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

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16 based organization to the new policy had not yet been found. Given Mali’s tradition of compartmentalization, impenetrability, and rivalry, it was crucial to have a coordinated and concerted implementation mechanism among several partners. Achievements Table 3. Achievements and new problems Problems � Past experiences and exchanges � The problem of essential drugs have strongly influenced new remains orientations � The legal and statutory � The new policy constitutes a environment does not yet exist framework and a coordination and � The transition between mobilization instrument decentralized and integrated � Credibility is reinforced by the management and vertical coherence and clarity of strategic management of programmes choices has not been clarified � Commitment of principal partners � Insufficient coordinating for implementation � Motivation and convergence of views in relation to a group of participants experience of several partners Studies in HSO&P,20,2003
1990-1992: towards a strategy for change Mobilizing under unfavourable conditions Political instability in the country prevented dissemination of the new health sector policy at the time desired, and it ended up being treated as just another new project. The entire vision for health system reform became marginalized. The practical implications for scheduling activities and implementing them in each region, and for the partners who supported the plan, were not clear, and were apt to vary according to the negotiator at the central level. The persistent disorder explains the lessened interest of some bilateral partners and NGOs. For its part, the community was not informed of the opportunities that the new policy offered, or the responsibilities it entailed. ELIGIBILITY REQUIREMENTS FOR THE DISTRICTS Some of the regional districts needed to meet the eligibility criteria given in Table 1 to receive support for programmes. The first priority was to prepare district social-health development plans and establish the first ComHC. Because the financing anticipated under the HPRWP did not take into account the preparatory stages, funds had to be sought from programmes already under way or those nearing completion. Yet programme managers (national or partners) were seldom inclined to adjust their support. The situation of blockage thus created was very frustrating for national managers, particularly because actual conditions were far removed from the criteria detailed in Table 1. A district team with at least two doctors. The State was committed to endowing all the districts with the required personnel, but very few of the districts had two doctors available. The structural adjustment programme, together with the end of recruitment for public service, did not improve the situation. Only much later, following the devaluation of the FCFA in January 1994, did the government authorize recruitment to compensate for the shortage of personnel in the districts. Redeployment of existing personnel to poorly served districts had limited impact. A plan for extending coverage. The method used to prepare plans had no provision for extending coverage. It was naturally oriented towards programming and budgeting available resources for national programmes, Studies in HSO&P,20,2003 17
Page 2 and 3: Studies in Health Services Organisa
Page 5 and 6: Acknowledgements The authors partic
Page 7 and 8: Limits of past experiences A new he
Page 9 and 10: purchase drugs from the dispensarie
Page 11 and 12: workshops and specialized studies b
Page 13 and 14: Community participation in managing
Page 15 and 16: decentralization, and integration o
Page 17 and 18: esearchers were often involved in d
Page 19: Achievements and problems Declarati
Page 23 and 24: technical assistants who were exper
Page 25 and 26: making all the right decisions at t
Page 27 and 28: plans started with a discussion of
Page 29 and 30: extending coverage. Initially, each
Page 31 and 32: the district, and to assess what hu
Page 33 and 34: of the area. • Guarantees a minim
Page 35 and 36: Health (to such an extent that some
Page 37 and 38: THE ISSUE OF ESSENTIAL DRUGS From i
Page 39 and 40: The new strategies were developed w
Page 41 and 42: That may appear simple and obvious,
Page 43 and 44: managerial instrument tools for fol
Page 45 and 46: operational forms to facilitate int
Page 47 and 48: that were largely committed did not
Page 49 and 50: Table 9: Achievements and problems
Page 51 and 52: 1993-1995: first achievements Distr
Page 53 and 54: Methods workshop 2 weeks Finalizing
Page 55 and 56: evaluation of the approaches was po
Page 57 and 58: approach through negotiations, with
Page 59 and 60: Figure 9. Performance in the health
Page 61 and 62: In Dougouolo, a survey 45 revealed
Page 63 and 64: REACTION Establishing the MPS with
Page 65 and 66: transformed into a ComHC? Should th
Page 67 and 68: contributed to the debate at the na
Page 69 and 70: 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
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Table 15. Effects of contractual mo
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Motivation of health staff received
Page 85 and 86:
Financing of the sector and viabili
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financing of the ComHCs was conside
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to placing the complex and costly r
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Profit on drugs. Another aspect tes
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These simulations deliberately favo
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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
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Specific contracts had no justifica
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etter still, to do it in a way that
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Table 22. Operating account for23 C
Page 107 and 108:
1995. Even though begun, this evolu
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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
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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
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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 and 130:
Figure 27. The position of national
Page 131 and 132:
commitment score 5 4 3 2 1 0 -1 -2
Page 133 and 134:
Joint central supervision 104 playe
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Table of contents Acknowledgements
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Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...

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