Strengthening the Decentralized Health System in Mali-PRSSD

Intermediate outcomes no. 1) Improved management of health care services by key players (ASACO, local authorities and decentralized health facilities) no. 2) Improved quality of social and health care services provided to the populations of the three regions, especially women and children 3) Increased use of preventive and curative health care services by the populations of the three regions, especially women and children.

For outcome 1: The Kayes region made the most progress with respect to the community health centre capital maintenance index (81% of the ComHCs in 2016 had an index equal to or greater than 1, versus 54% in 2009), whereas maintenance is seen in 100% of the ComHCs for the three districts of Ségou and a deterioration in some ComHCs of the three intervention districts of Sikasso resulting in 78% of the ComHCs in 2016 having an index equal to or greater than 1, versus 86% in 2013. For the referral health centres in the three regions: 100% had a capital maintenance index equal to or greater than 1 at the start of the PRSSD and maintained that index. Regarding the signing of mutual assistance agreements (77% in 2009 to 96% in 2016), again, it was the Kayes region that made the most progress since 2009. It is worth mentioning that in Ségou, 100% of the agreements were already signed in 2013, and that percentage remained unchanged until 2016; whereas for Sikasso, it went from 99% to 100%. Outcome 2: The Penta 3 rate stagnated in all three regions, but in 2016, the rate was 92% for Kayes, 87% for Ségou, and 93% for Sikasso, while the national target was 95%. With rates like these, it gets harder to see them evolve. Among the measures likely to change this situation, it is clear that mobilization efforts must be continued, vaccine interruptions prevented, and the advanced strategy carried out to reach communities that are far from ComHCs. The PNC3 rate seems to have deteriorated in all three regions between 2015 and 2016. This variance is mainly explained by the change in the calculation method. Initially, and until 2015, this calculation was done based on the PNC3 (3 consultations); since 2016, this calculation is done with the PNC4 (4 consultations). Moreover, none of the three regions will have reached the 70% target. This could be explained by the interruption of certain inputs, including insecticide-treated mosquito nets, the instability of qualified staff in the outlying facilities, and potentially the low quality of prenatal care. As such, a study on the quality of the PNC refocused in the Macina Health District (Ségou) confirmed this low quality of PNC in the health facilities. Outcome 3: The curative consultation rate among children under 5 changed in the three regions and reached the target forecast in 2017. In addition, the assisted childbirth rate in Kayes was up and down, dropping from 58% to 51% between 2009 and 2016. It dropped in Ségou between 2013 and 2016 (64% to 47%), and rose from 67% to 69% in Sikasso, where a great deal of effort was made to obtain all the data. In fact, one of the findings in all the regions is the difficulty of obtaining all the data for assisted childbirths with the proliferation of private consultation clinics over the years.