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

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92 Studies in HSO&P,20,2003 consumables • Provision of power • Materials Personnel • Salaries • Housing • HIS materials and supplies • Supervision • Continuing education • Depreciation for 4,694* Transportation • Fuel and 656 maintenance motorcycles (?) Communication • Maintenance • Depreciation for 360 s radio communication Total 3,047 * Includes the salary for four workers FCFA Figure 18. Financial outlook for rural ComHC based on simulation 2.000.000 1.500.000 1.000.000 500.000 0 -500.000 -1.000.000 5.000 7.500 10.000 12.500 15.000 Population 30% 50% 70%
Results for the first ComHCs projected balanced operational accounts or surpluses, even when they offered the full range of MPS activities. Figs 18 and 19 show the size of the population living within 5 km of the health centre, which was a determinant of the viability of the centre. Three health areas showed a surplus balance that clearly exceeded projections (Monzombala, Kalabankoro, and Fanga, with 52, 49, and 81%, respectively, of their total population living within 5 km of the centre). Three health areas fell below projections without incurring deficits (Touna and Dia, and Guétéma, with 51, 63, and 58%, respectively, of the population living within 5 km of the health centre). The remaining two areas are close to projections corresponding to the proportion of their population living within 5 km of the health centre (Dougoulo and Gagna, with 55 and 49%, respectively, of their population living within 5 km). Overall, none of the eight areas showed a deficit, and six closely matched the projections or had a surplus. But these encouraging results also underscored the limits of the method. Simulations do not take into account variables such as the competence and people skills of the auxiliary nursing staff or the motivation and degree of commitment of the community. Moreover, the ComHAs did not always follow the pricing schemes used in the simulations. Studies in HSO&P,20,2003 93
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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,
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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 and 94: These simulations deliberately favo
Page 95: Table 20. Distribution of investmen
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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