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

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months. The actual time allocated to the district health team was only 6-8
weeks.
Some development activities were not budgeted because they did not
require travel. Often this was less motivating for the local staff, and gave
rise to a few significant delays.
In the districts where the extended coverage map and the first
ComHC were already in place, finalization of the plan was most rapid: the
exercise became less abstract for the district team since an essential element
of the plan (the ComHC) was able to draw on real experience.
These experiences made it possible to reduce the scope of the initial
survey and to orient it more towards a search for pertinent information for
health interventions. That avoided the tendency to produce endless
monographs.
The planning stage was not without its critics: “What is the use of all
these planning efforts? The initiative should be left to expand and not be crushed
by complicated and unfeasible plans.” “The financing for the plans does not
benefit the community; it produces documents that have no follow-up.” These
comments had merit, not in raising doubts about the relevance of plans, but
to ensure that the emphasis was on the practical side of things, and to put
the importance of the document vis-à-vis effective implementation into
perspective. In addition to clear differences in sympathies, the debate was
marked by the position of officials responsible for planning in the Ministry of
Health. In any case, the plan was not an end in itself or the prerogative of
specialists, but a tool to help initiators of change to achieve their objectives.
In the event, the trial strategies turned out to be the right ones. The
support strategies really were designed to help regional staff understand the
tools and methods developed, to train district health teams in using them,
and to strengthen the interaction between partners and the health teams.
At each opportunity, the district and regional teams demonstrated good
understanding, thus confirming the appropriateness of the methods. The
health maps were useful in illustrating the methods’ advantages and
disadvantages. For the doctors, this was often their first in-depth look at
their districts. They also had the opportunity to interact with the
community outside of consultations and health education sessions.
Studies in HSO&P,20,2003