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

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coordinate support to verify conformity with the strategies of the new
policy. The government of Mali possesses a powerful tool in the HPRWP.
Cofinanced by a group of multilateral and bilateral partners, it was able to stimulate
and energize a convergent process.
The Ministry of Health organized regular meetings of donors,
sometimes in the presence of the Minister himself. At the beginning, donors
were chiefly partners directly involved in the HPRWP (e.g., the World
Bank, UNICEF, EDF, USAID, KFW, and the Fonds d’Aide et de
Coopération Française). This group rapidly expanded to include all partners
of the Ministry to clearly signify that it was a matter of implementing a new
policy and not just one “large project” among others. The formal framework
was indispensable in making everyone’s position known, and in creating an
environment where progress could be made with partners whose
commitments were explicit. A need for follow-up dialogue through either
more restricted or less formal meetings was also recognized, to give a hearing
to partners who preferred to air their reservations privately.
No sooner had implementation begun than criticisms from some of
the external bilateral partners and NGOs grew louder. “This is a World Bank
project; it has been imposed in the country.” “With so much financing, it will turn
into a ‘white elephant’ and will all collapse along the way.” These comments
implied a lack of information, but especially the anxiety of partners
insufficiently familiar with the previous stages. Concerning the content of
the new policy, few specific objections were made, though scepticism was
sometimes voiced about the viability of ComHCs in certain regions of Mali,
and doubt frankly expressed about the pharmaceutical reform’s chances of
success. On the other hand, genuine distress was apparent over the gradual
change and role of regional and central projects managed by bilateral and
non-governmental bodies.
Decisions taken to address the situation included (i) increasing
information meetings with NGOs, associations, and bilateral partners at the
central and regional level; (ii) explicitly giving first priority to each
traditional partner of a district or a region to contribute, within the limits of
financing, to implementing the new policy—HPRWP monies would then be
used as additional and supplementary resources; and (iii) involving all
partners, in particular their technicians, in developing implementation tools
through working committees and regional and central workshops.
These overtures did not entirely resolve the problems; however, they
did create a climate conducive to positive developments. On-going projects
Studies in HSO&P,20,2003