Abstract

The Bamako Initiative (BI) was launched in 1987 by the World Health Organization (WHO) and the United Nations International Children's Fund (UNICEF) with a view to revitalizing health services in developing countries through community participation in the management and financing of primary health services. After five years of implementation, it was decided to establish a formal evaluation program of the BI, of which this project will be a part. The aim of this project is to describe and analyze the functioning of health committees and their effect on the involvement of communities vis-à-vis their health problems. The research will involve multiple case studies and take place in various districts of Cameroon and Burkina Faso under the responsibility of the Institut Panafricain de Développement (IPD) in Cameroon and the Centre Régional pour le développement et la santé (CREDESA) in Bénin. The research results will help identify improvements that could be brought to bear on the functioning of community health committees, or whether they should be maintained as a community participation structure.

Post-Project Summary

Due to the closure of Unicef's Bamako Initiative Management Unit (BIMU), the project was limited to Cameroon. Researchers carried out a descriptive, cross-sectional study of health committees in the two English-speaking provinces of Cameroon. Over a period of 3 months, they interviewed 450 respondents drawn from the area of jurisdiction of 26 health committees. The respondents included health committee members, community members, health personnel, representatives of nongovernmental organizations (NGOs), and political and administrative officials. The researchers complemented this information with a literature review and direct observation.

It was noted that health committees worked within the theoretical framework assigned to them, although to varying degrees; that health committees played a useful role vis-à-vis the realization of health objectives; that community involvement in activities organized by health committees was a strong determinant of health committee performance; that most urban community dwellers were not aware of the existence of health committees; that, contrary to the existing literature, some of the expectations of health committee members were being satisfied; and that certain actions seemed to boost health committee performance. The last include providing feedback to the target community, the existence of a collective problem-resolution culture, a positive appreciation of the health committee by the community and the participation of all social groups in health committee-organized activities.

The short-term recommendations focused on strengthening and consolidating the use of health committees as instruments for enhancing community participation in the health sector; encouraging (especially urban) communities to get involved in health care through their health care communities; encouraging health committee members to provide the community with feedback, perhaps through organized rallies; and developing texts to be made available to committee members. In the middle to long term, it was recommended that committee members evaluate the aforementioned texts and recommend modifications, and that the government bring its contribution to health care into line with the prevailing crisis. The final report is on file. Unfortunately, it was not distributed as planned due to a major restructuring at the co-funding agency that resulted in the closure of BIMU and a freeze on earlier commitments.

Recipient Institution(s)