Dix ans d'expérience des centres de santé communautaire au Mali

Abstract

At the end of 10 years' existence, the community health centres of Mali show a way of organisation which meets the public health requirements and demands of financial viability of any health establishment. Their originality lays in several factors: their legal personality, their private status, their financial support of the medical staff, their management by a users association and the public utilities agreement they have signed with the department. In spite of their success which makes their numbers reach 350, they suffer from great deficiencies, which are resulted by the lack of democratic traditions within the associations, a inappropriate transparency of their accounts and an inefficient supervision from the part of the department. The main questions posed by this new experience concern the limits of the concept of community, the importance of citizenship in the development dynamics, the participation of private institutions in the accomplishment of public utilities, the jacobin and authoritarian attitude of the department representatives, the contradictions between multiplication of centres to improve geographic access and the requirements of financial viability.

Utilization and expenditure at public and private facilities in 39 low‐income countries

“…These policies also need to implicitly address patient needs with respect to responsiveness, quality of care as well as financial risk protection. Indeed, there are many pioneering programs engaging with the private sector in various settings (Balique et al. 2001; Mahmud et al.…”

“…These policies also need to implicitly address patient needs with respect to responsiveness, quality of care as well as financial risk protection. Indeed, there are many pioneering programs engaging with the private sector in various settings (Balique et al 2001;Mahmud et al 2002;Danel & La Forgia 2005;Mavalankar et al 2009;Meessen et al 2011). Building on existing experience and the lessons learnt, policymakers in every country could take steps to better engage with the private sector to achieve national goals.…”

Transversal analysis of public policies on user fees exemptions in six West African countries

“…Despite the known difficulties of real democratic community involvement [28-30], the windows of opportunity opened by these new exemption policies were not seized upon to revive this community-based participation. As with the BI, these committees largely confined themselves to financial management.…”

Expériences locales en santé communautaire : exemples choisis au Canada, Brésil et Mali, expérimentation en France. (Local experiences in community health : selected examples in Canada, Brazil and Mali, experiments in France)

“…L'observation de terrain montre également des carences en matière d'urbanisation, d'assainissement, etc. Si les données statistiques manquent ou sont anciennes, Banconi est en revanche, depuis longtemps, un terrain d'étude arpenté par différents chercheurs en santé publique et sa communauté a fait l'objet d'une série d'enquêtes et de recherches par l'institut national de santé(Balique 2001).En 1986, une des enquêtes sur les soins de santé primaires et la médecine traditionnelle, a montré que les ménages consacraient moins de 3% de leurs dépenses pour la santé en raison de coûts de santé énormes et de la distance importante à l'hôpital. De ce besoin identifié dans la population a germé l'idée de créer une Assaco (Association de santé communautaire).…”

“…Un Cescom est un centre de santé privé sans but lucratif, qui regroupe un dispensaire, une maternité et un dépôt pharmaceutique, et dont la gestion est assurée par une association d'usagers. Bénéficiant des services d'une équipe de professionnels de santé dirigée par un médecin ou par un infirmier, il met à la disposition des populations vivant alentour des soins de premier niveau(Balique, 2001). Le 9 mars 1989 a vu la création du Cescom sans argent, sans moyens et sans appui de l'Etat qui au contraire ne voyait pas l'initiative d'un bon oeil, mais avec l'appui de chercheurs en santé publique.…”