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Analysis of the health sector-wide approach (SWAP) dynamics in Mali

par Laokri, Samia ;Dujardin, Bruno ;Paul, Elisabeth;Samake, Salif
Référence TM & IH. Tropical medicine and international health, 12, Supplement 1, page (116-117), O27-64
Publication Publié, 2007-05

Article révisé par les pairs

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Résumé :

Objectives: To analyse the dynamics of the Health SWAp in Mali. Methods: Questionnaire and semi-structured interviews with various stakeholders (totalling 42 national health executives and donor representatives in 2005 and 27 in 2006) on the SWAp dynamics: sector-wide policy, medium-term expenditure framework, performance monitoring, donor coordination, procedure harmonization, users consultation; as well as on the preliminary results obtained. Results: The main observations communicated by the actors are as follows: the sector-wide approach is officially accepted by all but it requires deep changes of behaviour and mind on the part of all stakeholders, both nationals and donor representatives. It also requires the acquisition of new skills (thematic and financial) within donor local representations and the ministry of health. Donor local representatives experiment constant tensions with their headquarters (financial control, procedures harmonization, aid predictability). The presence of a technical advisor involved in the political dialogue seems necessary. At the beginning of the SWAp, some transaction costs increase but stimulating results are quickly obtained. Vertical programmes and specific funds (global fund, GAVI, etc.) are important constraints. A challenge is to reinforce the central level while encouraging decentralization. Conclusion: In the Health SWAp in Mali, the definition and the official acceptance of a common sector-wide policy has been easily reached. A stakeholders analysis is necessary in order to better understand the main issues linked to the changes of roles and behaviours of the different stakeholders. The difficulty in harmonizing the administrative and financial procedures in order to reduce their constraints, and the difficulty in handling the main problems of the health sector (human resource management,quality of care) are two factors that risk to cause the demotivation of SWAp stakeholders.Study supported by a grant from the Belgian Co-operation Directorate through a research group (GRAP-SWAP) for Health Sector Wide Approach in Sub-Saharan Africa.