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

1993-1995: first achievements
District health development plans
In October 1993 four regions (Kayes, Ségou, Mopti, and Bamako)
submitted their first district health development plans to the follow-up
committee of HPRWP for financing. The proposed plans had as many
similarities as differences. The latter were linked to the context, but also to
the scope for creativity left to the regions by the central level.
Developing the plans provided a training opportunity for the socialhealth
team of each district. Participants learned how to perform district
health situational analyses—inventorying and choosing priority problems,
inventorying means and available or mobilizable strategies, discussing and
choosing appropriate strategies, familiarizing themselves with the functional
organization of the district, gaining experience in developing health maps,
and learning community approaches. The social-health team was also able
to practice defining, organizing, and managing the MPS (particularly if the
ComHC test was implemented), and principles of referral organization and
support for the district team.
Implementing a first ComHC represented an opportunity for the
team to familiarize themselves with a programming and budgeting tool, and
later, with follow-up and evaluation tools. It was also an opportunity to
consult and negotiate with the community and with local partners about
adopting and implementing the plan. Finally, this achievement constituted
an opportunity to negotiate with upper-level managers and external
partners to mobilize the resources and conditions required for
implementation.
Obvious differences notwithstanding, these opportunities were as
much training opportunities as an information resource for local partners.
The process was long, and perceived as such: it could last from 12 to
19 months (Fig. 7). In extreme cases it pushed the bounds of
reasonableness. Nor was it the exercise itself that took the most time.
Negotiations with local partners, limited availability of regional support, and
the burden of routine work allowed the district teams very little time to
draft and finalize the planning document. Figuring in the time needed for
local negotiations, developing the plan could be expected to take 6-9
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