Nearly six percent of Chad's population are nomadic pastoralists. What specific problems do women in these groups face when trying to access healthcare? A study by the UK University of Durham shows that health resources are strongly gendered. Family and social networks are crucial factors in women's access to healthcare.

Nomadic groups may have problems in accessing healthcare. They tend to live far from urban centres where health services are located. Political marginalisation, cultural, ethnic and linguistic barriers, and very low levels of literacy also reduce access. Are these obstacles particularly great for women?

Interviews with 82 pastoralist women from three ethnic groups in the Chari-Baguirmi region of central Chad revealed that:

• They had 134 illness episodes in the last two years.
• 101 of these were treated in some way: 43 per cent through self-medication, 30 per cent in the informal sector and 27 per cent from formal healthcare sources.
• Home remedies are seen as having the least benefit, whereas most people see city hospitals and clinics as being of high status. However, the perceived success rate for all treatments is low.

Home remedies, caring and supportive roles and treatment of certain reproductive health problems fall within the female domain. But men control access to most other health practitioners, treatments and knowledge. Of 74 illness episodes where some financial outlay was required, men paid for 67, at least in part. The willingness of husbands or male kin to assist may be related to the:

• condition - not all illnesses are appropriate for male intervention
• marital relationship and the personalities of husband and wife
• woman's status within the household - the number of children she has and the number and age of other wives.

Spatial mobility and dispersion can be a problem for nomadic women when they are ill, but not only because of distance from health services. Most settled Fulani women make little use of the nearest health post, so being settled does not necessarily improve women's access to health treatment, at least in the early years. What happens to a woman when she is ill depends a lot on the networks available to her and on her ability to mobilise them effectively. Women are very vulnerable if they do not have good access to networks involving a husband, male relatives or female kin or friends.

The message for health policy-makers is that addressing issues of mobility, by setting up mobile clinics or encouraging the settlement of nomadic populations, will not necessarily improve access to health services for pastoralist women. They must also understand the social context of control and distribution of health resources. They should explore how women's social networks, particularly the less visible female networks, change over the course of a year and how this affects illness management.

Source(s):
'Networks of nomads: negotiating access to health resources among pastoralist women in Chad', Social Science and Medicine 54: 1025-1037, by K. Hampshire, 2002
related sources: 'Providing services for nomadic people', UNICEF Staff Working Papers 8, by J.Swift, C. Toulmin and S. Chatting, 1990
'Households, kinship and access to reproductive health care among rural Muslim women in Jaipur', Economic and Political Weekly 34 (10-11): 621-30, 1999

Funded by: Centre de Support en Santé Internationale/Institut Tropical Suisse; Durham University Special Staff Travel Fund; Durham University Anthropology Department

id21 Research Highlight: 24 October 2002

Further Information:
Kate Hampshire
Department of Anthropology
University of Durham
43 Old Elvet
Durham DH1 3HN
UK

Tel: +44 (0) 191 374 7524
Contact the contributor: k.r.hampshire@durham.ac.uk

University of Durham

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