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

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others. The initial progress and experience of the early regions was an
advantage to the ones following. The latter all the more rapidly caught on
to the progress of their predecessors because they had fewer problems of
human resources availability and field conditions were less difficult for
them. There as a definite gap between good ideas (disseminated in stages to
the regions) and the means and conditions to realize them. This observation
highlighted the inadequacy of accompanying measures permitting the designated
regions to achieve the desired objectives for the first phase.
The development of regional support strategies for the district
generated a major debate: Should a district develop and test methods and then
capitalize on the ones that worked by extending them to other districts? Or was it
preferable to organize simultaneous support for all the districts in a way that gave
each a real opportunity to meet eligibility conditions?
Funds budgeted under HPRWP corresponded to control of 21
districts or communes out of 35, which included the 5 regions covered by
the programme. Normally, external partners negotiated their choice of
intervention zone at the central level. Now, the regions needed to intervene
themselves. The districts not yet involved continued to benefit from regular
support from national programmes (EPI, Control of Diarrhoeal Diseases,
leprosy, tuberculosis, and so on), thus enabling channels of multiple central
support to coexist in the same region. The limitation of financing to 21
districts nevertheless gave the impression that the districts not chosen were
to be excluded from the support. That gave a political dimension to the
choice of priorities that was difficult for the national managers.
On another level, the support capacities of the Regional Directorates
remained limited despite the reinforcement provided under the programme.
Expanding support to regional teams with little working experience of tools
and methods meant documents and instructions were being distributed
without really involving participants at the operational level. That
heightened the possibility of errors and deadlocks in all the districts, and it
had consequences for collaboration between the regions and districts, and
between the latter and their partners.
So a compromise had to be found. 21 First off, a “transfer of
methodology” would be needed. Preparation of district health development
21 Direction Nationale de la Santé Publique (1992). Rapport du groupe de réflexion sur le
CSCOM. 8p. Bamako: Direction Nationale de la Santé Publique, Ministère de la Santé, de
la Solidarité et des Personnes Agées. Diakite D et Lacapere F (1992) Module d’appui de
l’équipe régionale de la santé et de l’action sociale aux équipes de santé de Cercle. 17p.
Studies in HSO&P,20,2003