TY - JOUR

T1 - Balancing professional autonomy and authority at the margins of a fragile state

T2 - Front-line health workers' experiences in Burkina Faso

AU - Pare Toe, Lea

AU - Samuelsen, Helle

PY - 2021

Y1 - 2021

N2 - The availability of diagnostic equipment, medical products and basic infrastructure is limited in most low-income societies. Poor motivation among health workers as well as recruitment and retention problems are key factors contributing to poor health care services in developing countries. The current paper describes how the front line cope with these difficult working conditions. Data for this study come from anthropological fieldwork in two districts of Burkina Faso and include a total of 27 unstructured and 40 semi-structured interviews with staff at dispensaries and medical centres in the two districts. Analytically, we make a distinction between their professional autonomy and their professional authority. We find that while the health workers experience a certain degree of professional autonomy, in the sense that they rely on their own clinical judgement and their discretion as decision makers and gatekeepers, their professional authority is constantly challenged when working at the margins of the state. Through improvisations and bricolaging, they compensate for the many shortcomings, but many of them feel that their skills are waning and that their professional identity threatened. Thus, massive strengthening of the front-line health worker's capacity is imperative for future improvement of health care services in Burkina Faso.

AB - The availability of diagnostic equipment, medical products and basic infrastructure is limited in most low-income societies. Poor motivation among health workers as well as recruitment and retention problems are key factors contributing to poor health care services in developing countries. The current paper describes how the front line cope with these difficult working conditions. Data for this study come from anthropological fieldwork in two districts of Burkina Faso and include a total of 27 unstructured and 40 semi-structured interviews with staff at dispensaries and medical centres in the two districts. Analytically, we make a distinction between their professional autonomy and their professional authority. We find that while the health workers experience a certain degree of professional autonomy, in the sense that they rely on their own clinical judgement and their discretion as decision makers and gatekeepers, their professional authority is constantly challenged when working at the margins of the state. Through improvisations and bricolaging, they compensate for the many shortcomings, but many of them feel that their skills are waning and that their professional identity threatened. Thus, massive strengthening of the front-line health worker's capacity is imperative for future improvement of health care services in Burkina Faso.

KW - Faculty of Social Sciences

KW - Health systems

KW - Burkina Faso

KW - health workers

KW - street-level bureaucrats

KW - anthropology

U2 - 10.1080/17441692.2020.1825768

DO - 10.1080/17441692.2020.1825768

M3 - Journal article

C2 - 33028153

VL - 16

SP - 1099

EP - 1110

JO - Global Public Health

JF - Global Public Health

SN - 1744-1692

IS - 7

ER -