Mali adopted a sectoral health and population policy in December 1990. This policy led to a reorganization of the health system according to a pyramidal model, the basic unit of which is the circle (equivalent to the health district), which includes first-line health services (Community Health Centers, CSCom) and the district hospital (Reference Health Center, CSRéf). The purpose of these structures is to improve the health of the population, to ensure financial and social protection and to be responsive to the expectations of the population. Youwarou, one of the poorest circles in Mali, is located in the central Niger delta. This geographical situation makes it difficult to travel because of the omnipresence of water (eight months out of twelve). The objective of our work was to analyze the local health system in the Youwarou Health District in Mali and to propose strategies for improvement. We were inspired by the action research framework of Nitayarumphong & Mercenier (1992) and that of Van Olmen (2012).