Anthropological and socio-medical health care research in developing countries

Research on health-seeking behaviour in developing countries is of both theoretical and practical relevance. It analyzes concepts of origin and management of illness, provides insights into people's use or non-use of traditional and/or modern health services available and finally it contributes to reveal perceptions regarding health care in particular settings. The paper first describes briefly the methodologies commonly used for analyzing the determinants and the pathways in the use of care. Then the extensive literature on health-seeking behaviour in developing countries is reviewed within an open-ended classification framework. The review shows a polarity between two major approaches, socio-medical and anthropological. The former emphasizes services factors such as accessibility, costs, acceptability, whereas the latter focuses primarily on aetiological concepts and world views. The main point of this review is to show that a combination of those two approaches is highly desirable: the different methods currently available should be combined in order to consider all the factors intervening in the use of health care. Fallacies in the quantitative analysis of medical pluralism and in the investigation of self-care are pointed out and some solutions offered. It is concluded that epidemiological and anthropological approaches should concentrate more intensively in order to contribute to the necessary improvement of adequate and environmentally adapted health services in developing countries.