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

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Quality of curative care. Supervisions have demonstrated that initial
training was effective. 43 Prescription of drugs improved. The percentage of
injectable prescriptions, formerly almost automatic, was reduced by 5 to
10%. In more than three out of four cases, prescriptions included three
drugs or fewer. The flow charts appeared to be used correctly in more than
90% of the cases. Still, the diversity and accuracy of diagnoses remained
weak. 44 The referral rate, rarely greater than 1%, suggests that nurses only
evacuated obvious emergency cases and rarely referred cases in advance.
Organizing and microplanning activities. All the ComHCs provided
microplanning and a schedule both of centre and itinerant activities in the
villages. Microplans were finalized with ComHA, and the villagers were
then informed on what day the nurse would visit.
A scorecard enabled participants to visualize progress towards
objectives, and appropriate tools allowed ComHA to resume coverage of
certain activities by village to improve the usefulness of discussions about
village participation in the different activities of the centre.
In a major innovation over the old “forward strategies”, the nurse
now provided this activity. Previously it was left to less-qualified auxiliary
nurses, who had neither the credibility nor the competence to develop
promotional activities in the villages.
The regular visits of the nurse not only improved the quality of
services in the villages (vaccination, nutritional follow-up, vitamin A
supplementation, follow-up of high-risk pregnancies, continuity of care), but
they also strengthened solidarity and the sense that the villages had a stake
in the health area. In Guétéma, the villages subscribed and renewed their
contributions before the expiry date to assure financing of itinerant
activities.
In other health areas, including a large number of villages and
hamlets (Monzambala), discussions were particularly lively when a schedule
of visits had to be stopped in favour of continuity at the health centre. All
the villages, whatever their size, required a monthly visit by the nurse.
43 Direction Nationale de la Santé Publique (1993-1996) Serie de rapports de missions
centrales conjointes (DNSP- PSPHR - UNICEF - Partenaires) de supervision des
CSCOM/CSA dans les régions. Bamako: Direction Nationale de la Santé Publique -
Ministère de la Santé, de la Solidarité et des Personnes Agées.
44 de Champeaux A, Hours B, Maiga M et al. (1994) Evaluation à mi parcours du PSPHR. 5-
23 December 1994. Report. 144p. Bamako: Projet Santé Population et Hydraulique Rurale.
Studies in HSO&P,20,2003