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

132
“Revitalizing” the SDHCs............................................................................... 60
Specific problems in the urban context ........................................................ 62
Organizing and developing referral in the rural setting.............................. 65
THE FIRST LEVEL ............................................................................................. 65
A MULTIPURPOSE TEAM FOR MANAGING THE DISTRICT .................................. 65
DISTINGUISHING BETWEEN FIRST LEVEL AND REFERRAL.................................. 66
STRENGTHENING REFERRAL FOR OBSTETRICAL CARE...................................... 67
Regulations and contracts: crystallizing the debate .................................... 72
Achievements and problems after initial implementation ......................... 77
Financing of the sector and viability of ComHCs............... 81
Doubts about the viability of ComHCs ........................................................ 81
New cost-sharing ............................................................................................. 84
From simulation to a provisional operating budget..................................... 86
From provisional to balanced budget............................................................ 89
Points for discussion ........................................................................................ 94
Devaluation ...................................................................................................... 98
THREATS TO REFORM...................................................................................... 98
VIABILITY OF ACCESS ...................................................................................... 99
Financing the district health system ........................................................... 102
1994-1995: Scaling up and improving quality.................... 105
Pressures to accelerate .................................................................................. 105
Real constraints.............................................................................................. 108
The persisting problem of integrating vertical programmes..................... 112
Accelerating without derailing .................................................................... 113
Visible results ................................................................................................. 115
From a strategy for extending coverage to a changing relationship
between services and users ........................................................................... 120
Managing change..................................................................................... 123
Studies in HSO&P,20,2003