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

118
According to the programming for health development plans, the
percentage of the population living within 15 km of a health centre
managed by the community and offering the MPS needed to rise from
3.35% in 1993 to 65% in the year 2000. In fact, from 1993 to 1996, it
progressed only to about 24.5%. The number of areas transformed
progressed to 173 units during the same period.
This progression was certainly lower than projected. But it was
effective, and supported. The gap between implementation and
programming was real, but a real acceleration was also in progress from the
second half of 1994. The momentum had to be maintained until the
beginning of 1997, the period during which all the SDHC programmes were
effectively revitalized (Figs 22 and 23). Beyond this deadline, increased
access to the MPS depended on the capacity to establish new ComHCs in
health areas whose viability was not assured.
Performance achieved by health areas transformed into ComHCs or
revitalized SDHCs demonstrated a few very significant improvements
compared with the previous situation.
Fig. 24 compares the performance levels for 195,000 inhabitants in 18
health areas, before and after the introduction of a ComHC or revitalization
of a SDHC. Improvements were made at acceptable cost. The average cost
of a prescription in these health areas in 1995 was FCFA 734. 97
In the districts of Bla and Djenne, where the accessibility to the MPS
increased with community management, this progression had a very
significant impact on the global performance of the whole district (Fig. 25).
The case of the sub-district of Mozambala illustrates the impact of
the new system. This sub-district was divided into two health areas: one
remained under the responsibility of the SDHC; in the other, a ComHC was
launched. Fig. 26 shows the differences between the services for the
community covered by the ComHC and the community still dependent on
the SDHC (non-revitalized, and operating as before).
Figure 26. Services to the population in the sub-district of Mozambala: on the left, the part
of the sub-district (17,401 inhabitants) that remained under the responsibility of the
97 UNICEF-Mali (1989-1996) Série de rapports de revues annuelles et à mi-parcours et notes
techniques. Bamako: UNICEF.
Studies in HSO&P,20,2003