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

Limits of past experiences
A new health policy for Mali
Mali has frequently reoriented its health policy since independence. The
first seminar for health and social workers (1964) led to a decennial plan for
the period 1966-1976. The plan focused on modernizing, expanding, and
improving the capacity of hospitals and medical centres, setting up village
infirmaries, creating mobile prevention units, and eradicating major
epidemics. The second and third national health seminars, held in 1978 and
1983, respectively, demonstrated the commitment of health professionals to
identifying problems.
Following the example of other African countries, Mali pursued the
recommendations of the Alma-Ata International Conference on Primary
Health Care. At the beginning of the 1980s, the one-party State developed
a national health policy based on the primary health care principles defined
at Alma-Ata. However, the decennial plan for health development that
resulted from it was never implemented. The support Mali received was
selective [national programmes such as Maternal and Child Health (MCH),
Expanded Programme of Immunization (EPI), leprosy, onchocerciasis, and
so on], or limited and confined to certain geographical areas, with
provisions differing from one locale to the other. The multilateral and
bilateral aid agencies backed only specific projects. Here and there, the
range and amount of this support helped to develop capacity and obtain
results. But the gains were too project-dependent and had no significant or
lasting impact on the health of the population, in particular that of women
and children.
Efforts to involve the community focused mainly on promotion and
use of health services. During the 1980s, a few participatory bodies were
created (e.g., management committees and boards for district health
centres, or DHCs) to manage revenue from cost-recovery financing. But the
representatives on these participatory bodies were local and regional
administrative staff, not people from the community.
Mali is a big country - 1.2 million sq. km - with a highly dispersed
population. Inhabitants number roughly 9 million, of whom more than 7
million live in rural areas (Fig. 1). At the end of the 1980s, one out of eight
children died before the age of one year, and one out of four before the age
Studies in HSO&P,20,2003 3