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

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Figure 11. ComHC performance after one year of operation (rates of coverage and use)
100
90
80
70
60
50
40
30
20
10
0
In rural settings geographical accessibility strongly influenced use of
the health centre. Use of curative care by village communities where a
ComHC existed or was located nearby was clearly higher—0.8-1 new case
per inhabitant per year—than for communities living far from the centre.
Good performance of certain preventive activities (in particular
vaccination) was possible due to the itinerant activities of the nurse in the
local villages. But this strategy of regular nurse visits to the villages could
not compensate for the distance factor in responding to needs for curative
care or increasing its use at the health centre.
In urban settings, the frequency of curative care at the ComHC also
remained very modest, often fewer than 0.2 new cases per inhabitant. Other
factors arose (Table 12), namely, the range of informal and formal offers of
care services that prevailed in the city. In a commune of Bamako in 1994,
four out of five consultations in modern care were sought in the informal
sector. 47
47 Ba SA, Ba SR & de Bethune X (1997) Comment se soigne-t-on en ville? In: Brunet-Jailly
E (ed) Innover dans les systèmes de santé. Expériences d’Afrique de l’Ouest, 41-51. Paris:
Editions Karthala.
Studies in HSO&P,20,2003
DTP3 Ant. Care Curative
GETEMA KALABANKORO DOUGOULO TOUNA MOZAMBALA MALI94