Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...

1994-1995: Scaling up and improving quality
Pressures to accelerate
Most contributors appreciated the achievements of the early 1990s. District
development plans were drawn up in consultation with local partners and
regional support. The coverage plans took into account demographic,
geographic, sociologic, and economic elements. These flexible maps were
used as tools to negotiate district health coverage and development. The
ComHCs provided the MPS through itinerant activities in the villages, thus
meeting underlying health sector policy objectives (financial accessibility,
improved quality of care, good preventive coverage, community
management, viability not dependent on external financial aid) in their area
of responsibility.
The replicability and fragility of the commitments of each party
(State and community), particularly following devaluation were of course a
matter of concern. But people recognized that there was no real alternative,
certainly not using the methods of the past.
Pressure to move faster and to extend coverage to the whole country
began to be felt. While approving quality and performance, some parties
placed too much emphasis on the time it took for each of the activities: for
example, 18 months for the district health development plan, and around
12 months for a ComHC. While some ComHCs had been able to start up 6
months after the start of negotiations, others took up to 24 months (Table
23).
Some people requested that strategies be revised to better respond to
their concerns, in terms of coverage, disbursement, or political satisfaction.
Obviously, if the time required for each implementation in every region
were laid end to end, it would have been necessary to wait well beyond the
year 2000 for substantial differences in coverage. This perspective was
clearly not acceptable to all, in particular those committed to attaining
institutional and political objectives.
Studies in HSO&P,20,2003 105