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Following ten years of existence, the community health centers of Mali show a type of organization that meets public health requirements as well as the need for financial viability that apply to all healthcare institutions. Their originality lies in several factors: their legal personality, their private status, their financial support of medical staff, their management by a users’ association, and the public utilities agreement they signed with the government. In spite of their success, which saw their staff rise to 350, they suffer from major deficiencies, which result from lack of a democratic tradition within the associations, inappropriate transparency in their accounts, and inefficient supervision by the government. The main questions posed by this new experience concern the limits of the concept of community, the importance of citizenship in the dynamics of development, the participation of private institutions in the delivery of public services, the centralized, authoritarian attitude of government representatives, and the contradiction between the multiplication of healthcare centers with a view to improving geographical access and the requirements of financial viability.