Health Sector Steering Committee Meeting

Mali shows good key health indicator results and a satisfactory macroeconomic context despite the economic crisis this year.  These results were presented to development partners’ technical representatives, heads of the MoH divisions and civil society and other observers at the PRODESS I steering committee meeting on November 27.

The Planning and Statistical Division of the MoH underlined the vital importance of the IHP+ Compact, signed in April 2009, to reinforce mutual engagement of both national services and development partners.  It was proposed that perceptions on the Compact should be discussed by policy heads of all partners at the upcoming National Joint Sector Review (December 2009)

Improvement for key MDG indicators

Key health service indicators were presented, including 2007-8 results for 35 agreed common indicators, and targets for continued efforts. All showed stable or increased results including the 4 key indicators for progress towards the MDGs:

• proportion of population living within 5 km of a public health facility (stable), 
• proportion of deliveries taking place with qualified medical assistance (2% increase)
• proportion of ante-natal consultations in the updated format (8% increase),
• child vaccinations with Penta3 (stable) and against measles (2% increase).

Objectives for 2011 are generally within a 5% increase range, with plans to increase assisted deliveries by 29%, as part of the strategy to reduce Mali’s maternal mortality rate.  Other objectives include reducing infant and child mortality rates by a similar (or higher) proportion, reducing malnutrition and increasing appropriate care of diarrhoea. There were questions about the details of a number of indicators, such as how maternal mortality will be significantly reduced within two years. An observer complimented the MoH on taking steps to integrate private sector results into the health information system, and estimated that with over 500 private structures, the sector has 0.85 physicians for every 1 working in the public health system.

Indicators are judged 85% satisfactory, and, according to supplementary findings, are continuing to improve. To enable technical and financial partners to continue and increase their use of common indicators to inform funding cycles, rather than introduce their own indicators and surveys, twice-yearly technical committee meetings were proposed for April and October.  These should help reduce the burden of monitoring on the MoH.

Spending, decentralisation and more support

Spending of the overall MoH financial budget was analyzed according to the type of structure in the regions, hospitals and central structures.  There are plans to increase the proportion of recurring expenditure directed to the country’s 703 communes, with active development of an operational local government system in 2011.

Joint monitoring visits took place in October 2009 to regional and local health facilities in 2 regions, involving Ministry officials, development partners (including Compact signatories and other donors) and civil society representatives.  Results were generally encouraging but the following needs were noted:

-        Solution to stock outages due to problems of financing mechanisms at national level

-        Ensuring technical support for health centre construction and a permanent water supply for all health centres

-        More timely reimbursement of free treatment kits to avoid destabilizing health centres’ finances

-        Installation of new VCT and PMTCT sites

-        Better articulation of referral of caesarean section cases from communes to Reference Centres for free surgery

-        Ensuring full initial supplies for Reference Centres, increasing surgery in those in regional capitals, and improving equipment maintenance

-        More support for setting up sustainable village funds to support community health associations (for health centre management)

-        Adequate information on legal requirements for local government commitments to their health centres to ensure effective decentralisation of grassroots health services

Future planning

It will be necessary to evaluate the SWAp funding mechanism in conjunction with work leading to PRODESS II to be proposed for 2011, and in parallel with implementation of Mali’s new Poverty Reduction strategydocument.  I will be reporting on these developments as well as on other news, but in the mean time, sign up, leave a comment, and let me know what you think. 

Violet Diallo is part of the IHP+Results team in Mali, working with Dr Mamadou Traore