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

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90 more than three workers, nurse included. The population of the area is also very variable, generally comprising between 5,000 and 15,000 inhabitants, more than half of whom live more than 5 km from the health centre. In the urban setting, the ComHC is generally run by a doctor and includes at least five other workers. The population of the area generally numbers more than 15,000 inhabitants. For urban ComHCs, estimates of costs are US$ 35,000 per year (an average of US$ 2.5 per inhabitant per year), and for rural ComHCs, US$ 13,000 per year (an average of US$ 1.3 per inhabitant per year). The State and its partners continue to finance part of the fixed costs of ComHCs. This contribution sometimes goes unnoticed and is often not calculated. It may represent up to 25% of the fixed costs. For a health area of 10,000 inhabitants, this contribution amounts to around US$ 3,000 per year (vaccines, anti-tuberculosis and anti-leprosy drugs, materials, supervision). The local development committee generally subsidizes salaries (e.g., the salary of a matron or auxiliary nurse). Studies in HSO&P,20,2003
Table 20. Distribution of investment costs Item Community Government Average cost (US$) Community Inauguration of Community 300 approach: negotiation and demonstration the ComHC approach Building 25% construction 75% construction 25,000 Human resources - Seed money for • training 500 personnel 300 • training the ComHA 150 • supervision Consumables Initial provision of Initial provision of power • drugs 4,780* • vaccines 1,112 • management support 250 Material and Local furniture Medical 6,350 equipment equipment 1,400 Logistics Furniture 120 Total 40,072 SOURCE: HPRWP and UNICEF Notes: US$ 1 = FCFA 520 *The allowance of drugs takes into account the contribution to the district distribution depot. Table 21. Distribution of operating costs of a rural ComHC (including depreciation) Community Government and Average costs external partners (US$) Building • Maintenance, charges • No commitment 50 Furniture and • Maintenance • Depreciation of 851 equipment large equipment, and EPI materials and supplies Consumables • Drugs • Vaccines 6,436 • Vaccines • Contraceptives, • Reagents and anti-tuberculosis medical drugs Studies in HSO&P,20,2003 91
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Studies in Health Services Organisa
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Acknowledgements The authors partic
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Limits of past experiences A new he
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purchase drugs from the dispensarie
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workshops and specialized studies b
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Community participation in managing
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decentralization, and integration o
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esearchers were often involved in d
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Achievements and problems Declarati
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1990-1992: towards a strategy for c
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technical assistants who were exper
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making all the right decisions at t
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plans started with a discussion of
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extending coverage. Initially, each
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the district, and to assess what hu
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of the area. • Guarantees a minim
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Health (to such an extent that some
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THE ISSUE OF ESSENTIAL DRUGS From i
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The new strategies were developed w
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That may appear simple and obvious,
Page 43 and 44: managerial instrument tools for fol
Page 45 and 46: operational forms to facilitate int
Page 47 and 48: that were largely committed did not
Page 49 and 50: Table 9: Achievements and problems
Page 51 and 52: 1993-1995: first achievements Distr
Page 53 and 54: Methods workshop 2 weeks Finalizing
Page 55 and 56: evaluation of the approaches was po
Page 57 and 58: approach through negotiations, with
Page 59 and 60: Figure 9. Performance in the health
Page 61 and 62: In Dougouolo, a survey 45 revealed
Page 63 and 64: REACTION Establishing the MPS with
Page 65 and 66: transformed into a ComHC? Should th
Page 67 and 68: contributed to the debate at the na
Page 69 and 70: Organizing and developing referral
Page 71 and 72: on these experiments, but in both s
Page 73 and 74: % Expected births Figure 12. Obstet
Page 75 and 76: ambulance evacuation by the health
Page 77 and 78: The ComHA-BA—the community health
Page 79 and 80: maintaining the centre’s capacity
Page 81 and 82: Table 15. Effects of contractual mo
Page 83 and 84: Motivation of health staff received
Page 85 and 86: Financing of the sector and viabili
Page 87 and 88: financing of the ComHCs was conside
Page 89 and 90: to placing the complex and costly r
Page 91 and 92: Profit on drugs. Another aspect tes
Page 93: These simulations deliberately favo
Page 97 and 98: Results for the first ComHCs projec
Page 99 and 100: The answers to these questions emer
Page 101 and 102: Specific contracts had no justifica
Page 103 and 104: etter still, to do it in a way that
Page 105 and 106: Table 22. Operating account for23 C
Page 107 and 108: 1995. Even though begun, this evolu
Page 109 and 110: 1994-1995: Scaling up and improving
Page 111 and 112: implementations and their acceptabi
Page 113 and 114: Extension of coverage had to be acc
Page 115 and 116: priority was always given to the se
Page 117 and 118: When achievements started to mount
Page 119 and 120: Faced with increasing pressure, tec
Page 121 and 122: Figure 24. Performance achieved in
Page 123 and 124: SDHC; on the right, the area that b
Page 125 and 126: situation opened prospects for inte
Page 127 and 128: Managing change Without the project
Page 129 and 130: Figure 27. The position of national
Page 131 and 132: commitment score 5 4 3 2 1 0 -1 -2
Page 133 and 134: Joint central supervision 104 playe
Page 135 and 136: Table of contents Acknowledgements
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