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

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40 Table 8. Example of the training curriculum for ComHC, Segou Region 1995 Date Module Duration Trainer 7-12 March Planning decision making for curative care 5 days Dr. F. Fofana Flow chart and measures to take: malaria, diarrhoea, leprosy, tuberculosis 1 day Dr. M. Traore 14-19 March Prescribing essential drugs 3 days Dr. H. Mamadou The perinatal period: prenatal care (PNC), deliveries (partograph), labour outcomes, postnatal care 2 days Dr. M. Colibaly Family planning: clinical and management of contraceptives 1 day Mrs. R. Sidibe 21-26 March Information, education, communication 1 day Mr. S. Moussa Control of children’s health, nutritional follow-up, exclusive breastfeeding, nutrition 2 days Dr. M. Traore Vaccinations 1 day Dr. Anafa Ag Integration of follow-up tools and care: actionoriented medical records, schedules, home visits, monthly visits to the villages 2 days Dr. G. Clarysse 28-31 March Microplanning activities 2 days Mr. A. Toure Quarterly reports, instruments and monitoring 2 days Early April Practical internship in a working centre using the tools and methods learned during training 10 days Head doctor USING THE LOCAL HIS AS ANCHOR The existing health information system (HIS) did what was expected of it: it transferred data required by the programmes to the central level. Decentralization imposed new demands on the HIS, including an emphasis on selfevaluation and help in decision making at each level. In this way, the local HIS developed in step with the initial experiences of the ComHC, without having to abandon transfer of information to the higher level. In addition to support for regular activity reports, a variety of tools also took into account resource management, and included items such as schedules to aid smooth running of the centre, centrales conjointes (DNSP - PSPHR - UNICEF - Partnenaires) de supervision des CSCOM/CSA dans les régions. Bamako: Direction Nationale de la Santé Publique - Ministère de la Santé, de la Solidarité et des Personnes Agées. UNICEF-Mali (1989-1996) Série de rapports de revues annuelles et a mi-parcours et notes techniques. Bamako: UNICEF. Studies in HSO&P,20,2003
operational forms to facilitate integration and uniformity, files classified by village of origin, and management control data to facilitate self-evaluation. The local HIS thus defined helped to anchor the processes of decentralization and change in district functioning. It formed the basis for global reform of the HIS to ensure better integration with the new health policy. 36 This ambitious goal impacted well-entrenched networks and services and was not easy to carry out. EXCHANGES AND COORDINATION “Instructions” for implementing the new health policy were left to the initiative, creativity, and negotiating skill of the participants. The uncertainty and inevitable trial and error typical of an undertaking of this magnitude make exchange of experiences and consultation at the different levels essential. Development of tools and methods for change was done together with national and regional staff, taking advantage of past experiences. Regional staff were formally assigned initiatives to test and extend where merited, an opportunity for diversity that was considered enriching. Still, harmonization was sought at each stage. This way of proceeding created a cohesive group of “pioneers”, irrespective of the level to which they belonged (central, regional, or district). Solidarity stimulated a healthy competitiveness between regions. Each of the participants found satisfaction in expanding its field of activities and of the number of new participants it was able to involve (which served as indirect proof of the validity of choices and methods). There was never any question of a closed or elitist lobby. Implementing such extensive reform doesn’t only take political will and skills, tools and appropriate methods, and experienced participants and beneficiaries. It also takes resources. Generally external partners are looked to, especially to mobilize funds. That is certainly appropriate, but the reality is more complex. External partners can have varying degrees of influence on all the other factors affecting reform, helping or hindering implementation either globally or locally. It was therefore important for the Ministry of Health to 36 UNICEF-Mali (1992) La situation des femmes et enfants au Mali. 50p. UNICEF. Van Leberghe W, Coulibaly CO, Sidibe O & Franklin C (1995) Etat d’avancement de la réforme du système d’information (SIS) au Mali. Report. 128p. Bamako: Projet Santé Population et Hydraulique Rurale - Ministère de la Santé, de la Solidarité et des Personnes Agées. Studies in HSO&P,20,2003 41
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 and 20: Achievements and problems Declarati
Page 21 and 22: 1990-1992: towards a strategy for c
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: managerial instrument tools for fol
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
Page 71 and 72: on these experiments, but in both s
Page 73 and 74: % Expected births Figure 12. Obstet
Page 75 and 76: ambulance evacuation by the health
Page 77 and 78: The ComHA-BA—the community health
Page 79 and 80: maintaining the centre’s capacity
Page 81 and 82: Table 15. Effects of contractual mo
Page 83 and 84: Motivation of health staff received
Page 85 and 86: Financing of the sector and viabili
Page 87 and 88: financing of the ComHCs was conside
Page 89 and 90: to placing the complex and costly r
Page 91 and 92: Profit on drugs. Another aspect tes
Page 93 and 94: These simulations deliberately favo
Page 95 and 96:
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
Page 101 and 102:
Specific contracts had no justifica
Page 103 and 104:
etter still, to do it in a way that
Page 105 and 106:
Table 22. Operating account for23 C
Page 107 and 108:
1995. Even though begun, this evolu
Page 109 and 110:
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
Page 115 and 116:
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
Page 121 and 122:
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
Page 135 and 136:
Table of contents Acknowledgements
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