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

workshops and specialized studies built on past experience to prepare new
national orientations for health programmes and projects being planned
with the principal partners of the sector (World Bank, UNICEF, USAID,
and the Coopération Française). These activities helped to develop a
convergence of views among an about-to-be critical mass of national health
professionals.
Under the direction of an ad hoc group comprising key officials from
the Ministry, and with the participation of health professionals at all levels
(nationals and expatriates working in Mali), the Bamako Initiative was
finalized in August 1989. 9 It integrates and formulates the principles of
health sector organization and development. Decentralization (with a new
definition of roles at each level) and genuine community responsibility for
managing health centres (storage of drugs in particular) were accorded the
same importance as availability of essential drugs.
A new national policy
Presentation of the Bamako Initiative to the Council of Ministers at the end
of 1989 testified to the extent and political importance of the changes
envisaged. It was in this context that formulation or reformulation of
programmes among partners such as the World Bank, UNICEF, USAID,
and the European Development Fund (EDF) could be coordinated, notably,
during joint World Bank-UNICEF evaluation missions. Finally, through the
Health, Population, and Rural Water Project, or HPRWP, the principle of
cofinancing and complementary support was retained as the vehicle for
motivating and implementing the new health sector policy. 10 The term
project did not reflect the scale of change. However, basically for legal
reasons, the World Bank was constrained to use the term at the time.
This process led to framing of a national health policy—solemnly
declared by the government—that went far beyond statements of intent and
reaffirmation of principles. 11 The policy was based on elements defined by
santé a partir de l’expérience de la région de Mopti: document de travail. 18p. Bamako:
Ministère de la Santé et des Affaires Sociales.
9 Ministère de la Santé et des Affaires Sociales (1989) Plan de relance des SSP. Initiative de
Bamako: cadre conceptuel. 39p. Bamako: Ministère de la Santé et des Affaires Sociales.
10 World Bank (1991) Rapport d’évaluation du Projet Santé, Population et Hydraulique
Rurale, République du Mali. Report. 204p. Washington: World Bank.
11 Ministère de la Santé, de la Solidarité et des Personnes Agées (1990) Déclaration de
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