Abstract
International and national preparedness policies assume that by anticipating and preparing for epidemics, these threats can be more effectively addressed. Public health surveillance is recognised as a pillar of preparedness, and at the local level it is recommended to improve the capacity to detect outbreaks through "community-based surveillance", carried out by populations. In Guinea, relying on community health workers has been promoted for carrying out surveillance and other public health interventions since the country experienced its first Ebola outbreak between 2013 and 2016. There are still few internationally published studies that analyse the implementation of these strategies. This thesis aims to identify the factors that hinder or favour community-based public health interventions, particularly concerning community actors and their insertion in the health system.In an approach that articulates public health and anthropology, the method used is based on observations in Conakry and the N'Zérékoré region, and interviews on epidemic preparedness and community health conducted with community health workers, health professionals and institutional actors. These data were supplemented by field surveys carried out in the context of the response to the Ebola epidemic that occurred in 2021, as well as in the context of the fight against Covid-19.The field survey, presented after a historical contextualisation of current epidemic preparedness interventions, shows that community-based surveillance is not yet fully deployed in Guinea. Like other surveillance and community health interventions carried out at the local level, the implementation of community-based surveillance is hampered by the precarious status of community health workers, who are still poorly integrated into the health system. When they are involved, like other health professionals, in the response to epidemics, these community actors still work in unfavourable conditions despite their involvement in the "front line". This is notably the case of the agents designated to carry out the follow-up of contact cases during the Ebola epidemic of 2021. In this context, community actors are nonetheless showing initiative, and are trying to improve the often difficult relationship between populations and the health system. In addition, a specific survey conducted among patients and professionals offers an ethically acceptable framework for the announcement of diagnosis or biological results in the context of surveillance.This thesis is part of the work on epidemic preparedness, which is rarely based on field surveys, especially in the South. Our results can guide institutions at the national, regional and global levels to develop surveillance and community health policies and interventions that are more acceptable to frontline actors and the populations concerned.