Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...

50
Dougoulo (Bla District), then Guétéma (Nioro) and Gagna (Djenne), made
these principles a reality. 38
Table 10. The ComHA benefits agreed to by the State
� Cofinancing civil engineering work
� Equipment financing
� Financing the initial provision of drugs
� Financing initial training
� Providing vaccine, contraceptive, and specific treatment supplies under terms
similar to State health centres
� Technical support by district health team
� Exemption from taxes on income of the ComHA as well as taxes on the activities
of the health centre
� Contribution to equipment depreciation.
THE COMMUNITY APPROACH: PAVING THE WAY FOR NEGOTIATION
The first ComHC had no explicit “set of instructions” adopted at the
central level for approaching the community. Instead, a few general
directions were provided based on past experiences. “Environmental
evaluation” was required in any case, but its significance varied depending
on the speaker. According to some proposals, “scientific” sociological and
anthropological research needed to be performed in each area before doing
anything. Yet studies carried out in this vein have not contributed all that
much to decision making.
The skills needed to launch a community approach were obviously
lacking, but it was thought that the community development technician on
the district team had the profile required to accomplish the task. Given the
difficulty of reaching precise agreement about potential training and which
procedures to follow, the regional teams were left alone to set up the first
trials. Later, in July 1994, these trials underwent critical examination. The
38 Directions Régionales de la Santé et de l’Action Sociale de Bamako, Mopti, Ségou, Kayes,
Sikasso, Koulikoro, Mali (1993-1996) Etat d’avancement, études de cas, séries de notes
techniques et de rapports de supervision des centres de santé de cercle et CSCOM/CSAR.
Bamako: Ministère de la Santé, de la Solidarité et des Personnes Agées. Magassa N,
Dembele R, Guindo I et al. (1995) Etude de cas: le centre de santé communautaire de
Dougouolo; 22 mois de fonctionnement. 25p. Ségou: Direction Regionale de l’Action
Sociale. Samake S, Dakono G & Guidetti F (1995) Etude de cas du CSCom de
Monzombala. Report. Koulikoro: Direction Régionale de la Santé.
Studies in HSO&P,20,2003