016) ‘Reflections on the unintended consequences of the promotion of institutional pregnancy and birth care in Burkina Faso’, PLOS ONE 11 (6): e0156503.CrossRefGoogle ScholarPubMed
Merry, S. E. (2011) ‘Measuring the world’, Current Anthropology 52 (S3): S83–S95.CrossRefGoogle Scholar
Merry, S. E., Wood, S., Baxi, P., Bhuta, N., Goodale, M., Hodgson, D. L., Jerven, M., Satterthwaite, M. L., Theidon, K. and Urueña, R. (2015) ‘Quantification and the paradox of measurement: translating children's rights in Tanzania’, Current Anthropology 56 (2): 217–18.CrossRefGoogle Scholar
Ministère de la Santé (2011) Plan National de Developpement Sanitaire 2011–2020. Ouagadougou: Ministère de la Santé.Google Scholar
Ministère de la Santé (2012) Guide Technique pour la Surveillance Integrée de la Maladie et la Riposte au Burkina Faso. Ouagadougou: Ministère de la Santé.Google Scholar
Moats, D. (2016) ‘Of stories and numbers: rethinking the settlement between anthropology and metrics in global health’, Science as Culture 25 (4): 594–9.CrossRefGoogle Scholar
Mogensen, H. O. (2005) ‘Finding a path through the health unit: practical experience of Ugandan patients’, Medical Anthropology 24 (3): 209–36.CrossRefGoogle ScholarPubMed
Mol, A. (2002) The Body Multiple: ontology in medical practice, science and cultural theory. Durham NC and London: Duke University Press.CrossRefGoogle Scholar
Nguyen, V. K. (2010) The Republic of Therapy: triage and sovereignty in West Africa's time of AIDS. Durham NC and London: Duke University Press.Google Scholar
Obadare, E. and Adebanwi, W. (2010) ‘Introduction: excess and abjection in the study of the African state’ in Adebanwi, W. and Obadare, E. (eds), Encountering the Nigerian State. New York NY: Palgrave Macmillan.Google Scholar
Olsen, W. C. and Sargent, C. (eds) (2017) African Medical Pluralism. Bloomington IN: Indiana University Press.CrossRefGoogle Scholar
Østergaard, L. R. (2016) ‘Occupational citizenships: practice, routine, and bureaucracy among nurses and midwives in rural Burkina Faso’, MAT: Medicine Anthropology Theory 3 (2): 244–68.Google Scholar
Østergaard, L. R., Bjertrup, P. J. and Samuelsen, H. (2016) ‘“Children get sick all the time”: a qualitative study of socio-cultural and health system factors contributing to recurrent child illnesses in rural Burkina Faso’, BMC Public Health 16 (1): 384.CrossRefGoogle ScholarPubMed
Owens, S. (2015) ‘Malaria and the Millennium Development Goals’, Archives of Disease in Childhood 100 (S1): S53–S56.CrossRefGoogle ScholarPubMed
Pigott, D. M., Atun, R., Moyes, C. L., Hay, S. I. and Gething, P. W. (2012) ‘Funding for malaria control 2006–2010: a comprehensive global assessment’, Malaria Journal 11 (1): 246.CrossRefGoogle ScholarPubMed
Porter, T. M. (1996) Trust in Numbers: the pursuit of objectivity in science and public life. Princeton NJ: Princeton University Press.CrossRefGoogle Scholar
Prince, R. and Marsland, R. (2014) Making and Unmaking Public Health in Africa: ethnographic and historical perspectives. Cambridge Centre of African Studies Series. Athens OH: Ohio University Press.Google Scholar
REN-LAC (2018) Étude sur les Présomptions de Corruption et Pratiques Assimilées dans le Système et les Services de Santé au Burkina Faso. Ouagadougou: Réseau National de Lutte Anti-corruption (REN-LAC).Google Scholar
Rose, N. and Lentzos, F. J. (2017) ‘Making us resilient: responsible citizens for uncertain times’ in Trnka, S. and Trundle, C. (eds), Competing Responsibilities: the ethics and politics of contemporary life. Durham NC and London: Duke University Press.Google Scholar
Rose, N. and Novas, C. (2005) ‘Biological citizenship’ in Ong, A. and Collier, S. (eds), Global Assemblages: technology, politics, and ethics as anthropological problems. Malden MA: Blackwell Publishing.Google Scholar
Samuelsen, H. (2016) ‘Health care systems’ in Callan, H. (ed.), International Encyclopedia of Anthropology. Chichester: John Wiley and Sons.Google Scholar
Samuelsen, H. (forthcoming n.d.) ‘Fragile relationships: elusive encounters with public services in rural Burkina Faso’ in Adebanwi, W. (ed.), Everyday State and Democracy in Africa: ethnographic encounters. Athens OH: Ohio University Press.Google Scholar
Scott, J. C. (1998) Seeing Like a State: how certain schemes to improve the human condition have failed. New Haven CT: Yale University Press.Google Scholar
Stapleton, P. and Byers, A. (2015) Biopolitics and Utopia: an interdisciplinary reader. New York NY: Palgrave Macmillan.CrossRefGoogle Scholar
Street, A. (2012) ‘Seen by the state: bureaucracy, visibility and governmentality in a Papua New Guinean hospital’, Australian Journal of Anthropology 23 (1): 1–21.CrossRefGoogle Scholar
Street, A. (2014) Biomedicine in an Unstable Place: infrastructure and personhood in a Papua New Guinean hospital. Durham NC and London: Duke University Press.CrossRefGoogle Scholar
Timmermans, S. and Epstein, S. (2010) ‘A world of standards but not a standard world: toward a sociology of standards and standardization’, Annual Review of Sociology 36: 69–89.CrossRefGoogle Scholar
Trnka, S. and Trundle, C. (eds) (2017) Competing Responsibilities: the ethics and politics of contemporary life. Durham NC and London: Duke University Press.Google Scholar
Von Schnitzler, A. (2008) ‘Citizenship prepaid: water, calculability, and techno-politics in South Africa’, Journal of Southern African Studies 34 (4): 899–917.CrossRefGoogle Scholar
Warren, N., Beebe, M., Chase, R. P., Doumbia, S. and Winch, P. J. (2015) ‘Nègènègèn: sweet talk, disrespect, and abuse among rural auxiliary midwives in Mali’, Midwifery 31 (11): 1073–80.CrossRefGoogle ScholarPubMed
Weber, M. (1978) Economy and Society: an outline of interpretive sociology: Volume 1. Berkeley CA: University of California Press.Google Scholar
Wendland, C. (2016) ‘Estimating death: a close reading of maternal mortality metrics in Malawi’ in Adams, V. (ed.), Metrics: what counts in global health. Durham NC and London: Duke University Press.Google Scholar
WHO (2015) World Malaria Report 2015. Geneva: World Health Organization (WHO).Google Scholar
WHO and UNICEF (2005) World Malaria Report 2005. Geneva: World Health Organization (WHO) and UNICEF.Google Scholar
Zeilig, L. (2017) ‘Burkina Faso: from Thomas Sankara to popular resistance’, Review of African Political Economy 44 (151): 155–64.CrossRefGoogle Scholar