Revue Francophone sur la Santé et les Territoires (May 2015)
Ville et dynamique de l’offre de soins : Bobo-Dioulasso (Burkina Faso)
Abstract
More than 50% of the world’s population lives in cities, and the urbanization process continues to proceed, especially in southern countries. This demographic trend, and associated economic, social and environmental dynamics, gives rise to medical challenges in urban areas. In the 1990’s, several African countries responded by establishing health districts in order to better serve population needs, and in so doing placed greater emphasis on the local scale. In Burkina Faso, health districts have had responsibility for primary health care since 2003, as part of a broader communalization policy, and their boundaries follow those of the municipalities spatial limits. This study investigated the characterization and localization of modern health-care structures in Bobo-Dioulasso, the second city of Burkina Faso. Although Bobo-Dioulasso profited from public investment and infrastructure, the growth of the city was irregular and sporadic, which contributed to the development of peripheries dominated by informal settlements (or “spontaneous habitats”). As for health care, the public sector is present at the point of first contact, but private structures dominate as one progresses up the medical hierarchy, raising fears for accessibility (figure). Data were integrated in a geographical information system (GIS). The spatial dispersal of the health-care structures was analyzed using a method based on the standard deviation ellipse (SDE). The standard distance and the distance to the nearest neighbour were also used, in order to highlight importance of the distance in the spatial distribution of healthcentres and in behaviours of users. Kernel density analysis was conducted for each kind of health-care supply (public or private). Confused urban policies were highlighted by changes in the ellipse axis orientation. Privileged spaces were identified from the ellipsoidal form of the dispersion, suggesting that urban sprawl was not linked with this organisation of the health care system. The presence of a primary health-care structure in each urban sector is one of the criteria for location of public health-care supply, explaining its territorial scattering. Though social and spatial equity rules governed the public sector provision of primary health care, lucrative private sector facilities exhibited aggregation: they were confined to the central area and its immediate periphery. This suggests that the health care needs of populations on the margins of the city are not satisfied, and are not regarded as not creditworthy.
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