Cet article discute de l’exceptionnalité de l’épidémie Ebola telle que vécue en Guinée-Conakry et analyse les rationalités à l’œuvre dans les rumeurs et les attitudes à l’égard des activités et des équipes de la « Riposte », qualifiées de « réticences » par l’OMS. Il adopte une perspective d’anthropologie symétrique, qui consiste à questionner aussi bien le contexte socioculturel et historico-politique que les aspects techniques de ce dispositif de lutte sans concéder de privilège épistémologique à l’un des deux aspects. Si la Riposte a justifié l’imposition de normes de biosécurité par le caractère exceptionnel de l’épidémie d’Ebola, les populations, elles, ne la vivent pas toujours comme un événement « hors normes ». Leurs discours et leurs comportements à son égard sont nourris par une longue histoire socioculturelle et prennent corps dans une économie politique locale et nationale faite de méfiances et de clivages ethniques. Plus spécifiquement, les attitudes face aux enterrements dignes et sécurisés expriment une critique d’un dispositif technique centré sur la biosécurité, qui retire aux familles leurs droits et nie leur capacité de gestion sécuritaire de l’espace mortuaire. Finalement, les attitudes dites réticentes témoignent d’une réaction à une violence structurelle produite par la Riposte et correspondent à des formes de mobilisation pour revendiquer une meilleure reconnaissance du rôle des communautés dans la gestion de l’épidémie. Cet article souhaite prouver qu’une lecture critique et symétrique par l’anthropologie du dispositif de lutte n’est pas purement négative. Au contraire, elle fournit les moyens et les arguments d’une approche plus collaborative et plus respectueuse des droits et des devoirs des communautés, en éclairant les enjeux sociopolitiques et contextuels de l’épidémie.

Community engagement is commonly regarded as a crucial entry point for gaining access and securing trust during humanitarian emergencies. In this article, we present three case studies of community engagement encounters during the West African Ebola outbreak. They represent strategies commonly implemented by the humanitarian response to the epidemic: communication through comités de veille villageois in Guinea, engagement with NGO-affiliated community leadership structures in Liberia and indirect mediation to chiefs in Sierra Leone. These case studies are based on ethnographic fieldwork carried out before, during and after the outbreak by five anthropologists involved in the response to Ebola in diverse capacities. Our goal is to represent and conceptualise the Ebola response as a dynamic interaction between a response apparatus, local populations and intermediaries, with uncertain outcomes that were negotiated over time and in response to changing conditions. Our findings show that community engagement tactics that are based on fixed notions of legitimacy are unable to respond to the fluidity of community response environments during emergencies.

Background: To improve the coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) in Africa, Medicines for Malaria Venture (MMV) developed, tested and validated a new packaging of sulfadoxine–pyrimethamine (SP), as well as specific communications tools designed to improve knowledge of IPTp and the motivation of women to adhere to it, particularly if it is distributed by community health workers (CHW).Methods: This article describes and analyses the results of an empirical research carried out in the Democratic Republic of the Congo (DRC), Nigeria and Mozambique, to evaluate the perception and social acceptability of SP for healthcare providers, CHW and pregnant women, and to assess the ability of the new SP packaging and the communications tools to change their perception of SP and improve their attitudes towards IPTp.Results: The results indicate that SP’s new individual packaging was perceived by pregnant women and healthcare providers as a “hygienic” and “safe”, with a specific identity. The graphics used in IPTp communications tools were modified according to the respondents’ feedback to make them more culturally and socially sensitive, and then validated. However, although the new blister packaging and IPTp communications tools generated greater confidence and motivation, SP side effects as well as preconceived ideas, particularly regarding its efficacy, remain a challenge that must be addressed to improve IPTp acceptance and compliance by healthcare providers and pregnant women.Conclusion: This participatory approach to social research based on ongoing feedback to the graphic designer provided more empirical evidence to improve and adapt the textual and visual content of communication tools (SP blister packaging, leaflet, user guide) to local contexts and user preferences. Tested and validated in different socio-cultural and socio-political contexts, these tools provide a good basis for the promotion of IPTp in Africa.

Introduits dans les services de santé publique au Sénégal depuis 2007, les tests de diagnostic rapide (TDR) sont une nouvelle possibilité technique pour le diagnostic clinique du paludisme. Nous analysons la manière dont les différentes catégories de soignants, qui en sont les prestataires, se l’approprient dans leurs pratiques professionnelles. De même, nous documentons, à partir de l’analyse de leurs demandes de soins, les attitudes des bénéficiaires face aux TDR. Les résultats montrent des usages décalés de cet outil par rapport aux recommandations. Les TDR ont une utilité épidémiologique reconnue. En revanche, leur intégration positive requiert un changement de comportements que les soignants et les bénéficiaires ne sont pas toujours prêts à assumer. En effet, l’architecture, les conditions de travail, les demandes de soins influencent les modes d’appropriation de cette innovation technique. Introduced in the public health services in Senegal since 2007, Rapid Diagnostic Tests (RDTs) are a new technical opportunity for clinical diagnosis of malaria. We analyze how different categories of caregivers, who are the providers, assume appropriation of their professional practices. Similarly, we document, from the analysis of their application for care, attitudes of recipients towards RDTs. The results show a time lag between the uses of this tool and the recommendations. RDTs have a recognized epidemiological usefulness. However, their positive integration requires a change in behaviors that caregivers and recipients are not always willing to assume. Indeed, the architecture, working conditions and applications for care influence the modes of appropriation of this technical innovation.

The notion of performance has become dominant in health programming, whether being embodied through pay-for-performance schemes or through other incentive-based interventions. In this article, we seek to unpack the idea of performance and performing in a dialogical fashion between field-based evaluation findings and methodological considerations. We draw on episodes where methodological reflections on performing ethnography in the field of global health intersect with findings from the everyday practices of working under performance-based contracts in the Senegalese supply chain for family planning. While process evaluations can be used to understand contextual factors influencing the implementation of an intervention, we as anthropologists in and of contemporary global health have an imperative to explore and challenge categories of knowledge and practice. Making room for new spaces of possibilities to emerge means locating anthropology within qualitative global health research.

Introduction High discontinuation rates of contraceptive methods have been documented in sub-Saharan Africa. However, little is known about gaps within individual episodes of method use, despite their implications for unintended pregnancies. The objective of this mixed methods study was to examine the prevalence of, and explore the factors contributing to, delays in repeat appointments for pills and injectables in Senegal. Methods First, we constructed a longitudinal data set of women’s contraceptive consultations using routine records from 67 facilities in Senegal. Consultations for pills and injectables were classified as on time, delayed or with unknown delay status based on time since previous appointment. We described the prevalence of delayed appointments and used backward stepwise regression to build a mixed-effects model to investigate risk factors for delay. Second, we conducted workshops with family planning (FP) providers, and indepth interviews and focus group discussions with women of reproductive age, to explore factors contributing to delays. Results Almost one-third (30%) of appointments for pills and injectables were delayed, resulting in risk of pregnancy. Previous delay, pill use, lower educational level, higher parity, third and subsequent visits, and Islamic faith were independently predictive of delays (p<0.04 for all). Although women’s ‘forgetfulness’ was initially mentioned as the main reason for delays by women and providers, examining the routines around appointment attendance revealed broader contextual barriers to timely refills—particularly widespread covert use, illiteracy, financial cost of FP services and limited availability of FP services. Conclusion Delays in obtaining repeat pills and injections are common among contraceptive users in Senegal, exposing women to unintended pregnancies. Strategies to reduce such delays should move beyond a narrow focus on individual women to consider contraceptive behaviour within the broader socioeconomic and health systems context. In particular, effective interventions addressing low acceptability of contraception and appointment reminder strategies in high illiteracy contexts are needed.