Informal work, informal mobilisation? The lateral paths of health volunteers in Senegal

ABSTRACT

Community health workers (CHWs) are neither a profession nor a volunteer group, but a hybrid professional group, receiving modest allowances that vary according to the reference authority (states or non-governmental organisations). Their identities are manifold, depending on whether their work brings them closer to the hospital, the population, or the municipality. Sometimes loyalist, sometimes rebel, CHWs oscillate between municipal clientelism (to gain access to employment) and illegal practices (surreptitiously selling medicines or even conducting clandestine abortions). It is such empowerment and professional frustration that justifies their organisation to preserve their activity. It goes from the creation of associations to negotiate with public authorities, via more radical mobilisations in parallel, up to protest, boycotts of health campaigns, or sit-ins for improved status.

RÉSUMÉ

Les agents de santé communautaires (ASC) ne sont ni une profession ni un groupe entièrement bénévole, mais un groupe professionnel hybride, touchant des indemnités modiques variant avec la tutelle de référence (État ou ONG). Leurs identités sont multiples, selon que leur travail les rapproche de l’hôpital, de la population ou de la municipalité. Tantôt loyalistes, tantôt rebelles, ils oscillent notamment entre le clientélisme municipal (pour accéder à l’embauche) et le recours à des pratiques « illégales » (ventes parallèles de médicaments, avortements clandestins). Cette autonomisation et la frustration professionnelle qui l’accompagne trouvent un prolongement dans l’organisation de la défense de leur activité, avec la création d’associations pour négocier avec les pouvoirs publics, tandis que des mobilisations plus sauvages voient parallèlement le jour, au travers d’activités de freinage, de la mise en place de boycotts des campagnes sanitaires ou de la tenue de sit-in pour faire reconnaitre leur activité et accéder à un meilleur statut.

KEYWORDS:

• Mobilisation
• informal work
• community health workers
• local arena
• Senegal

MOTS-CLÉS:

• mobilisation discrète
• travail informel
• agents communautaires de santé
• arène locale
• Sénégal

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 The main argument for convincing local officials of the interest of our study was: ‘our study aims to identify the difficulties inherent in paramedic practice in order to envisage solutions for improving working conditions, in human, material and financial terms’. (Extract from the introductory letter co-signed by the universities of Lille and Dakar [UCAD]). In addition to the letter of introduction, I relied on my network of knowledge in the health system, built from previous research mandates, to better negotiate my place in the field.

2 Senegal's health pyramid is composed of three distinct levels: (1) the central or ministerial level, which includes the minister's office, the general secretariat, and the directorates and services attached to it; (2) the intermediate level of the medical region, whose area corresponds to that of the administrative region. At this level, coordination, supervision, inspection, and support for public and private health structures in the region must be ensured; (3) the peripheral or departmental level of the health districts. Medicine must be delivered in rural or semi-urban areas in a four-dimensional manner: curative, preventive, social and educational. One or more health centers encompass a network of health posts, which in turn supervise health huts and rural maternity units

3 Parents, friends, and familiarity: this is a partisan selection of community health actors that favors people who are part of knowledge networks.

4 The bàjjenu gox plays a role of unifying the inhabitants, of advising on relationship management and personal hygiene. She bases her actions on the exemplary nature of her actions, learning by doing.

5 The actors in charge of community development projects attached to the Ministry of the Family, constitute indirect competitors because of the transversality of their interventions, which affect the fields of the family, children, etc.

6 A local instance composed of municipal representatives and permanent staff, which is responsible for the administrative and financial management of public health establishments (health posts and centres).