The process called `structural adjustment` means many developing countries in the world are reducing the size of their public sector. The impact of these reductions on state-provided medical services in Senegal is the subject of this dissertation research project by an anthropology student from Michigan State University. The project will look at medical behavior of people in urban and rural locations to assess the health impacts and strategies used by men and women and children. Specific hypotheses dealing with the differences of medical care-seeking of individuals varying in residential type, gender, age and class will be tested. For example, women of all residential locations and classes are hypothesized to be more active in organizing family health care than men; women's groups enrolling men into their health care projects will be expected to achieve their goals more often than groups which do not include men; the impact of the reduction of state services is expected to expand the role of traditional, non-biomedical practitioners, who are also hypothesized to include more bio-medical therapies in their practices. The methods include analysis of the change in state services through interviews and health statistics documents; a survey of available health resources in two locations in Senegal, an urban neighborhood and a rural village; interviews and focus group discussions with local people, and a health survey of 300 households, and a morbidity study of 50 households visited once monthly for three months. This project should advance our understanding of the health impacts of a global process of structural adjustment by moving beyond a focus on individual decision making to include structural constraints on choice. In addition to training a young social scientist the project will provide valuable ethnographic information on this important area of the world.
