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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28<br />
Will the rural communes ratify the negotiated division of the health map?<br />
Can they allow for one to three health areas without hav<strong>in</strong>g to redraw the map?<br />
What will happen to the relationship between the communes and the ComHA if<br />
basic services devolve to the communes? These questions no longer depend<br />
only on the health <strong>sector</strong>. What has been achieved up to this po<strong>in</strong>t could<br />
still undergo major changes. 25 Information gleaned <strong>in</strong> form<strong>in</strong>g rural<br />
communes often seems to re<strong>in</strong>force efforts made by the health <strong>sector</strong>. In a<br />
very few cases we will face a real problem. Concern<strong>in</strong>g the relationship<br />
between the communes and the ComHA, one can imag<strong>in</strong>e that <strong>in</strong> the<br />
future, ComHA will assume more the role of an association of commune<br />
partner users.<br />
Table 4. Advantages and disadvantages of criteria used for the health map<br />
Advantages Disadvantages<br />
• Allows formulation of plausible<br />
hypotheses about district health<br />
coverage for the medium and long<br />
term.<br />
• Replaces the isolated <strong>in</strong>itiative of the<br />
health care establishment with a<br />
global context of district coverage,<br />
promot<strong>in</strong>g rational decision mak<strong>in</strong>g.<br />
• Gives the district team the<br />
responsibility for negotiat<strong>in</strong>g with<br />
those who wish to support district<br />
health coverage.<br />
• The ComHC has responsibility for the<br />
health of the community for all the<br />
villages compris<strong>in</strong>g the health area—a<br />
different approach from simply<br />
respond<strong>in</strong>g to demands presented to<br />
the health centre.<br />
• Local costs are transparent and<br />
controlled by the community.<br />
• Focuses on a common tool for villages<br />
Studies <strong>in</strong> HSO&P,20,2003<br />
Inclusivity<br />
• The need to plan and budget<br />
improvements may create comb<strong>in</strong>ed<br />
pressure to proceed much more quickly<br />
everywhere, despite <strong>in</strong>sufficient support<br />
capacities and other unmet conditions.<br />
• Conflicts with participants—e.g.,<br />
NGOs—who wish to target support to a<br />
particular village.<br />
Def<strong>in</strong>ed area of responsibility<br />
• Involves additional operat<strong>in</strong>g costs and<br />
opportunity costs through it<strong>in</strong>erant<br />
activities for the villages far from the<br />
health centre<br />
• Invites criticism from (i) <strong>in</strong>discrim<strong>in</strong>ate<br />
advocates of a market economy<br />
approach for health services <strong>in</strong><br />
develop<strong>in</strong>g countries and (ii) those who<br />
contest responsibility at this level for<br />
25 Ballo M, Duponchel JL & Traore S (<strong>1996</strong>) Décentralisation et mise en oeuvre de la<br />
politique <strong>sector</strong>ielle de santé et de population. Série d’aide-mémoires. 7p. Bamako.