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

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Table 7. Conditions required for unitary programming by health area
1. The health map is developed.
2. The MPS is defined and adopted in the context of the district.
3. The following inputs are feasible:
• Process leading to the creation of the ComHA
• Rehabilitation or construction of infrastructure
• Standard equipment for the health centre and estimated depreciation
• Initial provision of drugs and vaccines and estimate of annual
consumption
• Training of personnel and of the management committee
• Supervision of start-up and of on-going training
• Resources to cover salary costs and current operation
4. A broad outline is made of cost-sharing investment and functioning
between the different partners in health development.
Each unit took into account the logical sequence of all the activities
involved in transforming an entire functional health area, maintaining it
(e.g., supervision and support for operations), and estimating costs. Costs
were split into investment costs and operating costs. Under each section,
the source of financing was specified as deriving from cost-sharing with the
State, external partners, or the community (e.g., own revenue from the
centre, contributions, and local taxes). A schedule for implementation was
proposed according to the stage of negotiations and support capacity, to
allow timely planning and programming of resource needs. One of the
benefits of this approach was that apart from the traditional unit costs (e.g.,
infrastructure, equipment, and initial seed monies), all of the activities and
inputs required to transform an area (creating a ComHC, revitalizing a
health centre) were considered together. It would not be possible, for
example, to consider isolated training in maternal health or for vaccination,
nor community approaches without taking into account the material,
technical, and financial support for the other parts of the transformation.
Thus it was possible to avoid bottlenecks through lack of coordination and
waste resulting from inappropriate implementation.
Of course, resources had to be available at the operational level
according to the provisional planning, with effective decentralization of
their management. The central level (all programmes intermingled) would
mobilize resources so that the operational level (with the support of the
region) could undertake the transformations.
Studies in HSO&P,20,2003