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Utilisation et perception des systèmes de santé par les enfants et leur famille: recherche appliquée interdisciplinaire


This research carried out in four developing countries (Algeria, Morocco, Congo, Togo) by multidisciplinary teams combining the fields of epidemiology, anthropology or sociology, and economics, had the following objectives :

- To analyse the utilisation of diverse components of the health system by children under five.
- To analyse the users' and health professionals' views of illness and health care.
- To strengthen the capacity of researchers to conduct multi-disciplinary research projects in the field of child-health;
- Using the results from the above analysis, to promote sustainable and appropriate action and improve child care.
- In all the countries, results converged and demonstrated the association between problems of health seeking behaviour encountered by families on the one hand, and problems of the functioning of health services on the other. At the family level, one is particularly struck by the length of the delay between first symptoms and consultation, and by the high frequency of self-medication at home. Recourse to traditional practitioners appears to be of modest importance. It appears that, more than there being a problem of incorrect use of health services by patients, there is a problem of delayed recourse to these services. Patients often arrive at hospitals late, after complex therapeutic itineraries, with the consultation taking place under emergency conditions and with sometimes high mortality among hospitalised children. However, families have a good understanding of how the health system functions. Rather, it appears families are discouraged by the considerable problems posed by social relations and communication with health care personnel. A teaching programme such as the one developed in Algeria thus appears justified since it would allow professionals to understand the complexity of health seeking behaviour and their own role in problems of health system functioning. In Morocco, a relative failure of activities undertaken by the Moroccan team was attributed primarily to the lack of sociological input on the role of families and on interaction between them and health care personnel.
- A final seminar brought together all of the participants in March of 1996. Future collaboration is planned: an extension of training activities in the Congo and in Togo; development of a project on the use of drugs in Congo and Togo; activities at the level of health care centres in all the countries, with integration of results of this research into existing programmes, as is already the case with the National Plan for Health Development in Congo.
- The complete results of the research programme will be published as a special issue of the "Revue d'Epidémiologie et de Santé Publique", which will appear in early 1997.
Data from a descriptive first phase had been gathered in the four countries during the STD2 programme. This phase included an epidemiological study of the use of the different types of health facilities caring for children, and an anthropological study in families both using and not using these facilities, as well as among health personnel (physicians and allied health personnel in the public sector, private physicians and nurses, and tradipractitioners). The research began later in the Congo than in the other countries. It was carried out with considerable difficulty because of serious social and political problems in three of the countries beginning in late 1992 (Algeria, Congo, Togo). The work in this project was as follows :

- The completion of data collection of the first phase for the Congo;
- The continuation of analysis of epidemiological data and anthropological information collected during the first phase;
- The development of specific research projects on topics identified during the first phase of the research (the utilisation of medicinal drugs by children in Togo, emergencies, therapeutic interventions, and behaviour of health personnel in Morocco);
- The development of training activities and applied research;
- The organisation of meetings on research progress.

Teaching activities have been carried out primarily in Algeria, and have consisted of the development of innovative teaching methods using results from the anthropological study (the contents of interviews with families on health seeking behaviour for sick children). These activities have targeted health professionals in initial training programmes (nurses) or in the context of continuing education (interns and residents in hospital departments). In Morocco, activities were carried out at the level of health centres and "diagnostic centres" with the objective of improving the rate of utilisation of curative facilities and of reducing the percentage of "unjustified" emergencies and self-referrals.

Funding Scheme

CSC - Cost-sharing contracts


Centre International de l'Enfance et de la Famille
Carrefour De Longchamp
75016 Paris

Participants (5)

Direction de la Santé Maternelle et Infantile

Hopital d'Ain-Taya
Chu Alger-est
35165 Ain-taya - Wilaya De Bourmedes
Institut National d'Administration Sanitaire
Route De Casablanca Km4.5
10100 Rabat
Instituut voor Tropische Geneeskunde Prins Leopold
2000 Antwerpen
Université Nationale du Bénin