The community is the heart of the local health system, and we help strengthen both.

There are many barriers in Mali’s health system which prevent mothers and children from accessing the high-quality primary care that saves lives. We cannot help improve health in Mali without understanding, and appreciating, the way healthcare is delivered in marginalized communities.

Like many West African countries, Mali’s health system is tiered and decentralized. But at the community level, Mali’s health system is unique. It gives communities a central role that we think is worth preserving, and strengthening.

The community is represented in two key structures in the local health system:


Primary care in Mali is delivered at community health centers, Centres de Sante Communautaire, or CSComs. The Ministry of Health provides limited support to CSComs, such as some commodities like prescription drugs and some salary support. But, the financing and governance of CSComs – their overall management – is not overseen by the government; it is done by the community.


To create and manage a health center, community members form a community health association known as the ASACO and elect leaders. ASACO leaders receive no formal training or support, but they are responsible for the governance and oversight of the health center, including everything from payroll to keeping the pharmacy stocked.

The decentralized health system has not been properly supported in Mali. We think it can be.

We believe the two underlying strategies behind decentralization are necessary to community-driven, responsive, and accountable primary care. There’s no question they can be improved, but they should be preserved, as crucial strategies for achieving health for all in Mali:

Community participation and ownership

Community ownership is embedded within Mali’s health system and policies, but communities are left without the resources they need to participate and manage their health centers effectively. We see not only incredible potential for a democratic community-led health system, but the opportunity to innovate. Especially in marginalized and underserved communities, when community members exercise their rights and responsibilities, the health system is stronger.

We strengthen the ties between communities and their CSComs.

Cost Recovery

Community health centers receive some start-up resources in the form of pharmaceuticals, but state support for operating expenses is limited. Limited revenue often leads to basic challenges, like an inability to pay staff salaries or stock shortages of basic medications. But if supported properly, CSComs can recover costs and still provide affordable, accountable care. For too long, cost recovery has meant burdensome user fees – but they are just one strategy.

We are working on others.


Without sufficient support, the decentralized local health system can create a negative cycle. Limited resources leads to limited quality, which drives down demand for services and means health centers cannot generate the revenue they need, continuing the cycle.


We can help communities build the knowledge, skills and resources to break the negative cycle caused by limited resources. By supporting the core of the local health system, we can help it function the way it was designed to, with local ownership and local financing that ensure equitable access for all:

We believe that cost recovery and community ownership in local health systems does not prevent healthcare that is affordable and accessible to all, but can actually reinforce and strengthen it.  Read more about how.

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Mali Health improves maternal and child health by supporting women, communities, and the community health system to develop local solutions that ensure every mother and child has access to quality primary care.

US //
PO Box 51632, Durham, NC 27717

Mali //
Hamdallaye ACI 2000
Rue 100, Porte 222
Commune IV du District de Bamako
Côté Ouest de l’Ecole de Maintien de la Paix Alione Blondin Beye