title: [Patient's role and chronic disease in Mali: between policies and expert and lay practices].
abstract: BACKGROUND
  The growing burden of non-communicable diseases challenges health systems of low-and middle-income countries and requires health care reform by the introduction of models focused on patient participation.
  
  
  OBJECTIVE
  This article puts into perspective the management of two chronic diseases, diabetes and HIV/AIDS, in Mali. It explores the way in which the patient’s role is conceived and implemented at three levels: policy-makers, healthcare professionals and patients, in order to more clearly understand the dynamics and rationales underlying promotion of the patient’s role in the context of a low-income country.
  
  
  METHODS
  Results were derived from qualitative interviews conducted between 2010 and 2012 with key stakeholders involved in policy, healthcare professionals and patients, and from observations of healthcare relationships in two specialized healthcare structures in Bamako.
  
  
  RESULTS
  The chronic nature of the disease is not sufficient to define the patient’s role in healthcare. Other factors also influence the emergence and practice of an active patient care model: the political, clinical and social history of the disease; the institutional work contexts of healthcare professionals; patients’ representations and practices. Patients are well aware of the role they need to play in the management of a chronic disease and they develop resources to remain active.
  
  
  CONCLUSIONS
  These various dynamics should be better taken into account to make effective changes in the health care system and to strengthen patients’ autonomy.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Gobatto
authors.forename: Annick
authors.initials: A
authors.lastname: Tijou Traoré
authors.forename: Jessica
authors.initials: J
authors.lastname: Martini
mesh_terms: D003906:Developing Countries; D003920:Diabetes Mellitus / Q000453:epidemiology*; D019468:Disease Management; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007407:Interviews as Topic; D008302:Mali / Q000453:epidemiology; D010358:Patient Participation