Power Resources in Health District Governance in Burkina Faso

Abstract

Introduction; The pluralistic nature of the governance of the health system with the multiplicity of actors disrupts power relations. Since the adoption of the Bamako Initiative in 1987 in Burkina Faso, we have noted the presence of community representatives in the decision-making space of health districts. They participate alongside government representatives in the decision-making process. This article aims to analyze the influence of the different actors involved in the governance of a health district in Burkina Faso. A total of 32 people were included in the study. These people were divided into three main groups: members of the district team (n=9), managers of the government's decentralized technical services (n=8) and community representatives (n=15). The data were collected through individual interviews. The content analysis method was used. NVIVO software was used for data processing. The results indicate that community representatives have little influence in the decision-making process at the health district level. Indeed, all the resources that allow actors to influence exchanges are beyond their reach. Language skills, expertise, and economic capital are the main resources that are mobilized in this space. They are easily mobilized in interactions by both health district officials and community representatives. As a result, the views of the communities are poorly taken into account in the governance of health districts in Burkina Faso. The article notes that mastery of the language of communication, economic situation, and expertise on health issues give more scope for action to health district officials than to communities.