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

When achievements started to mount up, the chief doctors and
regional managers began to criticize the excessive demands of vertical
programmes. The National Health Directorate then took formal measures
to prioritize execution of district health development plans. Still, external
partners and managers of programmes at the central level used the pretext
of insufficient coverage to justify their parallel interventions.
Despite the will of some, problems of coordination and harmonization
of interventions at the central level were not easy to resolve. At the
beginning of 1994 the National Health Directorate organized consultation
days with the participation of all the divisions and regional offices. The
differences in levels of information and reasoning were strikingly apparent.
These consultations helped to make progress, but without resolving all the
problems. The thinking behind the divisions and programmes of the
National Health Directorate was strongly influenced by tradition and the
involvement of external partners. The people most closely involved in
implementing the new policy had no miracle solution to propose.
Nevertheless, they were able to correct the major inconsistencies and to
resolve conflicts of priority.
Beyond closed arbitration at the central level, the field could hardly
best the challenge without an alternative solution. Consequently,
programmes were urged to channel their support towards launch of the
ComHCs. Once the number of operational health areas exceeded 100, a
new, strong relationship was established. External partners and managers of
national programmes had a more positive attitude with regard to the new
health system. Now the trick was to manage the new risk arising from a
flood of proposals for integration originating from projects and programmes.
Accelerating without derailing
The national technical staff and expatriates all expressed doubts about the
chances of success for rapid acceleration. Their convergent positions
mitigated the demotivating effect of pressure.
It was possible to plan a few measures for speeding things up.
Establishing the first ComHC was a nucleus that allowed the district team
to be formed gradually and to avoid possible apathy (including from within),
when transforming a State health centre. Thereafter, it was possible to
revitalize SDHCs more rapidly than to set up other ComHCs: the
infrastructure and the staff were already in place.
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