Primary health care assistance has become prominent in the rural development programs of many nongovernment organizations throughout sub-Saharan Africa. By emphasizing education and the promotion of new participatory health systems, most such programs aim to enhance the conditions of women as principal community care givers. Yet village-level health assistance in Africa is not without shortcomings. This is exemplified in a case study of two nongovernment programs in Burkina Faso's Namentenga Province. Although both programs have contributed to maternal health and infant survival, they have also induced new ties of donor dependency. This appears to present a conundrum for the sponsoring agencies which espouse self-reliance as a development assistance goal. In fact, however, where the intervention of nongovernment organizations helps to improve rural health, new dimensions of dependency may prove to be a positive first stage in the mobilization of women and the development of locally managed health systems. For this to be so, much is contingent on the capacity of these organizations to integrate local participation in their own planning and management processes, and to augment the professional status of indigenous health workers.
PIP: The relative effectiveness of foreign-funded nongovernmental organization (NGO) development programs in the province of Namentenga in east-central Burkina Faso was evaluated by studying two NGO programs. In 1971 the resident Catholic mission initiated a neighborhood women's health assistance program in Boulsa township entitled Sante Maternelle et Infantile (SMI), which by 1991 extended assistance to 14 villages. In 1978 a second NGO program started, the Plan de Parrainage International de Boulsa (PPIB), which provided village assistance, school construction, bore-hole well drilling, and agricultural extension. By 1991, 18 extension agents were working in 26 villages. The two NGOs provided infrastructure (first aid clinics, maternities, and midwife lodgings); education and consultation assisted by village health workers in growth monitoring and education (GME), nutrition, and prenatal care; and community health development (health committees and women's development committees to foster female participation in community affairs). The impact of the primary health care (PHC) programs was assessed during a 16-month period from late 1985 to early 1987 in 4 villages by visiting 873 households and conducting interviews with 99 married women 18-45 years old (7% of all married women). Most women had attended GME clinics and 73% of the households had charts to prove it. 145 (43%) of 334 children born to 79 women who had attended GME clinics had been delivered in village maternities; only 8 of 103 children born to 20 women who had not attended clinics had been delivered in maternities. Only 11 of 128 deceased infants under 5 years of age had been examined at these clinics. The maternities and clinics improved maternal health and child survival. People's knowledge about the causes of disease and community hygiene had improved, however, the treatment of diarrhea and malnutrition did not change much, and the new knowledge did not lead to behavioral change. In addition, the ineffectiveness of the village committees to support indigenous paraprofessionals indicates the dependency that has emerged from NGO intervention.