Policies of fighting against malaria in Casamance, Senegal: a public health activity dependent on the context of conflict and decentralization

Through ethnography carried out in Oussouye (in Casamance), this article analyses the way in which national health policies are incarnated and translated in specific local contexts. It discusses what constraints are encountered by an overarching policy, or more precisely, the blind spots of a policy that does not sufficiently incorporate context, meaning, regional and geopolitical specificities. The results indicate that the context of Casamancian decentralization and conflict affected funding, management of promotional activities and the domestication of official malaria control recommendations. Furthermore, prior recommendations leave a trace that can be found in what actors say and in current thinking behind the malaria control struggle, even though it is supposed to originate from a new paradigm. Finally, the dissonance of prescribing anti-malarials in Mlomp and Elinkline leads to reflection on local health 'territories' where national recommendations yield to contextual and local specificities. Health policies cannot do away with such actors, nor with local context; nevertheless, taking specificities into account should not be done to the detriment of a certain 'togetherness'. [PUBLICATION ABSTRACT] Reprinted by permission of Sage Publications Ltd