Maternal mortality in rural Senegal. The experience of the new Ninéfescha hospital

Africa continues to suffer from an acute lack of healthcare provision. Is the construction of new healthcare facilities suffi cient to improve the health of the population? This is certainly a question raised when the opening of a new hospital fails to bring about any rapid improvement in health indicators. What are the reasons for the slowness of change here? Does it stem from a mismatch between supply and demand? Or from “cultural barriers” hindering the spread of modern ideas? This article investigates possible factors in the case of a modern hospital built in Bandafassi, a rural area of Senegal where facilities had previously been scarce. Data collected over several decades through demographic surveillance of the local population showed that there was no noticeable decline in maternal mortality immediately following the hospital’s opening. To identify the reasons for this failure, we conducted several surveys of local people’s health-seeking behaviour and the way they utilized this facility, notably for childbirth. Four years on, villagers were still making very little use of the hospital. Few women went there either for antenatal visits or to give birth. The hospital management ascribed this failure to the villagers themselves and, more particularly, to their traditions. These surveys, however, indicate that the heart of the problem lies in a mismatch between the services offered by the hospital and local people’s actual needs