Contenu du sommaire : Aspects des systèmes de santé dans les pays du Sud

Daniel Lévy-Bruhl, J. Cook, B. Legonou, Y. Jaffré, P. Amévigbe, G. Sanou, N. Guérin: Methodological approaches in studying the acceptability of vaccination: example of three investigations conducted in West Africa. Immunization program directors in three West African countries asked the help of social scientists to better understand non-utilization of immunization services. Semi-structured interviews carried out in homes sought to identify how parental models of childhood illnesses, especially concepts of their causes and prevention, affect immunization levels. These studies are examples of applied social science research providing, in a matter of months, information useful to health personnel for the management of their programs.

Gérard Salem, Thierry Lang: Epidemiological transition and social change in African towns: an anthropological approach to high blood pressure in Pikine (Senegal). African cities are the main place of an epidemiological transition, in particular of an increase in cardiovascular diseases. A research on Pikine, a Senegalese of 630 000 inhabitants city is about the traditionnal healer's perceptions of high blood pressure. This work shows that the concept of chronicity is not common knowledge in thèse traditionnal Systems and explains the contradictions between biomedical and local therapeutics as well as the social consequences of these contradictions.

Mohamed Mebtoul: Daily health: the dispensary of the neighbourhood, El-Hamri (Oran). This paper attempts to evaluate the kind of relationships established between the medical personnel and the patients in a neighbourhood of Oran (El-Hamri). From an ethnographical point of view, it appears that the dispensary's daily activity is essentially (mainly) based on a logic of assistance for the clients. The employees representation indicates the predominance given to the establishment of paternalistic relations with the patients. Ail the uninformed interpretations of the disease are received by the médical personnel as a paradoxal breaking with biomedical logic. So it is ail the subjectivity of the patients which is socially denied by the health institution.

Yannick Jaffré, Alain Prual: "The midwives corps", between professional and social identities. In subsaharian Africa, maternai mortality is a public health problem. Its rate is between 20 and 70 times higher than in industrialized countries. The most frequently cited causes concern the attitude of the populations and a lack of qualified personnel, both quantitatively and qualitatively. Logically enough, to solve this problem, the "professionals" of development hesitate between a naive valorization of traditional medicine (e.g. traditional birth attendants) and the implementation of technical programs and training programs. Several epidemiologic and anthropologie surveys, conducted in Niger, allow to better analyze the situation. In urban settings, pregnant women utilize widely public health centers, that, on the other hand, are overstaffed. An analysis of the "social identity" of nurses and midwives, of the representations they have of their profession and an analysis of the themes of the conflicts between the health personnel and the populations, allow to suggest explanatory causes of the dysfunctioning of maternal health services. Both the health personnel and the population are "trapped" in between two Systems: the System in relation to their respective social identity and the System of their professional identity. Improving the health situation in subsaharian Africa thus requires to add to the technical training programs of health personnels a qualitative training, where those problems of social identification and of professional identification would be approached in an innovative way.

Jérôme Dumoulin, Miloud Kaddar: Financing health care by patients in subsaharian countries: economie rationality and subsequent puzzles. Financing health care by patients is an help to the failures of government financing. In a first part the neoliberal foundations of this policy is exposed; in a second part, the analysis of its implementation suggests a mitigated judgment. In a third part, three key issues are focused: health care quality, social solidarity in front of health hazards and decision decentralisation. These puzzles are underevaluated and misunderstood by neoliberal thinkers and ground experimenters.

Beatriz Kalinsky, Wille Amie: The intercultural co-managenient of health in the south of Neuquen (Argentine). The coercive contact between indigenous people and the western society in Latin America has given raise, nowadays, to a spectrum of intercultural processes which has not still been taken into account accordingly by a simple scientific vision, from the point of view of the winners as well as of the defeated. In the south of Neuquen (Argentine), territory inhabited by the Mapuche People until the end of the past century, the health area is a matter of a hard symbolic confrontation (material and social) in which the formal and popular medicines have been unequal opponents. Notwithstanding, the latter has performed the institution of meanings into the former, not only in relation to the construction of the suffering experience but also in the ways of healing. It cornes out, thus, a quite complex innovation's dynamics of the popular knowledge which, in the health domain, has generated political bases of redefinition of the sociocultural imposition. The practice of the co-management is a rotund example of change moved in this sense into the formal medical styles standing until now.