Accelerated fragility: exploring the supply–demand nexus in health facilities in rural Burkina Faso

Associate Professor Helle Samuelsen has contributed to the journal Africa with the article ‘Accelerated fragility: exploring the supply–demand nexus in health facilities in rural Burkina Faso’.

In Burkina Faso, political turmoil, escalating insecurity and a looming pandemic challenge the population's trust in the state. The article contributes to the debates about state–citizen relationships in fragile countries by connecting local health-seeking practices with the global trends of datafication and a strong focus on the fight against malaria in this part of Africa.

Drawing on long-term research engagement in Burkina Faso, the author examines the health-seeking practices of rural citizens and look into diagnostic routines and reporting in two rural dispensaries. Helle Samuelsen shows how the routinization of diagnostic procedures combined with a strong national and global political focus on the fight against malaria create what she terms a ‘supply–demand nexus’ in which rural citizens selectively ask for the health services that they know the system can supply.

The article argues that the routinized diagnostic practices that mainly focus on malaria serve as a ‘technology of invisibility’ by not capturing other important diseases among the rural population. Finally, it asks whether the limited healthcare services in the current context of political insecurity, instability and a global pandemic spur a process of further fragilization of the social contract between rural citizens and the state.

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