Paper long abstract:

In the field of applied medical anthropology, researchers deal more and more with populations viewed as health facilities' clients. This is the background of our involvement in a public health program to improve the quality of medical care (QoC) in case of emergency obstetrical need in Burkina Faso. This program used case review audits as a tool for QoC. Case review audits are an auto-evaluation approach of clinical practices by health personnel. During the audit sessions physicians and nurses analyse a critical case (i.e., still birth, hemorrhage during delivery, etc.) and try to find solutions for preventing these situations. The original feature here was to add to the medical and clinical approach a reporting of the women's personal experiences of their delivery based on interviews at home made by anthropologists. Generally speaking, audits sessions, even if they are strictly confidential and on a voluntary basis, seem to be like a trial for health personnel, always underlining a failing, a mistake or an error. The reporting by anthropologists of women's experiences makes personnel's bad practices more acute., and they were seen to be exclusively on the women's side. They are suspected not taking account of bad work conditions, especially when care seems to be convenient and health personnel not involved in the critical event reviewed. Therefore, anthropologist intervention can be counter-productive and at the opposite of audit sessions objectives which are supposed to achieve collective solutions and to reinforce teams.