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

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.

The role of community-based health workers in disease surveillance of potential epidemics: A case study from Burkina Faso

“…By not initiating a training strategy on the COVID-19 pandemic, it is believed that the Burkinabè State has reached the limit of its nancial capacity to ensure national health security. This nancial inability to respond to health emergencies is part of a structural fragility of health systems (7). It is in this logic of explanation that we understand why little is done to strengthen the capacities of CBHWs despite their complaints, the occurrence of re-emerging diseases and the propensity of emerging ones to occur, more and more, frequently (2).…”

“…Other epidemic diseases such as Ebola and COVID-19 have illustrated the sensitivity of health systems in speci c vulnerable communities, especially in Subsaharan Africa (5,6). Additionally, security crises in West Africa have increased the fragility of health systems (7), which is re ected in inadequate investments in the health sector(8). One of the consequences of the fragility of health systems is poor surveillance of disease transmission chains in contexts of infectious disease outbreaks (9).…”

Untitled

“…Det var sjaeldent synligt for dem, når de kom på de lokale sundhedscentre i Koutenga, som blot modtog få midler såsom enkelte mundbind til sundhedspersonale og håndvaskstationer for at minimere risikoen for smittespredning. 8 Fortaellingerne om, at covid-19 blev opfundet, eller at smittetallene blev forhøjet af politikerne, som var interesseret i at tiltraekke donorbistand for egen vindings skyld, gav genklang i en kontekst, hvor det donorfinansierede sundhedssystem ikke i tilstraekkelig grad kan daekke patienternes behov (Samuelsen 2020;Bjertrup 2021). Snarere end at vaere en benaegtelse af eksistensen af covid-19 var fortaellingerne om covid-19-bizness vores informanters kritik af, hvordan donorpenge og støtte cirkulerer i Burkina Faso og ikke på tilstraekkelig vis kommer dem til gode.…”

Covid-19 Temporalities: Ruptures of Everyday Life in Urban Burkina Faso

“…Citizens of Bobo-Dioulasso and other parts of the country are, in other words, experiencing a number of insecurities and disruptions of their everyday lives. Furthermore, many state institutions are weak, including the health system, which is characterised by the lack of infrastructure and equipment as well as poorly qualified and motivated health personnel (Ostergaard, Bjertrup, and Samuelsen 2016;Melberg et al 2016;Samuelsen 2020;Pare Toe and Samuelsen 2020).…”