Financing urban primary health services. Balancing community and government financial responsibilities, Pikine, Senegal, 1975-81.

It is difficult to prejudge a community's capacity to satisfy its basic human needs, because no satisfactory method has been developed to predict the potential resources of a poor community. To improve their health conditions, all people, even poor, have some resources available. When they can manage themselves and be involved in decision making, they can become very efficient and contribute many material and human resources needed to organize health facilities in situations where the government fails to provide for wide-ranging needs, especially in the new cities. This was demonstrated by our experiment in Senegal between 1975 and 1981. This paper discusses the respective roles and responsibilities of the communities and the government in terms of: the process of setting up and carrying out the project in Pikine and the stages of community participation; and the pre-conditions for successful co-management in a primary care organization financed in a large part by the community.