6533b860fe1ef96bd12c2cef

RESEARCH PRODUCT

Behavior in case of fever or cough in four districts of Madagascar : eterminants and implications for access to the health

subject

description

Malaria, tuberculosis and acute respiratory infections constitute a major public health issue in Madagascar, the first two of which are the subject of national control programs largely inspired and financed by international organizations. The diagnostic, therapeutic and preventive methods recommended officially in the conventional health system are standardized and are based on a solid corpus of scientific knowledge. Among other diseases, they are explicitly targeted by the universal sustainable development goals (SDG). To reach them, the United nations recommend the implementation of an universal health coverage (UHC). Madagascar has adopted the SDG and is committed to the implementation of a UHC. The acceptance and implementation of these disease management methods depend on logistical and organizational factors, but also on the beliefs and practices of individuals, families and social or professional groups. In practice, there are many obstacles in the way of effective access to health care for diseases targeted by SDG and UHC, including those already covered by vertical and internationally supported control programs. These works on malaria, tuberculosis and acute respiratory infections were carried out within the framework of this sociological thesis, using a qualitative methods (among 83 individuals) and quantitative methods (with about 26,000 people interviewed), by population surveys, on several fields in Madagascar, involving caregivers, cared population and institutional actors. The acceptance and implementation of these disease management methods depend on logistical and organizational factors, but also on the beliefs and practices of individuals, families and social or professional groups. In practice, there are many obstacles in the way of effective access to health care for diseases targeted by SDGs and UHC, including those already covered by vertical and internationally supported control programs. The representative elements of the studied zones of Madagascar presented in this thesis provide an insight that could be useful for the implementation of a CSU across the country. They also reveal the challenges, not just financial, that remain to be overcome.