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The availability of diagnostic equipment, medical products and basic infrastructure is limited in most low-income societies. Poor motivation among health workers as well as recruitment and retention problems are key factors contributing to poor health care services in developing countries. The current paper describes how the front line cope with these difficult working conditions. Data for this study come from anthropological fieldwork in two districts of Burkina Faso and include a total of 27 unstructured and 40 semi-structured interviews with staff at dispensaries and medical centres in the two districts. Analytically, we make a distinction between their professional autonomy and their professional authority. We find that while the health workers experience a certain degree of professional autonomy, in the sense that they rely on their own clinical judgement and their discretion as decision makers and gatekeepers, their professional authority is constantly challenged when working at the margins of the state. Through improvisations and bricolaging, they compensate for the many shortcomings, but many of them feel that their skills are waning and that their professional identity threatened. Thus, massive strengthening of the front-line health worker's capacity is imperative for future improvement of health care services in Burkina Faso. [ABSTRACT FROM AUTHOR]

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Objectives.Ethnic minority children in Vietnam experience high levels of hygiene- and sanitation-related diseases. Improving hygiene for minority children is therefore vital for improving child health. The study objective was to investigate how kindergarten and home environments influence the learning of hygiene of pre-school ethnic minority children in rural Vietnam. Design.Eight months of ethnographic field studies were conducted among four ethnic minority groups living in highland and lowland communities in northern Vietnam. Data included participant observation in four kindergartens and 20 homes of pre-school children, together with 67 semi-structured interviews with caregivers and five kindergarten staff. Thematic analysis was applied and concepts of social learning provided inputs to the analysis. Findings.This study showed that poor living conditions with lack of basic sanitation infrastructures were important barriers for the implementation of safe home child hygiene. Furthermore, the everyday life of highland villages, with parents working away from the households resulted in little daily adult supervision of safe child hygiene practices. While kindergartens were identified as potentially important institutions for improving child hygiene education, essential and well-functioning hygiene infrastructures were lacking. Also, hygiene teaching relied on theoretical and non-practice-based learning styles, which did not facilitate hygiene behaviour change in small children. Minority children were further disadvantaged as teaching was only provided in non-minority language. Conclusions.Kindergartens can be important institutions for the promotion of safe hygiene practices among children, but they must invest in the maintenance of hygiene and sanitation infrastructures and adopt a strong practice-based teaching approach in daily work and in teacher's education. To support highland minority children in particular, teaching styles must take local living conditions and caregiver structures into account and teach in local languages. Creating stronger links between home and institutional learning environments can be vital to support disadvantaged highland families in improving child health. [ABSTRACT FROM PUBLISHER]

Introduction: the health information system (HIS) in Burkina Faso has improved significantly in recent years. In order to suggest further improvements, we specifically assessed the HIS performance indicators of the epidemic surveillance system from the perspectives of the stakeholders. Methods: we conducted a mixed methods study to assess the performance through timeliness and completeness indicators, strengths, and weaknesses of the HIS in Burkina Faso with specific focus on epidemic surveillance in the health districts of Dandé and Tenkodogo for the period of 2016 to 2019. Results: fewer than 35% of health districts were able to report at least 90% completeness of community reports since 2017. In 2018, four districts did not exceed 1% completeness of community reports. Some concerns remain related to a need of local support and inter-sectoral collaboration. The technical and organizational factors affect process and performance of the system directly or indirectly through behavioral determinants. Conclusion: the ability to measure the performance of all health facilities and to share all community reports online are challenges for the health system in Burkina Faso. New technologies, training-sensitization, and the involvement of actors with influence on social or behavioral change could help to ensure dynamic performance, if perceptions of actors are taken into account. [ABSTRACT FROM AUTHOR]