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

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126 Figure 28. The position of health managers throughout the four stages commitment score Figure 29. The position of bilateral partners throughout the four stages commitment score Studies in HSO&P,20,2003 5 4 3 2 1 0 -1 -2 4 3 2 1 0 -1 -2 Central Level Vertical programmes Involved regions not involved regions stage 1 stage 2 stage 3 stage 4 USAID French Coop. KFW Neederland NGOs stage 1 stage 2 stage 3 stage 4
commitment score 5 4 3 2 1 0 -1 -2 -3 Figure 30. The position of multilateral partners throughout the four stages W. Bank UNICEF WHO EU UNFPA stage 1 stage 2 stage 3 stage 4 Initial field implementations have had a leveraging effect. The capacity of staff to defend and promote their new findings mobilized indecisive participants while rallying opponents. They had some effect on the evolution of the position of external partners, broadened alliances, and favoured much greater mobilization. They also allowed better management of pressure while reassuring partners and giving them more confidence in the actors themselves. Over time, word of mouth following initial experiences succeeded in changing the climate. The positions of external partners were themselves far from being homogeneous. It is only at the mid-term review that there was a consensus on support. As for national participants, the stage of development of strategies for change and, to a lesser degree, of first results did not provoke enthusiasm. It is very likely that even if political transition had not Studies in HSO&P,20,2003 127
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Studies in Health Services Organisa
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Acknowledgements The authors partic
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Limits of past experiences A new he
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purchase drugs from the dispensarie
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workshops and specialized studies b
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Community participation in managing
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decentralization, and integration o
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esearchers were often involved in d
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Achievements and problems Declarati
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1990-1992: towards a strategy for c
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technical assistants who were exper
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making all the right decisions at t
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plans started with a discussion of
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extending coverage. Initially, each
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the district, and to assess what hu
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of the area. • Guarantees a minim
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Health (to such an extent that some
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THE ISSUE OF ESSENTIAL DRUGS From i
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The new strategies were developed w
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That may appear simple and obvious,
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managerial instrument tools for fol
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operational forms to facilitate int
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that were largely committed did not
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Table 9: Achievements and problems
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1993-1995: first achievements Distr
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Methods workshop 2 weeks Finalizing
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evaluation of the approaches was po
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approach through negotiations, with
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Figure 9. Performance in the health
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In Dougouolo, a survey 45 revealed
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REACTION Establishing the MPS with
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transformed into a ComHC? Should th
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contributed to the debate at the na
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Organizing and developing referral
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on these experiments, but in both s
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% Expected births Figure 12. Obstet
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ambulance evacuation by the health
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The ComHA-BA—the community health
Page 79 and 80: maintaining the centre’s capacity
Page 81 and 82: Table 15. Effects of contractual mo
Page 83 and 84: Motivation of health staff received
Page 85 and 86: Financing of the sector and viabili
Page 87 and 88: financing of the ComHCs was conside
Page 89 and 90: to placing the complex and costly r
Page 91 and 92: Profit on drugs. Another aspect tes
Page 93 and 94: These simulations deliberately favo
Page 95 and 96: Table 20. Distribution of investmen
Page 97 and 98: Results for the first ComHCs projec
Page 99 and 100: The answers to these questions emer
Page 101 and 102: Specific contracts had no justifica
Page 103 and 104: etter still, to do it in a way that
Page 105 and 106: Table 22. Operating account for23 C
Page 107 and 108: 1995. Even though begun, this evolu
Page 109 and 110: 1994-1995: Scaling up and improving
Page 111 and 112: implementations and their acceptabi
Page 113 and 114: Extension of coverage had to be acc
Page 115 and 116: priority was always given to the se
Page 117 and 118: When achievements started to mount
Page 119 and 120: Faced with increasing pressure, tec
Page 121 and 122: Figure 24. Performance achieved in
Page 123 and 124: SDHC; on the right, the area that b
Page 125 and 126: situation opened prospects for inte
Page 127 and 128: Managing change Without the project
Page 129: Figure 27. The position of national
Page 133 and 134: Joint central supervision 104 playe
Page 135 and 136: Table of contents Acknowledgements
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