Community distributors as key players in seasonal malaria chemoprevention in Burkina Faso : recognition, constraints and adaptation strategies

Abstract

Seasonal malaria chemoprevention (SMC) relies on community distributors (CDs), who are key players in administering medicines and raising awareness among the population. However, despite their strategic importance, CDs face multiple organisational, financial, sociocultural, and security constraints. They also operate in a context of professional precariousness, marked by the absence of official status. These conditions undermine their social legitimacy and institutional recognition, thereby affecting the quality of intervention implementation. This study examines the role of DCs, focusing on their social and professional recognition, the constraints they face, and the coping strategies they develop. We favoured a qualitative approach using several data collection techniques: direct observation, documentary research, individual interviews, focus groups, and life stories. Data were collected from DCs, parents, health workers, and the media before, during, and after the SMC campaigns in Bobo-Dioulasso over an eight-month period from March to October 2023. A total of 87 individual interviews, eight focus groups, and four life stories were conducted. The results show that the lack of social and professional recognition of DCs limits their legitimacy and authority in the community. The constraints they face, along with the coping strategies they use daily, reveal significant gaps between official standards and actual practices in the field, affecting coverage, parental adherence, and the overall effectiveness of the intervention.