"Natural remedy" but without scientific evidence! Ethnography of the logics structuring the prescription of phyto-drugs by physicians in Burkina Faso

Since the 1970s, WHO has recommended the valorization of medicines derived from "traditional" medicine. In Burkina Faso, despite a political will to promote phyto-medications, their prescription by health professionals remains weak. The purpose of this article is to highlight the logics behind the prescribing practices of phyto-drugs by Burkinabe doctors. Adopting a qualitative approach, this study was conducted in Ouagadougou with general practitioners and specialists. Data collected were from semi-directive individual interviews and direct observation. A total of 47 interviews were conducted at medical centers with a surgical unit (CMA) and university hospital centers (CHU). Our results show that phyto-drugs have not been included in the initial training of the doctors surveyed. The only sources of information for doctors are then from colleagues, family, patients or the media. Their perceptions of this type of medication are ambivalent, ranging from "natural products" to products at risk due to lack of studies. Prescribing practices are subject to four main rationales : personal and professional experiences, patient judgment, validation by clinical trials and consideration of iatrogenic risk. In the absence of a strong academic setting, knowledge of phyto-drugs has been acquired informally. As the standards and technical references remain weak, several subjective logics are essential in the construction of prescribing practices. Beyond the symbolic and subjective logics explaining the low prescription of phyto-medications, our study invites us to wonder about the place of political and institutional logics in the weak integration of traditional medicine into the Burkinabé healthcare system.