Nomads of the West African sahel and the delivery of health services to them

Abstract

This paper presents the experiences had in delivering health services to pastoral Tuareg and Maure nomads living in the West African sahel. Because of the rudimentary nature of the existing general health services structure and existing attitudes towards health services among nomads, the mass campaign technique was employed. Between 1968 and 1971 campaigns were directed at Tuareg and Maure groups living in Mali, Mauritania, Niger, Senegal and Upper Volta. Such campaigns consisted of preparatory, planning and execution phases. During the first two, nomadic movements were studied and program logistics planned in detail. Because nomads have historically resisted the payment of taxes on themselves and their livestock, special efforts were made to completely dissociate health temas from administrative authorities associated with tax collection. The low population density of the sahel, the dispersion of nomads over a wide geographic area and the long distances between individual nomad camps necessitated the investment of man hours and gasoline far in excess of those invested in campaigns for sedentary farmers living in the same areas. In one program for both nomads and sedentaries living in the same topographic zone, a comparison of costs and resources necessary was made between the two sets of medical teams established. The operational costs for the program for nomads was eleven-fold more than that for the sedentary agricultural population. The short term goals of the program were: (1) the delivery of specific immunizations; (2) health education; and (3) a demonstration of the complete separation of health service delivery and tax collection. The long term goals were: (1) the extension of general health services to the nomadic population; and (2) the use of fixed curative medical facilities by the nomadic population. Crucial to the program's success was the delivery of a service such as measles immunization which had an immediate and striking effect on the health of the community.