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

evaluation of the approaches was positive, and their diversity attested to
their appropriateness. 39
Over time, the community approach became more pragmatic (Table
11). A minimum of preliminary information needed to be gathered by local
and regional resource persons. This was done as soon as contacts were
developed between the district team (doctor, community development
technician, health technician) and the different villages and
neighbourhoods. In fact, the information was often collected at the district
description stage, and used in developing the theoretical map for extended
coverage.
With a few exceptions, spontaneous initiatives to create a modern
care service were rare. It usually took the enthusiasm of the administration
or of an external partner, or, as in the case of Bamako, doctors in search of
work. The initiative to establish first ComHCs generally arose in the district
team for totally different reasons than in the past.
Table 11. Elements and stages of the community approach
� Feasibility study a precondition for establishing a ComHC
� Information as complete as possible about the opportunities that the new
sectoral policy offers: partner relationship to resolve health problems and need
to group villages and sometimes neighbourhoods to assure viability and
adequate technical performance
� Information from all the villages and neighbourhoods of the area
� Sufficient time in intravillage and intervillage consultations before obtaining
their agreement to the principle, and verification in each of the villages
� Expansion of contacts and discussions beyond the chief of the village and
advisers (heads of families, women, youth, and so on)
� As soon as the majority of villages affirm their commitment, support formation
of a ComHA (status, rules, constitutive assembly, election of the committee,
legal approval from administrative authorities)
� Negotiation of the contract with specified commitments of each party for the
establishment and operation of the ComHC
� Execution of commitments of each party and establishment of the ComHC.
39 Direction Nationale de l’Action Sociale (1995) La participation communautaire dans la
zone d’intervention du PSPHR: rapports d’étape de l’évaluation du processus d’animation
pour la mise en place des CSCom. Workshop Report. 72p. Bamako: Direction Nationale de
l’Action Sociale.
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