Prospects for primary health care in Africa: another look at the Sine Saloum rural health project in Senegal
Bloom, A.L.
AID Evaluation Special Study, US Agency for International Development 20: 25
1984
Document Number: 374098
The Sine Saloum Rural Health Care Project, one of USAID's early large-scale primary health care projects in sub-Saharan Africa, provides a study in the problems of creating a viable health programme in a poor, rural environment. USAID's support for health activities in Sine Saloum, Senegal began in 1978. When USAID sponsored an impact evaluation of the project in 1980, the programme was teetering on the brink of failure. This special study, carried out in 1983, reports on the aftermath of the pessimistic 1980 evaluation. The study describes the reversal of the failing project, and examines the policy and programmatic changes that were instrumental to its new found success. A major theme that emerges from this review of the programme is the critical importance of village payments towards the cost of health care, and the surprising success of village management of user fees. A number of important but unresolved issues and new problems emerging from the Sine Saloum project are also raised, which it is suggested will be a useful warning for those involved with similar projects at an early stage of implementation.