Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...
Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...
Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...
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Jo<strong>in</strong>t central supervision 104 played a very important role <strong>in</strong> the process<br />
of change and its diffusion. These field visits were undertaken by the<br />
National <strong>Health</strong> Directorate, with the HPRWP and UNICEF. They also<br />
often <strong>in</strong>volved one of the external partners, <strong>in</strong> particular the WHO. The<br />
supervision missions allowed the central level to have a better appreciation<br />
of the field. Through their participatory approach they also <strong>in</strong>volved all the<br />
participants (e.g., ComHA, ComHC health team, district health team, and<br />
regional team). Corrections were made <strong>in</strong> the field, and a consolidated<br />
report was systematically shared with all the regions and central offices. In<br />
this way, problems <strong>in</strong> implementation could be handled and sometimes<br />
resolved. The approach was shared with regional teams who provided<br />
cont<strong>in</strong>uous support <strong>in</strong> the field. Leadership was represented by a critical<br />
mass of staff shar<strong>in</strong>g the same pr<strong>in</strong>ciples and a good sense of collaboration,<br />
negotiation, and partnership, <strong>in</strong> <strong>Mali</strong>’s overall favourable political context of<br />
democratization. The necessary alliances among external partners were<br />
created to overcome obstacles.<br />
It takes time to put a <strong>reform</strong> of such magnitude <strong>in</strong> place.<br />
Negotiations, adaptation, and learn<strong>in</strong>g all proceed slowly. Moreover, the<br />
critical mass of health professionals is limited, and transform<strong>in</strong>g the health<br />
system is a lengthy process. Each situation has its own best pace for<br />
advanc<strong>in</strong>g without los<strong>in</strong>g ground. The <strong>in</strong>volvement of representatives from<br />
civil society can help <strong>in</strong> reconcil<strong>in</strong>g the health services and the community,<br />
ally<strong>in</strong>g them side by side to face the challenges of development.<br />
104 Projet Santé Population et Hydraulique Rurale (1992-<strong>1996</strong>) Série de rapports de revues<br />
conjo<strong>in</strong>tes, gouvernement-bailleurs de fonds du projet. Bamako: Projet Santé Population et<br />
Hydraulique Rurale.<br />
Studies <strong>in</strong> HSO&P,20,2003 129