RESUMO
The 1990s witnessed great progress in increasing community participation in the management of health care services as an objective for reform of healthcare systems especially in urban areas benefiting from funding from the international community. Community participation has taken various forms from one country to another in terms of sources of healthcare training (public; private; or both); organization of management committees (inclusion or not of healthcare personnel); and scope of public service assigned to district health care units (preve n t ive and/or curative care; management of proceeds from provision of health care procedures and/or medication; etc.). These strategies have had variable results and; although some urban programs have been evaluated; no attempt has been made to use this experience as a basis for analyzing the political implications of issues involving citizenship and public health. This report presents some ideas on these issues from the point of view of both governments and citizens and restates the purpose of user participation in healthcare services in Africa. That intent involves the need not only to increase household contributions to the cost of healthcare especially within the uncertain economic environment of urban areas but also to improve access to as well as quality of healthcare services