Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...
Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...
Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...
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Profit on drugs. Another aspect tested <strong>in</strong> the simulations was the<br />
<strong>in</strong>fluence of profit marg<strong>in</strong>s expected on the sale of drugs. In the rural<br />
sett<strong>in</strong>g, the global result only became positive with a 40% marg<strong>in</strong> on 29%<br />
attendance (Fig. 16). That showed the <strong>in</strong>fluence of the profit marg<strong>in</strong> on<br />
drugs for the viability of the ComHCs and also the possible side effects of<br />
high profit marg<strong>in</strong>s.<br />
Fixed charges and appropriateness of the workload for available staff.<br />
Salaries <strong>in</strong> both the rural and urban sett<strong>in</strong>g needed to be adjusted to fit the<br />
volume of work (curative, preventive, and promotional activities).<br />
Estimation methods were developed to determ<strong>in</strong>e the optimal charges<br />
compatible with the f<strong>in</strong>ancial equilibrium of the centre and a f<strong>in</strong>ancial<br />
accessibility of the service for the community. One of the obvious<br />
revelations of the simulation exercises was that hav<strong>in</strong>g to pay doctors’<br />
salaries made it impossible for most of the rural community health centres<br />
to balance their accounts. Fig. 17 presents the workload expected at a<br />
centre compris<strong>in</strong>g two workers and provid<strong>in</strong>g all MPS activities (<strong>in</strong>clud<strong>in</strong>g<br />
it<strong>in</strong>erant services). It shows the factors affect<strong>in</strong>g the number of contacts<br />
accord<strong>in</strong>g to the proportion of the population of the area liv<strong>in</strong>g with<strong>in</strong> 5 km<br />
of the centre (30%, 50%, and 70%) due to greater use of curative care.<br />
Attendance rates are the same as those used for Fig. 15.<br />
Figure 15. Balance sheet of a rural ComHC accord<strong>in</strong>g to the proportion of the population<br />
liv<strong>in</strong>g with<strong>in</strong> 5 km of the centre (simulation)<br />
FCFA<br />
2.000.000<br />
1.500.000<br />
1.000.000<br />
500.000<br />
0<br />
-500.000<br />
-1.000.000<br />
30% 50% 70%<br />
5000 7500 10000 12500 15000<br />
T otal population<br />
Studies <strong>in</strong> HSO&P,20,2003 87