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

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