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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
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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
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Copyright
Copyright © International African Institute 2020

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