Utilizing ethnographic research methods, this case study examines the experiences of an NGO-sponsored health care program in rural Mali. The findings indicate that while, in principle, the organization operates from an alternative development base, it has been unable to decentralize the decision-making process and facilitate community dialogue and participation. Numerous problems resulted, including superficial forms of local participation, lack of community ownership, non-remuneration of health workers and midwives, inadequate training, and ultimately, limited program gains. The analyses highlight the complexity and dynamic nature of health program implementation in a developing context, and suggest several factors important to project success. These include drawing on diverse local perspectives, promoting broad-based participation, and providing culturally appropriate ways to include all community members, particularly women.
HDI.Human development report 2007/2008: fighting climate change. [Internet] 2007/8 [cited 2008 Jan 8]. Available from: http://hdr.undp.org/en/reports/global/hdr2007-2008/
2.
IFAD.Rural poverty in Mali. [Internet] Updated 2007 Mar 13 [cited 2008 Jan 8]. Available from: www.ruralpovertyportal.org
3.
One World Organization.Diagnosing challenges: health and the new millennium. Panos Briefing No. 36. [Internet] 1999 [cited 2008 Jan 8]. Available from: www.oneworld.org/panos/briefing/diagnosing_challenges.htm
4.
World Health Organization.Health. A key to prosperity: success stories in developing countries. [Internet] 2000 [cited 2008 Jan 8]. Available from: www.who.int/inf-new/
5.
World Health Organization.Country health system fact sheet 2006: Mali. [Internet] 2006 [cited 2008 Jan 8]. Available from: www.afro.who.int/home/countries/fact_sheets/mali.pdf
6.
USAID.Reproductive health services: HIV/AIDS prevention and control program. [Internet] 2000 [cited 2008 Jan 8]. Available from: www.usaid.gov/procurement_bus_opp/procurement/annual_pstatements/mali.html
7.
Roberts B.NGO leadership, success, and growth in Senegal: lessons from ground level . Urban Anthropol. 2000;29(2):143-80.
8.
Markowitz L.Finding the field: notes in the ethnography of NGOs. Hum Organ. 2001;60(1):40-6.
9.
Green A., Mattias A.Non-governmental organizations and health in developing countries . New York: St Martin's Press; 1997 .
10.
Edwards M., Hulme D.Introduction. In: Edward M, Hulme D, editors. Beyond the magic bullet: NGO performance and accountability in the post-cold war world. West Hartford: Kumarian; 1996. pp. 1-20.
11.
Brohman J.Popular development: rethinking the theory and practice of development . Oxford: Blackwell Publishers ; 1996 .
12.
DeJong J.Non-governmental organizations and health delivery in sub-Saharan Africa. Washington, DC: The World Bank; 1991.
13.
Gilson L., Sen PD, Mohammed S., Mujinja P.The potential of health sector non-governmental organizations: policy options . Health Policy Plan. 1994;9(1):14-24.
14.
Brett EAVoluntary agencies and development organizations: theorizing the problem of efficiency and accountability. Dev Change. 1993;24(2):269-303.
15.
Tandon Y.Foreign NGOs, uses and abuses: an African perspective. IFDA Doss. 1991 Apr/Jun;81:67-78.
16.
Maclure R.Primary health care and donor dependency: a case study of non government assistance in Burkina Faso. Int J Health Serv.1995;25(3):539-58.
17.
Akukwe C.The growing influence of non-governmental organizations in international health: challenges and opportunities. J R Soc Promo Health . 1998;118(2):107-15.
18.
Pfeiffer J.International NGOs and primary health care in Mozambique: the need for a new model of collaboration. Soc Sci Med.2003;56(4):725-38.
19.
Ouelessebougou-Utah Alliance.A brief history of the origin, mission, and accomplishments of the Ouelessebougou-Utah Alliance. Salt Lake City, UT : OUA;1997.
20.
Hale P.Medical expedition report: Ouelessebougou-Utah Alliance. Salt Lake City, UT: OUA;1998.
21.
Survey on OUA development projects. Ouelessebougou , Mali; 2003.
22.
Focus group interviews with village council. Ouelessebougou , Mali; 1999-2002.
23.
Focus group interviews with women's associations. Ouelessebougou , Mali; 1999- 2002.
24.
Focus group interviews with men's associations. Ouelessebougou , Mali; 1999- 2002.
25.
Participant observation field notes. Ouelessebougou , Mali; 1999-2003. 24a. Interviews with midwives. Ouelessebougou, Mali; 1998- 2003.
26.
Interviews with health workers. Ouelessebougou , Mali; 1998-2003.
27.
Interviews with family groups. Ouelessebougou, Mali; 1998-2003.
28.
Ward C., Ballif-Spanvill B., Fuhriman A., Solomon Y., Widdison-Jones K.Weeding out failed practices: a case study of community gardens in rural Mali . Hum Ecol.2004; 32(4):509-21.
29.
Bender DE, Pitkin K.Bridging the gap: the village health worker as the cornerstone of the primary health care model. Soc Sci Med. 1987;24(6):515-28.
30.
Haliman A., Williams G.Can people move bureaucratic mountains? Developing primary health care in rural Indonesia. Soc Sci Med. 1983 ;17(19):1449-55.
31.
Matomora MKS . A people-centered approach to primary health care implementation in Mvumi, Tanzania. Soc Sci Med. 1989;28(10):1031-7.
32.
Chabot HM, Bremmer J.Government health services versus community: conflict or harmony. Soc Sci Med.1988;26(9):957-62.
33.
Stebbins KRPolitics, economics, and health services in rural Oaxaca, Mexico. Hum Organ. 1986;45(2):112-18.
34.
Pandey S., Messerschmidt DA, Braaten B., Eslinger G.Process evaluation of primary health care projects: a mid-term evaluation of a primary health care project in Northern India. J Community Practice. 1997;4(3):1-21.
35.
Phillips DRHealth and health care in the third world. New York: Longman Scientific & Technical; 1990.
36.
Interviews with OUA nurse. Ouelessebougou, Mali; 1999-2002.
37.
Intern report on current status of the OUA health program. Salt Lake City, UT: OUA; 1996-8.
38.
Nyamwaya DOThree critical issues in community health development projects in Kenya. In: Grillo RD, Stirrat RL, editors. Discourses of development: anthropological perspectives. Oxford: Berg;1997. pp. 183-201.
