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

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Acknowledgements The authors particularly wish to thank Prof. Wim Van Lerberghe for his help and encouragement at different stages of the work; Prof. Joseph Brunet Jailly for his substantial contribution; Mr. Ian Hopwood for his contributions and encouragement; and Mr. Hubert Balique for having stimulated the thought process. Thanks go also to the reading group established by Mr. Salif Coulibaly, Director of the Planning and Statistics Unit, Prof. Moussa Maiga, Technical Adviser to the Ministry of Health and Dr. Lanseni Konate, National Director of Public Health; to the entire public health team of the Institute of Tropical Medicine of Antwerp for creating a welcoming and stimulating environment that enabled the authors to undertake this work; and to Dr. Jean Louis Lamboray, Dr. Andre Stroobant, Prof. Harry Van Balen, Mr. Bassery Ballo, Dr. Guy Clarysse, Dr. Jean Luc Duponchel, and Dr. Pierre Blaise for improving the document through critical reading. Finally, the work owes much to the productivity and achievements of the staff at the regional, district, and central level. The authors hope that this publication conveys the magnitude of everyone’s contributions towards change and the success of the reform. Studies in HSO&P,20,2003 1
Page 2 and 3: Studies in Health Services Organisa
Page 6 and 7: 2 Studies in HSO&P,20,2003
Page 8 and 9: 4 of five. Maternal mortality was a
Page 10 and 11: 6 Region and in Bamako District fol
Page 12 and 13: 8 the Bamako Initiative. The major
Page 14 and 15: 10 Level Table 2. New functions by
Page 16 and 17: 12 two-level health system. 13 This
Page 18 and 19: 14 Figure 3. Chronology of commitme
Page 20 and 21: 16 based organization to the new po
Page 22 and 23: 18 rather than planning for distric
Page 24 and 25: 20 An explicit implementation strat
Page 26 and 27: 22 others. The initial progress and
Page 28 and 29: 24 Complementary field support was
Page 30 and 31: 26 months—were necessary to produ
Page 32 and 33: 28 Will the rural communes ratify t
Page 34 and 35: 30 Studies in HSO&P,20,2003 Table 5
Page 36 and 37: 32 Table 6. The alternatives: globa
Page 38 and 39: 34 major assets (monopoly and distr
Page 40 and 41: 36 Table 7. Conditions required for
Page 42 and 43: 38 ComHCs. 32 It was an example whe
Page 44 and 45: 40 Table 8. Example of the training
Page 46 and 47: 42 coordinate support to verify con
Page 48 and 49: 44 Health for All was a major asset
Page 50 and 51: 46 Studies in HSO&P,20,2003
Page 52 and 53: 48 months. The actual time allocate
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50 Dougoulo (Bla District), then Gu
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52 These principles were not actual
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54 PERFORMANCE The performance of t
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56 Quality of curative care. Superv
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58 Figure 11. ComHC performance aft
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60 ComHA highlighted the fact that
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62 who observed that the chairman o
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Table 12. Characteristics of health
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66 It is in the DHCs that one finds
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68 unmet: for maternal absolute val
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70 obstacles at the referral level
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72 were developed to create mutual
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74 (especially in the area of drugs
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76 managers (chief doctor, represen
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78 not the same teams as before; th
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80 difficult to handle. The obligat
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82 Like most developing countries,
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84 drugs as a contribution to opera
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86 From simulation to a provisional
Page 92 and 93:
88 Figure 16. Influence of the marg
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90 more than three workers, nurse i
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92 Studies in HSO&P,20,2003 consuma
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94 Figure 19. Financial results obs
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96 needed to increase access for th
Page 102 and 103:
98 What are the solutions for the n
Page 104 and 105:
100 unused prescriptions increased.
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102 Figure 20. Depreciation and dev
Page 108 and 109:
104 A major problem remaining is th
Page 110 and 111:
106 Table 23. Time to launch of the
Page 112 and 113:
108 Mali. The Bank and UNICEF alike
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110 ineffective and inefficient wit
Page 116 and 117:
112 Percentage 18 16 14 12 10 8 6 4
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114 The combination of initial trai
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116 Figure 22. Proportion of the to
Page 122 and 123:
118 According to the programming fo
Page 124 and 125:
120 consolidated, and the new rules
Page 126 and 127:
122 That is the principle underpinn
Page 128 and 129:
124 organizations, especially on th
Page 130 and 131:
126 Figure 28. The position of heal
Page 132 and 133:
128 occurred, the concerns, impatie
Page 134 and 135:
130 Studies in HSO&P,20,2003
Page 136:
132 “Revitalizing” the SDHCs...
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