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

Abstract

AbstractIn Burkina Faso, political turmoil, escalating insecurity and a looming pandemic challenge the population's trust in the state. This 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, I examine the health-seeking practices of rural citizens and look into diagnostic routines and reporting in two rural dispensaries. I show how the routinization of diagnostic procedures combined with a strong national and global political focus on the fight against malaria create what I term a ‘supply–demand nexus’ in which rural citizens selectively ask for the health services that they know the system can supply. I argue 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, I ask 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.