P070 – Medical Pluralism, Good Governance and Popular Politics in Subsaharan Africa
8 July, 16:00 – 17:30

Roca Albert / Universitat de Lleida
Carvalho Clara / ISCTE


During the first decade of twenty-first century, calls from the WHO to enable traditional medicine in the developing world, particularly in Africa, have transformed medical pluralism in an acceptable horizon, even if, until then, it had been regarded as a marginal situation, damned to extinction. It is difficult to assess the effects – limited by the moment in any case – this change may have had on the African national health systems. However, it has become clear that indigenous health conceptions and practices continue to be closely linked to local power relations, that is, this “invisible” world that cannot be captured neither by state institutions nor by territorial administration.
The panel proposes to explore this connection starting from the holistic concept of health that is prevalent among African populations, a notion that has never separated the three well-beings – physical, mental and social – gathered by WHO’s famous and controversial definition. The participants will analyse the influence of medical pluralism on local governance, and on local response to state and international political pressures, while considering the roles of the different stakeholders: communities, traditional healers, religious healers, NGOs, State services, biomedicine professionals…

Pluralisme médical, bonne gouvernance et politique populaire en Afrique subsaharienne
Pendant le XXIe siècle, les appels de l’OMS à activer la médicine traditionnelle dans le monde en développent, en particulier en Afrique, ont fait du pluralisme médical un horizon acceptable, même s’il avait été jusqu’alors considéré comme marginal, voué à l’extinction. Il est difficile d’évaluer les effets, en tout cas limités pour le moment, que ce changement peut avoir sur les systèmes nationaux de santé africains. Par contre, il est devenu évident que les conceptions et pratiques autochtones de santé sont étroitement liées aux relations de pouvoir locales, ce monde « invisible » que ne capturent ni les institutions étatiques ni l’administration territoriale. Ce panel propose d’explorer ces connexions à partir de la notion holiste de santé qui populations africaines, une conception qui n’a jamais dissocié les trois bien-être –physique, psychique et social- réunis par la fameuse et polémique définition de l’OMS. En particulier, les contributeurs analyseront l’influence du pluralisme médical sur la gouvernance locale, et sur les réponses locales aux pressions politiques étatiques et internationales, en prenant en compte les différents acteurs impliqués : communautés, tradithérapeutes, guérisseurs religieux, ONGS, services de l’État, professionnels de la biomédicine etc.

Paper 1

Schrippa Pino / Università di Roma

What is left of collaboration between biomedicine and traditional medicine

After Alma Ata, the projects which aimed to a collaboration between biomedicine and the traditional medicines have spread in all African continent. Such a process has involved states and transnational institutions as well. Many projects were financed by WHO and WB and carried out by NGOs, Universities and, in some ways, by the states. These projects have often encountered many difficulties in their realization.
Starting from my fieldwork in Ghana and from a critical review of some experiences carried out in Ghana in the 1990’s, I would like to discuss the results achieved.
After many years from the end of these projects, what is left in the social arena? Have these projects chanced the perspectives of the social actors?
The aim is to demonstrate that most of the limits of the projects depended on a narrow idea of traditional medicine. These projects have focused too much on the technical and operational aspects, leaving out fundamental dimensions that link traditional medicines to the society as a whole. To be effective, such interventions should take into account a broader context, and therefore cannot neglect to analyze therapeutic practices as complex wholes, as well as the dynamics exchange and syncretism, and even more by the relations of power and resistance within the field of therapies.

Paper 2

Ngalamulume Kalala / Bryn Mawr College (Pennsylvania, USA)

Therapeutic Itinerary in Saint-Louis-du-Senegal between Indigenous and Western Medicine: Past and Present

This paper examines the choices made by some residents of Saint-Louis in their search for therapy. It addresses one of the questions that have puzzled the French health officers and Western-trained African physicians and led them to conclude that the urban poor were resisting Western Medicine. Drawing on the evidence collected in the French and Senegalese national archives and from ethnographic investigation, the paper argues that, far from being irrational, the urban poor’s response to Western medicine made sense in the context of their worldview.

Paper 3

Sekhejane Palesa / Human Sciences Research Council (RSA)

Political Governance as a Crucial Anchor for Developmental Health Goals

Debilitated human conditions in Africa are mainly attributed to diseases as a result of multiple aspects such as poverty and lack of basic social services like accessible health care system. Therefore, in order for Africa to protect its human capital and deliver health services as human right, health system is a pillar that ought to be recognized and pursued earnestly. Health system is a sum of total institutions, organizations and resources, whose primary function is to improve health through responsiveness and financial fairness. Effective health systems do not only contribute to human development, but also contribute to economic development and growth, hence health system must be viewed as a rudimentary “life support” system. The deficiency in the capacity of mechanisms that could be utilized to hinder the pandemics through technical expertise, resources, mobilization, political and financial support suggest that Africa needs tailor-made solutions. Problem: African health care system(s) are not designed to support the immediate continental problems, thus require innovative intra-solutions. Study propounds that political and civil governance have a potential to promote and orchestrate desired health goals in the continent.

Paper 4

Fulane Gefra / CEI-ISCTE-IUL

Health care seeking and medical pluralism: narratives of women co-infected with HIV/AIDS and cervical cancer in southern Mozambique

Non-communicable diseases (NCDs) are coming up strongly in the African region and it is estimated that they will victimize twice as much as communicable diseases (CDs) disease by 2030 (WHO, 2014). In contexts like Mozambique, the rising of ‘new’ NCDs generates synergies with ‘old’ CDs, causing threaten to vulnerable population while affecting the global health and the global economy. However, the National Health Service of Mozambique has its focus at controlling CDs and is still far from prepared for the recent emergence of NCDs through the deficiency and fragmentation control programmes. Furthermore, the existing literature about co-infections tends to be centred at CDs interactions, such as HIV/AIDS+TB, and little attention is given to the connection between CDs and NCDs.
Since it has been demonstrated that HIV leads to the risk of cervical intraepithelial neoplasia (Ouattara et al, 2009; Denny et al, 2012; Teixeira, 2012), it is unacceptable that in Mozambique – where 18.4% of women live with HIV/AIDS (MOH, 2008) and 72% of screened women lost their lives due to CC (Jornal Notícias, June 14, 2014) – reliable data on the incidence and management of HIV/AIDS+CC patients’ body are scarce. It is also not acceptable that in a society of medical pluralism (Honwana, 2002), there are no socio-anthropological studies that illustrate the patients’ life.

Paper 5

Baldursdottir Sigridur / University of Iceland

The Exclusion of Traditional Birth Attendants (TBAs) in Guinea-Bissau: Effects and Consequences

Traditional birth attendants (TBAs) have been important providers of maternal health care. From the 1970s until the 1990s the WHO promoted training of TBAs as a strategy to reduce maternal and neonatal mortality. However, by the late 1990s the work of TBAs became debated and international policy started to promote skilled birth attendance, excluding TBAs. Thus, births assisted by TBAs are not included in MDG statistics. In Guinea-Bissau TBAs became part of the community health programme launched in 1977. Their role was to assist women in their communities with birth, prenatal consultations and refer women at risk to health facilities. This changed in 2010 with a new community health policy which excludes TBAs.
This paper explores the role of TBAs in Guinea-Bissau and the effect of the new policy based on theories of global governance. The data is based on 20 months of anthropological fieldwork between 2009 and 2012. The study shows how international health policy has affected the policy of Guinea-Bissau. The exclusion of TBAs was controversial as the majority of women still give birth at home with the assistance of relatives, older women or TBAs. The motives for giving birth at home are various, including geographical accessibility to health facilities, customs and user fees. This paper argues through empirical examples for the importance of taking local contexts and barriers to maternal health care into consideration when contemplating to exclude TBAs from birth attendance.

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