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

Table 15. Effects of contractual modes between the State and the ComHC on the
motivation of personnel
Factors affecting staff motivation Global MPS agreement Specific contracts
• Having a model (to know
where one is going)
• Genuinely being able to do
what is expected (being on
top of things)
• Having adequate tools for
the job
• Being in a position to
protect one’s family
• ComHC with MPS and
management control
data
• Specific training,
supervision, referral,
and feedback for the
entire MPS
• Simultaneously put in
place all the tools
needed for the range of
MPS activities
• Assure the financial
health of the ComHC
contracts
• Appropriate payment
for personnel
• Feeling validated • Validated by the
community and by the
local health authorities
depending on the
quality and global
results achieved
• Specific objectives in
activities where one
is under contract
• For activities under
contract
• Puts in place specific
tools each time a
contract is signed for
an activity; takes no
or almost no account
of unrelated
activities
• Depends on
continuation of
contracts
• Validated by the
technicians in charge
of the program based
on specific results
Achievements and problems after initial implementation
The initial achievement was indisputably the implementation of functional
models in each region. The various participants had acquired experience
and skills. The implementation became clearer, and the policy less abstract
for the regions and the central level. Subsequent stages were envisaged with
more confidence and much more realism.
The interaction between health personnel and the community was no
longer that of direct provision of care or of “health education”. The
perceptions of some of the people had changed, notably owing to a desire
not to disappoint others. The teams that participated in the community
approaches, from negotiating the health map to opening the ComHC, were
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