Reforming healthcare systems from “the bottom up”

Abstract

Despite improvements in some of its indicators, Niger’s healthcare system remains fragile and is largely characterized by “unwelcoming  medical practices”. This is partly due to the fact that intervention schemes, protocols, and most health policies aimed at reforming  healthcare systems are largely driven and funded by international aid actors and struggle to take into account the real-life contexts and  day-to-day operations of health services. However, despite precarious working conditions in which they operate, some facilities offer  better quality care. These facilities share the commonality of being led by “local reformers.” Invisible, hardly known, poorly promoted,  and insufficiently encouraged, they invent solutions adapted to the daily problems of public healthcare services with the means at their  disposal. Drawing on ethnographic data, this article offers an analysis of the solutions and innovation systems they propose. By revisiting the experience of operational research, we invite exploration of avenues to support this “bottom-up” approach to healthcare system  reform, which can be an alternative, or at the very least, an essential complementary approach to contemporary strategies for improving  healthcare.