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

approach through negotiations, without losing or being caught up in endless
details. The starting point was clear. Based on a partner relationship, the
community would be offered an opportunity to participate in managing its
health problems and to use the health map as a negotiating tool for
regrouping villages and creating a viable ComHC. In this way, an
intervillage process—not imposed by the administration—began with the
promise of new active solidarity in a context broader than a single village.
LAUNCHING A COMHC
Although benefiting from critical analysis of past experiences and from new
tools and methods (clearly defined MPS, standard equipment list, specified
initial training field), detailed instructions for launching the ComHC
remained to be devised. The fear of erring or of not meeting a multitude of
expectations sometimes inhibited initiative.
Figure 8 illustrates the successive stages for establishing a ComHC:
duration varies between 29 and 59 weeks.
Figure 8. Stages and their average duration for implementing a ComHC
Environmental study
Community approach
(village by village and
general layout of the
area)
Choosing where to
locate the ComHC
12-24 weeks
Launching the ComHC
1 week
Supervising the start
26 weeks
Creating the ComHA
Developing rules and
regulations
Legal recognition
4-8 weeks
Recruiting staff
Training staff
Forming a committee
6 weeks
Developing the ComHC
project
Approval
Agreement
2-4 weeks
Putting components in
place (building,
equipment, initial supply
of drugs)
4-16 weeks
Studies in HSO&P,20,2003 53