Understanding the challenges to initiate a community-based health system observation approach

Since the early 2000s, around 20 community observatories focusing on access to health have emerged in different parts of Africa. In areas where dysfunctional health systems, in particular supply chain management issues, continue to persist (medical drugs and inputs stockout, delivery of expired medication, shortages and unreliability of equipment for laboratory diagnosis and treatment monitoring, poor service experience for patients, failure to provide free care…), there is increasing interest in observatories as they respond to two major challenges: equitable access to health services and sustainable health systems strengthening.

The 5% Initiative (implemented by Expertise France) has supported the development of several observatories since 2014, which is the basis for this mutual learning exercise. Launched in April 2018, this mutual learning exercise combining field visits, participatory workshops and evaluations makes it possible to identify common issues, share the responses developed by each of the observatories and collectively learn from them, and produce shareable knowledge.

This document is true to the word of those involved, and is a reflection of the reality of observatories, the operational issues they face and the solutions they have put in place. As a product of a collective learning process, this document combines definitions with quotes from people involved in the daily operation of observatories.