It is not normal that a pregnant woman walks 20 km to reach the closest community health centre. It is not normal to have one community of more than 5,000 inhabitants with no community health centre around. It is not normal that a community health centre operates without a Technical Director and a midwife. The lists of abnormal things that do happen in community health centres are unfortunately so many.
But what is normal? What ought to be done? How is the rural citizen aware of what should or shouldn’t be in the community health centre of his/her village? It is to provide an answer to Malian citizens that World Vision Mali conducted through the Citizen Voice and Action (CVA) approach a massive review of the national norms and standards in the community health centres.
In partnership with the National Health Department, the National Federation of Health Associations, the Mali Municipalities Associations, Civil Society Organisations and other partners, World Vision Mali supported the collection of all existing norms and standards for Community Health Centres in Mali. The rules were dispersed among various documents for administration, law and management making their usage, application and monitoring very challenging.
The several months work of research, collection and compilation led to the national workshop to validate one single document which displays community health centre norms and standards. According to Yaya Konare, president of Mali National Federation of Health Associations: ‘‘having a single document of norms and standards for a community health centre in Mali guaranties the harmonisation of the rules. It will help avoid wrong interpretations, it will ensure that all health actors have the same understanding of the requirements and it will facilitate monitoring and evaluation of health services in all community health centres.’’
World Vision Mali has been working over a year with 79 Citizen Voice and Action groups to ensure that citizen understand their rights, engage with public service providers, influence the quality of services, hold their local government accountable and that they practice an active citizenship. As such, ensuring that a document for norms and standards in a community health centre is available is an important step that enables even the most vulnerable citizen to demand for a level of service that is a requirement from the government.
Furthermore, based on this document, community health centres can also hold accountable the municipality for providing the necessary materials and human resources for their best performance. It goes from the bottom of the pyramid to the top where each actor can hold the next one responsible in order to construct a society where each one plays his role in the view of creating the best conditions for child well-being.
Fatoumata Dianka, 14 years, member of Mali Children Parliament participated in the validation workshop, she said: ‘‘this document is important for all of us but it is more important for rural people who are not literate. Once it is popularised, villagers will be able to demand a quality service to community health centres even in the most remoted village. It makes me happy to know that. I dream that each village in Mali has a community health centre which provides quality services to all children.’’
The validated compendium is soon to be shared with the Ministry of Health then it will be reproduced in necessary quantity for dissemination on the national territory giving an opportunity to each Malian to engage with a community health centre, to demand for required services, to hold the provider accountable, and together with him, to influence for a quality health service. It is the first time that such work is done in Mali and all stakeholders believe that this milestone will boost citizens’ involvement and engagement as much as it will induce a positive change in community health centers management for better quality services delivery.