Paper short abstract:

This paper takes the perspective of ‘front line health workers’ to discuss how global public health priorities are implemented in public health facilities under extreme material limitations. How can public health care workers make sense of their work in a context of material limitations?

Paper long abstract:

This paper takes the perspective of so-called 'front line health workers' to discuss how global public health public priorities are implemented in health facilities with little of the medical equipment and pharmaceutical products which are required to perform biomedicine. How do public health care workers make sense of their in a context of material limitations? With a point of departure in the dynamic interplay between foreign donor agencies involved in health system strengthening and complex local realities, this papers explores the way nurses and midwives in rural Burkina Faso engage in public health. The term 'friction' (Tsing 2005) is used to unfold the way these health workers grapple with different agendas formulated by external donors and national authorities. Priorities such as 'maternal and child health' or 'universal health coverage' must be implemented by local actors, in this case nurses and midwifes. These health workers experience frictions when they have to juggle different accountabilities. These accountabilities are towards their supervisors and the local health communities, and are intertwined with their own more mundane concerns over livelihoods, exposure to risk and health hazards at the workplace, and social obligations. In the paper I argue that three different repertoires are available to rural health workers in Burkina Faso, each repertoire coming with a different objective of public health care.