When development breeds contempt: case examples of community-driven health systems initiatives

Abstract

This article discusses case examples of community-led initiatives triggered by the introduction of an external development programme in Senegal and Mali. These are community initiatives that learn from projects initiated and funded by an external donor organisation, and transform interventions to better meet their own needs. The circumstances leading to the demand for, and successful establishment of, health infrastructure are examined to understand the triggers. These breakthroughs demonstrate unintended benefits of development, and the need to leverage donor-led initiatives. Therefore, community involvement, participation, and empowerment are key in establishing local ownership in development projects.

Cet article traite d'exemples de cas d'initiatives impulsées par la communauté déclenchées par l'introduction d'un programme de développement externe au Sénégal et au Mali. Il s'agit d'initiatives communautaires qui tirent les leçons de projets initiés et financés par une organisation donatrice externe, et qui transforment les interventions pour mieux satisfaire leurs propres besoins. Les circonstances qui aboutissent à la demande et à l’établissement réussi d'infrastructures de santé sont examinées pour comprendre les déclencheurs. Ces percées démontrent les avantages imprévus du développement et le besoin d'exploiter l'effet de levier des initiatives menées par des bailleurs de fonds. Ainsi, la mobilisation, la participation et l'autonomisation des communautés sont essentielles pour l’établissement de l'appropriation locale des projets de développement.

El presente artículo analiza algunos ejemplos de iniciativas comunitarias que se desencadenaron a partir de la introducción de programas de desarrollo externos implementados en Senegal y Malí. Dichas iniciativas comunitarias incorporaron aprendizajes surgidos de proyectos iniciados y financiados por una organización donante externa, transformando dichas intervenciones a fin de que respondieran mejor a sus propias necesidades. Asimismo, con el objetivo de comprender el proceso de desencadenamiento se examinan las circunstancias que dieron lugar a la demanda de instalación de infraestructura de salud y al cabal cumplimiento de esta exigencia. Estos logros dan cuenta de la existencia de beneficios no previstos resultantes de las políticas de desarrollo, así como de la necesidad de apalancar las iniciativas impulsadas por los donantes. Ello lleva a concluir que en los proyectos de desarrollo la participación y el empoderamiento de la comunidad constituyen factores importantes para crear un sentir de apropiación local de estos.

Keywords:

• Social sector – Health
• Aid – Accountability
• Civil society – Participation
• Sub-Saharan Africa

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Ingrid Nanne currently works in Monitoring and Evaluation in the Behavior Change Education and Community Participation programmes at the Fundación del Azúcar in Guatemala. Previously, she was the Community Health Worker Regional Coordinator at the Millennium Villages in West and Central Africa of Columbia University's Earth Institute.

Mosa Moshabela joined Rural Health at the University of KwaZulu-Natal in 2013. He was previously the regional health advisor for the Millennium Villages in West and Central Africa, concurrently working with the Earth Institute at Columbia University. His interests include strengthening health systems, maternal and child health care, and controlling chronic infectious diseases.

Uyen Kim Huynh is Senior Research Officer for the Monitoring and Evaluation team of the Millennium Villages Project (MVP). Her research focuses on the qualitative measurement and documentation of the MVP model, and its implementation, studying the mechanisms of action that drive progress and performance in rural African communities.

Papa Meissa Diop is a forestry engineer who has been in charge of community development at Millennium Villages Project's Potou, Senegal site since 2006, becoming the site's team leader in 2009. While working on community development activities, he also manages operations of all the integrated sectors, and partnerships with local, national and regional institutions.