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

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PERFORMANCE
The performance of the first ComHCs differed from previous first level
services in Mali. There were distinct improvements, particularly in the
quality and coverage of care more than in organization and management of
health centres. The inadequacies—and the constraints—were evident, but
the ComHCs showed that significant progress was possible.
Three types of activities (curative care, prenatal care, and
vaccination of children less than 1 year of age) were evaluated before and
after transformation of the health area. The differences were more
pronounced in areas benefiting from an established ComHC (Fig. 9) than in
areas that had undergone “revitalization” of their existing SDHC 42 (Fig. 10).
The contrast is obviously more significant in the health area of Mozambala,
seeing that previously it was deprived of a health centre. Before the
establishment of a ComHC, services were provided by a distant sub-district
health centre about 15 km away.
The range of MPS services. While the MPS necessarily comprised a
group of curative, preventive, and promotional activities, it was recognized
as minimal: besides the control of current and priority diseases (malaria,
acute respiratory infections, diarrhoea), an integrated care for infant
nutrition was organized (nutritional follow-up, vitamin A supplementation,
vaccination, and promotion of child spacing for mothers). Normal
deliveries, prenatal care, and family planning were also included. In
contrast, STDs were not yet benefiting from adequate support, and the
control of chronic diseases was limited or not developed outside of existing
vertical programmes (e.g., leprosy and tuberculosis).
The basic training of health personnel was unsuitable, inconsistent,
and generally weak; it made rapid development of the MPS during the
training that preceded the launch of new ComHCs more problematic.
42 As we will see further on, there are some areas where it was preferable to transform
(“revitalize”) the SDHC rather than to create a new ComCH.
Studies in HSO&P,20,2003