Appréhender les conceptions locales de l'équité pour formuler les politiques publiques de santé au Burkina Faso

Abstract

Equity is an essential health promotion concept and must be included at the heart of public health policy making. However, equity, which can also be referred to as social justice, is a polysemic and contextual term which definition must stem from the discourse and values of the society where the policies are implemented. Using a case study from Burkina Faso, we try to show that the non-acknowledgement of the local concept of social justice in the policy making process partly explains the resulting policies' relative failure to achieve social justice. Data collection methods vary (individual and group interviews, concept mapping, participant observation, document analyses) and there are qualitative and quantitative analyses. The four groups of actors who generally participate in the policy making process participated in the data collection. With no intention to generalise the results to the entire country, the results show that mass social mobilisation for justice is egalitarian in type. Health or social inequalities are understood by individuals as facts which we cannot act upon, while the inequalities to access care are qualified as unjust, and it is possible to intervene to reduce them if incentive measures to this effect are taken. We also observed a certain social difficulty to conceive sub-groups of population and fierce will to not destabilise social peace, which can be provoked when looking for justice for the impoverished sectors of the population. This research allows better understanding about the emic aspect of equity and seems to confirm the importance of taking into account local values, especially social justice, when determining public policy.

Lutter contre les inégalités sociales de santé

“…Ces propos quelque peu exagérés dans un objectif heuristique montrent combien la perception des acteurs influence le passage à l'action ou explique l'inaction. Les normes sociales et les valeurs ne forment évidemment pas les seuls éléments déclencheurs de l'action visant à réduire les inégalités sociales de santé, mais elles y contribuent grandement (Sen, 2000), comme certains travaux menés en Angleterre, en Suède, au Burkina Faso, en France ou encore au Canada l'ont montré (Dubet, 2006;Jones, Burström et al, 2006;Ridde, 2006a;Collins, Abelson et al, 2007).…”

Social inequalities in health from Ottawa to Vancouver: action for fair equality of opportunity

“…Basically what should be retained from these debates is that the way issues are presented depends on whether these disparities are understood as differences (unavoidable) or as inequalities (avoidable and unjust). These issues of conceptual differentiation have been raised by numerous authors in the U.S.A., U.K, (Exworthy, Bindman, Davies & Washington, 2006), France (Fassin, Aïach & Philippe, 1996) or Burkina Faso (Ridde, 2006). For example, some think that use of the term 'disparities' in the U.S.A. denotes a perception of differences that are of a racial/ethnic or even 'cultural' origin (Braveman, 2006;Exworthy et al, 2006), whereas others affirm that this is not the case (Carter-Pokras & Baquet, 2002), as the "Healthy People 2010" policy seems to demonstrate (U.S. Department of Health and Human Services, 2000).…”

Approche socio-anthropologique de la dynamisation du réseau d'acteurs de prise en charge des malades tuberculeux au Burkina Faso

“…Dans la mise en oeuvre des stratégies d'accès aux soins, plusieurs acteurs interviennent en jouant des rôles spécifiques dans l'offre de soins (1); surtout lors du déroulement des politiques de santé publiques (2). La prise en charge des pathologies chroniques, singulièrement la tuberculose intéresse aussi bien les animateurs des systèmes de santé que les professionnels de la recherche en santé publique et en sciences sociales (3,4).…”