La collaboration dans le pluralisme thérapeutique au Burundi : étude menée dans les communes Mukaza et Ntahangwa de la province de Bujumbura

Abstract

This research work focuses on collaboration within therapeutic pluralism in the communes of Mukaza and Ntahangwa in Bujumbura Province. It analyzes the interactions between biomedical practitioners, traditional healers, and religious leaders, as well as their effects on patients’ therapeutic pathways and access to healthcare services. The study is based on the observation that the Burundian healthcare system is characterized by the coexistence of multiple therapeutic systems operating simultaneously. The main objective is to examine the dynamics of collaboration, competition, and tension among these actors in order to understand their socio-anthropological implications for healthcare delivery. Data were collected through a qualitative approach, including interviews, life histories, and documentary analysis involving the various stakeholders. The findings show that collaboration among therapeutic actors mainly exists in informal forms, particularly through patient referrals and occasional advice between practitioners. However, this collaboration remains limited by several constraints, including mutual mistrust, cultural and religious differences, the absence of a clear legal and institutional framework, andconflicts over legitimacy between healthcare systems. Patients play a central role in connecting these systems by constructing multiple and circular therapeutic itineraries. The study concludes that therapeutic pluralism is both a resource for the healthcare system. It promotes diversified access to care but also leads to fragmented and sometimes inefficient therapeutic pathways due to the lack of coordination. Therefore, formalizing collaboration, strengthening health education, and valuing local knowledge appear as key strategies to improve comprehensive patient care.