Fragile encounters: exploring public healthcare in Boulgou Province, Burkina Faso
This dissertation explores the dynamics of social relations between state-employed health workers and patients in public health facilities in rural Burkina Faso and the role of trust in these relations. Based on ethnographic fieldwork in the Boulgou Province, one of the poorest and most marginalized places in the world, Lise Rosendal Østergaard explores how public health care is practiced in times of strikes, sub-regional Ebola outbreaks and political fragility. Østergaard approaches public healthcare as:
- A place
- A group of people
- An idea
In doing so, Østergaard describes empirically how public healthcare is done as a collaborative effort by healthcare providers and healthcare users. By adopting a combined perspective, Østergaard challenges the commonly held focus on power asymmetry and unequal positions. She unfolds a space of collaboration and of coordinated interaction that is often under the radar in the literature that adopts a singular perspective.
Healthcare in a context of material and technological limitation
In the small, state-sponsored clinics, health workers must carry out biomedical healthcare with recourse to improvisation and tinkering rather than to advanced diagnostic technologies. Østergaard shows that local social relations become critical for patients because they mediate access to services, medicines and health technologies. These social relations are challenged by a number of moral and medical risks that frontline health workers and patients, both in precarious positions, are exposed to.
Trusting health sector relations
Based on peopled accounts of how public healthcare is done, Østergaard argues that trust in healthcare encounters is differentiated and is multiple. Trust can pertain to interpersonal relations, technologies and to institutions and to any combination of these. Furthermore, she argues that there should be no taken-for-granted of trust in health sector relations without empirical analysis. It is far from evident that full trust always serves the patient better than some balance of trust, mistrust, criticism and skepticism.
Lise Rosendal Østergaard defended her PhD dissertation "Fragile encounters: exploring public healthcare in Boulgou Province, Burkina Faso" in February 2016
LR Østergaard (2015). Maternal healthcare in context: A qualitative study of women’s tactics to improve their experience of public healthcare in rural Burkina Faso in Social Science and Medicine, Volume 147. December 2015 pp. 98-104.
LR Østergaard (2015). L’Ebola vu de loin : les travailleurs de la santé face au risque et à l’incertitude dans les campagnes burkinabé in Santé et Anthropologie Vol 11. November 2015.
LR Østergaard (2015). Trust Matters: A narrative literature review of aspects of trust in health-care systems in Sub-Saharan Africa in Global Public Health: An International Journal for Research, Policy and Practice. Vol 10, Issue 9, March 2015.
Public healthcare in CSPS
- 1300 Centres de santé et de promotion sociale (CSPSs) in Burkina Faso
- Staffed by state-employed nurses and midwives and locally recruited aides
- Main clinical activities are deliveries, child vaccinations, treatment of simple malaria, distribution of food supplements to malnourished children
- Patients must pay a fee for consultations and medicines
- In 2012 and 13 health workers went on strike for weeks claiming better working conditions
Ebola is a merciless indicator of the weakness of West African health-care systems