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13.3: Health Care Facilities in Burkina Faso (H Samuelsen)

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哥本哈根大学

4.8（416 個評分） | 17K 名學生已註冊

This course will provide you with an overview of the most important health challenges facing the world today. You will gain insight into how challenges have changed over time, we will discuss the likely determinants of such changes and examine future projections. Successful international strategies and programs promoting human health will be highlighted and global health governance structures will be mapped and the role of the key actors explored.

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Maternal Child Health, Reproductive Health, Public Health, Community Health

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4.8（416 個評分）

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RR

Mar 19, 2018

I really learnt alot on introduction to global health, from learning the greatest challenges in healthcare to Global burden of diseases. The course was quite helpful.

ES

Apr 21, 2017

Very structured, perfect overview of aspects of Global healthcare, engaging lectures with multiple experts and professors in their field. Highly recommended!

從本節課中

Health Systems and Global Health Governance

In this final module of the course we will go full circle, with lessons about the role of health systems and the impact of policy. The last lesson of the course will focus on global health governance and the health aspects of the UN Sustainable Development Goals.

13.1: NCDs and Health Care Systems (G Galea)11:33

13.2: Financing Universal Health Coverage (A Bjerrum)15:13

13.3: Health Care Facilities in Burkina Faso (H Samuelsen)8:49

13.4: Health Systems in Fragile States (TA Dræbel)22:02

13.5 Medical Tourism16:57

教學方

Flemming Konradsen
Professor, Director

腳本

Hi my name is Helle Samuelsen. I'm from Department of Anthropology, University of Copenhagen

In this case study, I will take you to Burkina Faso, a land-locked West African country with

a population of about 17 million. Burkina Faso is one of the poorest countries

of the world, ranked as number 183 out of 186 countries at the United Nations Human

Development Index. The government of Burkina Faso signed the

Alma-Ata Declaration on Primary Health Care in 1978 and has since worked to increase the

distribution of health care services in rural areas. Today, the maximum distance to a health

center is about 15 kilometres. However, studies show that many of the public

health facilities, which are government run, are under-utilized. The low use of public

health facilities is paradoxical because the need for health care services is huge. Burkina

Faso has one of the highest child mortality rates in the world: it is estimated to be

176 per 1000 (UNDP 2013). In other words, almost every fifth child will die before he

or she reaches the age of five. Why is the public health care system under-utilized

. The data for this case study was collected in three villages in the south-eastern part

of the country. Most villagers here live from subsistence agriculture with remittances from

migrants as another important source of income. In studies of health care seeking practices

of rural populations, these five factors have been highlighted as important for an

understanding of use and non-use of public health care facilities:

Availability: Are health care facilities within geographical reach of the rural population?

Accessibility: Does a sick person or a mother of a sick child have the means of transport

to reach a health service facility? Cost (both direct and indirect costs): Can

a household actually afford to seek treatment at a health facility and pay for the drugs?

And can a family afford to miss a half day or full day of income in order to take a sick

child to a health facility? Quality of care: Are the health staff trained

well enough to provide the best possible treatment? And are the treatment procedures explained

well enough for the patients so that they can follow the prescribed treatment?

Delay: Does a sick person or a mother to a sick child seek professional help promptly

- and does the sick person receive timely treatment when contacting a health facility?

The Primary Health Care Centre in the rural areas of Burkina Faso is usually staffed with

two nurses and an auxiliary midwife, and each center covers approximately 10 villages. The

services offered at a health center include out-patient and ante-natal and post-natal

care. There is also a small ward with a few beds for admitted patients and for maternity

care. The standard procedure is that the patient

is first examined by one of the nurses at the Primary Health Center, who writes the

prescription on a small piece of paper; the patient then buys the medicines from a small

pharmaceutical store selling the most essential drugs. Finally, the patient returns to the

nurse for instructions about how to take the medicine, or the nurse gives the injection/s

with the needle, syringe and medicine bought by the patient. The supply of drugs is usually

sufficient, but the health care center has neither electricity or water and latrines,

and the nearest hospital for referral is the district hospital of which there are 42 in

the country. Vaccination is free in Burkina Faso and while

the health centers are buzzing with activity at the scheduled vaccination days, they are

surprisingly quiet at other days - taking the health care needs into account.

All of the aforementioned factors are important for an understanding of the relatively low

use of the government health facilities in these villages.

In order to obtain a more in-depth understanding of why government health facilities may be

under-utilized, we need to know a bit more about the local ethnography.

In addition to the government health care center, our study identified a fairly large

number of other people who offered some kind of health care services. The majority of these

were herbalists who collect plants in the surrounding bush, prepare medicines and treat

villagers who come for consultation. They are specialists in relation to specific symptoms

or diseases. Another group of healers includes the bonesetters, who have specific skills

in treating fractures. In addition, one person possessed specific knowledge about how to

treat cases of sorcery, while another person was a diviner, who not only dealt with cases

of sickness, but also with other kinds of misfortunes.

The marabouts are those who, having attended Koran school and acquired skills in treating

sickness, use quotations from the Koran as well as herbs and minerals as therapy. The

therapeutic skills of these groups of healers are both technical and spiritual. The health

care practices of these local healers are based on various types of indigenous knowledge

traditions. At the market, young peddlers sell western pharmaceuticals and others sell

herbal medicine. Furthermore, the local villagers themselves have an extensive knowledge about

local plants used in herbal medicine and self-medication is widespread here as like in some other parts

of the world. Thus, the health system in these villages comprises much more than the government

health facilities. The fact that various knowledge traditions

co-exist in a society is called medical pluralism. The primary health care center is thus not

the only available health care facility and in cases of illness many villagers act very

pragmatically by trying out various types of treatment simultaneously, which sometimes

causes a delay before efficient treatment is reached.

We discovered another important explanation of the under-utilization of the primary health

care center in these villages, when we studied a number of monthly reports from the health

centers. Here it became clear that malaria accounted for about 34% of all the cases attended.

This is not necessarily surprising, but it was surprising that only very few people were

diagnosed with heart problems, high blood pressure, diabetes and mental problems. This

finding indicates that villagers mainly consult the government health facility with malaria

related symptoms. Other symptoms and diseases are dealt with in other ways and through other

types of consultations. In conclusion, by using ethnographic data

and looking in detail at the health care seeking practices we can obtain a better understanding

of why -- and in which cases - government health facilities are used and why these facilities

are under-utilized in one of the poorest countries of the world.

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