The health basin of the Upper Casamance straddles four states that are Senegal, Guinea-Bissau, Guinea and Gambia linked through the past by the same territorial practice in the pre-colonial era. However, the division into states just after the colonial conquest has set a cut by parceling off this huge territorial into artificial borders different from how the populations live in the space through a differentiation due to the natural typology between Sahelian, Sudanese and forest areas. The secular spatial experiences of the population which are still representative further an eternal beginning of customs in this great territorial by ignoring the new borders. Thus, the border polarities are built by carrying a gravity center status around a same space between numerous states. The health field is not exempt from that. Small towns as Kolda that is in the middle of this space of many borders attract populations from different origins who are not expected in the health infrastructures. Some dynamics of recourse are being set up with high cares for a special sanitary territory. This draws numerous populations in search of better cares in relation with the physical accessibility, the quality of cares offered in some areas, the economic activities. Nevertheless, the cares supply does not follow this logic of continuity insofar as there is a lack of connection between the different countries. This is due to the fact there is no health cooperation between the countries and this makes this space of sharing a sanitary setting with visible disparities between the states that have the same endemicity problems.
Polarization of health care structures of Upper Casamance: between the national construction of health systems and cross-border use of care facilities