Research and policy on African health care distinguishes between biomedical and traditional practices, and between public and private providers. But do these distinctions accurately reflect people's experience of using health care systems? A new study examines the case of parents seeking care for their infants in the Republic of Guinea. Researchers from the Institute of Development Studies and the University of Sussex, in the UK, analysed ethnographic data as well as evidence from 1550 'infant health biographies' from rural and urban areas of Guinea Conakry in Guinea. They focused on the ways that people identify and seek different categories of health care for their infants. The Republic of Guinea is a West African country with a depressed economy and a weak state. Its health services are pluralistic, meaning that there are a large number and variety of different health providers and types of care. The growing market in health care products and services is mostly unregulated. An estimated 93 percent of health expenditure takes place outside the state sector. The researchers found that distinctions between public and private, and between biomedical and traditional therapies, were not relevant to people's practices and experiences than is usually credited. Other quite different categories are emerging in health seeking that are not being recognised. These categories cut across biomedical-traditional and public-private divides. Findings showed the following. There was a gender distinction between health centres which had become women's and children's spaces, and private pharmacies which were used mainly by men. There was a distinction between places associated with strength-building (prevention of child illness through herbal remedies, hygiene or immunisation) and those associated with cure. People distinguished between familiar ailments with known therapies, and unfamiliar ones requiring expert diagnosis (whether from biomedically trained doctors, pharmacists, or Islamic and other traditional healers). People distinguished between illnesses treated by injection and those aggravated by injection. Biomedicines were distinguished from traditional medicines through their different types of payment, whether immediate or delayed (for example by credit). The researchers conclude that there is not one public health system in Guinea but many, experienced in very different ways. There should be an open debate on more effective ways of operating health systems that might consider offering diagnosis in pharmacies, or enabling market traders to sell imported drugs.
Social Science and Medicine (2008) 66 (10) 2157-2167 [http://dx.doi.org/doi:10.1016/j.socscimed.2008.01.039] Special issue: Future Health Systems (Eds Bloom, G.; Standing, H.)