Faced with the lack of essential medicines and equipment, frontline health workers have to mobilise other skills that go far beyond the theoretical knowledge they acquired at medical school. They perform procedures, they are not qualified for, and at other times, they have to refer patients up to the higher-level doctors or hospitals, simply because local clinics lack basic medicines and instruments.
The recent research project “Emerging Epidemics: Improving Preparedness in Burkina Faso” – Department of Anthropology – University of Copenhagen explores how the frontline healthcare workers compensate for the many shortcomings of their clinics. For example, researchers found evidence that local nurses and doctors in Burkina Faso sometimes end up paying for the treatment of their patients out of their own pockets.
“You face a patient who can’t pay for his medication. He regrets attending the health centre, (…)” a nurse that works at a dispensary in Burkina Faso told the researchers:
“You know, the last time I paid for one lady because I understood from our exchange that she doesn’t want to come to the health centre again – because she doesn’t have the money to pay. In her view, it is better to stay at home with the disease and try to find an alternative such as self-medication or a traditional healer. I paid for her to encourage her to come back for health services.”
The researchers stress that despite the huge challenges posed by lack of equipment and essential drugs, the hospitals in Burkina Faso continue to be efficient and perform their daily duties.
The front-line health workers – in particular, the physicians – emphasised their listening skills, their patience and their ability to give advice based on their knowledge of the individual patients. Rather than emphasising their technical skills, they highlighted their direct relationship with their patients. As expressed by a physician participating in the study:
“We, the frontline doctors… the success of our work is not based on equipment, but on proximity to the patient. We do not have the medical equipment necessary to make a very specific diagnosis, as our doctor colleagues at the hospitals do, but we are closer to the patients, we take more time to listen and learn the history of their illnesses (…). That creates a confidence between the patients and us.”
Another physician said,
‘We only have proximity to offer our patients, we are accessible and that relieves them a little. Other than this, we do not have enough equipment to diagnose the diseases and treat them.”
Previous research has shown that poor infrastructure, the lack of essential drugs as well as low motivation among health workers, all affect the ability of the health services to provide good quality care.
But the current study goes beyond the problems. It shows what frontline health workers actually do in their daily work to keep services running. They find ways to adapt, improvise, and make do with very limited resources to continue to treat patients.
“The findings make one thing clear. If healthcare in Burkina Faso is to improve, frontline health workers need stronger support, better tools, and improved working conditions,” says Dr Lea Tore, one of the researchers behind the recent study.
She adds that these findings cannot stand alone and beside being published in numerous academic journals, for example in the Global Public Health Journal they have been shared with the health authorities in Burkina Faso as part of ongoing efforts to strengthen the country’s healthcare sector.
The article was produced as a press release by Dr Lea Toe as part of the Danida Fellowship Centre’s online training seminar for researchers Bridging the Gap. Research for the Public #2026.
