Economic role of solidarity and social capital in accessing modern health care services in the Ivory Coast

At the beginning of the 1990s, health service reforms were implemented in public health institutions in most African countries South of the Sahara. In the Ivory Coast, the imposition of user fees for public services was adopted in 1994. Such fees require each person to have adequate financial resources in order to access modern health care services. Many poor people-despite their poverty-are able to access modern health care services that have become quite expensive. The factor that allows this access lies within the solidarity of parents, friends or members of a social network. In Africa, illness is a social phenomenon and a state of illness is negative. The sick human being is one who cannot fully participate in community life. The treatment of a sick person is, then, an act, which is tied to the systems of life, which are produced and maintained collectively. Once the causes of illness are identified and consequences evaluated, it is the entire family or group that participates in the finances which bring about treatment. In this study, we show the role of social capital in the processes of financial solidarity for access to modern health care services that now require payment. Our investigation provides valuable insights on the role of social capital with respect to social strategies and community financing mechanisms for the acquisition of modern health care in Africa. (C) 2002 Elsevier Science Ltd. All rights reserved.