Juggling with the norms:Everyday practice in an emergency service in Niger

Abstract

The article shows that care in developing countries is a complex matter that cannot be reduced to corrupt practices. The literature on informal payments highlights the role played by corrupt practices in the health sector and tends to attribute corruption to a so-called ‘endemic culture of gifts’. However, as the case of the emergency service of Niamey National Hospital suggests the interactions between civil servants and users in health facilities have little to do with a traditional culture. They are better understood through the lens of practical norms. Furthermore, as the authors demonstrates corruption in the health sector is one of the many ways by which users access a public health service. This perspective allows us to explore the agency of users and practitioners in health facilities. In acute conditions, the life of a patient does not only depend on the quality and efficiency of the services provided by the medical staff, it also depends on the qualifications of the persons (relatives, friends) accompanying the patient. In Niger (and other developing countries), the patient’s attendant is a crucial component of the organisation and the effectiveness of health facilities in emergency situations. After a few interactions with the staff, the attendant should be able to understand the practical norms that govern the service if his/her patient is to survive. Users do know that chronic lack of materials and equipment is a result of systemic petty corruption and artificial shortages created by staff. They do know that they contribute to the reproduction of this system when they bribe health workers. Although everyone knows the consequences of such practices, they are done by all. Neither health workers nor users are just victims of a system or a set of cultural practices. Both contribute to the fabrication of the practical norms that regulate the daily functioning of health facilities and shape people’s behaviour.The article shows that care in developing countries is a complex matter that cannot be reduced to corrupt practices. The literature on informal payments highlights the role played by corrupt practices in the health sector and tends to attribute corruption to a so-called ‘endemic culture of gifts’. However, as the case of the emergency service of Niamey National Hospital suggests the interactions between civil servants and users in health facilities have little to do with a traditional culture. They are better understood through the lens of practical norms. Furthermore, as the authors demonstrates corruption in the health sector is one of the many ways by which users access a public health service. This perspective allows us to explore the agency of users and practitioners in health facilities. In acute conditions, the life of a patient does not only depend on the quality and efficiency of the services provided by the medical staff, it also depends on the qualifications of the persons (relatives, friends) accompanying the patient. In Niger (and other developing countries), the patient’s attendant is a crucial component of the organisation and the effectiveness of health facilities in emergency situations. After a few interactions with the staff, the attendant should be able to understand the practical norms that govern the service if his/her patient is to survive. Users do know that chronic lack of materials and equipment is a result of systemic petty corruption and artificial shortages created by staff. They do know that they contribute to the reproduction of this system when they bribe health workers. Although everyone knows the consequences of such practices, they are done by all. Neither health workers nor users are just victims of a system or a set of cultural practices. Both contribute to the fabrication of the practical norms that regulate the daily functioning of health facilities and shape people’s behaviour