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

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ComHCs. 32 It was an example where actual use built confidence in the
methods without clearly resolving the underlying problems (evolution and
transition in the management of certain vertical programmes), which
became increasingly apparent.
A TRAINING STRATEGY
Between 1989 and 1992 the Family Health Division introduced new
training strategies, under a programme that reorganized services for MCH
activities. The reorganization proceeded from health centre to health centre
with on-the-spot facilitators, in a process that led to the desired change.
The limitation of this intervention was that it only concerned MCH, even
though the health centres had other needs (e.g., essential drugs, effective
curative care, financial and material management, and community
participation). Training could not be offered by the specialized service of the
central level but required staff or a team in the field with more flexible
responsibility and abilities.
Whatever its shortcomings, the programme proved the basic utility of
on-site training. In the interest of continuation, the staff conducting the
training were those in charge of supervising the centre. The district team,
including the chief doctor, became indispensable for the training activities
associated with the ComHC. The region provided support to the district
teams to initiate the process and to develop expertise. They also specified
suitable standards and procedures, developed training modules,
strengthened regional managers’ teaching skills, and evaluated the results of
training.
The HPRWP Interinstitutional Group for Training, originally
traditional in its approach to training trainers, saw its role evolve in the
context of these new responsibilities. A problem to resolve was how to tailor
the training programme to the first ComHCs. It was also important to adapt
or create the appropriate medium (e.g., integrated questionnaire for mother
and child follow-up, schedule, outline for microplan development,
32 Directions Régionales de la Santé et de l’Action Sociale de Bamako, Mopti, Ségou, Kayes,
Sikasso, Koulikoro, Mali (1993-1996) Etat d’avancement, études de cas, séries de notes
techniques et de rapports de supervision des centres de santé de cercle et CSCOM/CSAR.
Bamako: Ministère de la Santé, de la Solidarité et des Personnes Agées. Direction Regionale
de la Santé de Segou (1993) Evaluation de l’operationnalité du CSCOM de Dougouolo.
Rapport d’évaluation. 27p. Ségou: Direction Régionale de la Santé.
Studies in HSO&P,20,2003