Community health in Mali: Asset, stakes and prospects after two decades for implementation

Abstract

From 1970 to 1988, the share of the budget of the State devoted to health passed from 9% to 4%; from 1983 to 1997, the investments in the Health sector passed from 52% to 9% (17). Vis-a-vis this crisis in the sector of health, the populations were organized to ensure the assumption of responsibility of their health. Thus was born in 1988, the first Community association of health of Mali in the perish-urban district of Banconi. In response to this new reality, the populations were organized to ensure the social mobilization and the covering of the costs of their structure of health. Community health constitutes today the base of the national policy as regards health. The goal of this article is to analyze this model of covering of the costs and social mobilization in term of current stakes and of the prospects. The method is based on a retrospective study with abstract and maintenance of the key actors. The analysis shows that the advent of Community health A creates new stakes of a political nature and of capacity related to the nature of the relationship between the medical authorities and the community, and economic by the effective contribution of the households (75%) in the expenditure of health including the investments. In the social plan, the extension of the medical cover clearly improved with in 1998, nearly 21 % of the population located at less than 5 km of a medical formation. In the same way 75 % of the medical consultations and 70 % of the labour take place in a Community center of health. In term of extension of the medical cover, it clearly improved with nearly 958 Community associations of health create between 1989 and 2008. Although models it Community health clearly improved the offer and quality of the services, there remain nevertheless confronted with certain challenges relating to the insufficiency of democratic life and transparency in management and the difficulties for the state of playing its role of supervision, as well as the instability of the personnel which he causes because of insecurity of the use and the plan of career. Its challenges deserve that the principal actors of this policy think on it of the risk to compromise the perennisation of the model.