Social science research shows that across Africa decisions about where, when and from whom to seek help when a person is sick tend to involve groups of people, not just individuals. Sometimes the person who is sick might have little say in health seeking decisions. Therapy management groups can include family members, groups of peers and others such as religious or community leaders and friends. We also know that when health care is costly or health facilities are far away, people often delay seeking treatment or seek alternative remedies, including home-remedies, medicines from medicine vendors (in Nigeria known as patent medical vendors), pharmacies, traditional healers, prayer houses and healing homes. Health seeking behaviours and the use of remedies are also shaped by local understandings of disease aetiology, which may include biological and spiritual dimensions that do not map simply upon biomedical categories and understandings.
During the Ebola and other viral haemorrhagic fever outbreaks, people often decided not to seek care because they were afraid of dying alone in treatment centres, which they associated with death. Misinformation and rumours also contributed towards avoidance of healthcare workers and treatment facilities during the height of the Ebola outbreak. Evidence from many contexts across sub-Saharan Africa also shows that even when treatment is available, people may prefer to stay at home if they think they are going to die, because this is cheaper for family members who worry about the expense of transporting a dead body. At home, people may have also have a better ‘social’ death, surrounded by loved ones who can care for them in and easily perform burial rituals. These factors can stop people from accessing formal medical care.
Merlin. 2002. 'Licking' Lassa: A strategic review. London.
The British relief agency Merlin carried out a Knowledge, Attitudes and Practices survey to inform a strategic review of Lassa fever in Sierra Leone during the 1990s. Although the material is dated, the reflections on health seeking behaviour in this document remain relevant. The review highlights that knowledge is not sufficient to change behaviour, particularly when people are faced with a poorly functioning, expensive health system that may be difficult to reach. The review also shows that health seeking for Lassa Fever is made more difficult because the disease is not easily distinguished from other infections.
- The informal and commercial medical sectors are often providing first line care. Any comprehensive outbreak monitoring and response system needs to involve informal and commercial providers
- These providers also need to know how to stay safe when treating patients, and when and how to make referrals to the formal health system.
- People living in Lassa endemic areas may benefit from a more nuanced public health messaging about treatment of fevers that is better attuned to local models of care.