2011年-世界发展银行全球_Private_Health_Sector_Assessment_in_Mali___The_Post-Bamako_Initiative_Reality_128页_1mb

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Private Health Sector Assessment in Mali Summary

Core Content

This report, Private Health Sector Assessment in Mali, provides a comprehensive analysis of the role and impact of the private health sector in Mali. It outlines the current state of the sector, identifies key challenges, and proposes strategies to enhance its contribution to public health objectives and strengthen public-private partnerships.

The assessment is part of a broader series by the World Bank Group aimed at improving the health policy framework, business environment, and investment climate in African countries. It was conducted with support from the Bill & Melinda Gates Foundation and in close consultation with the Ministry of Health and other stakeholders.

Main Components of the Health System

The private health sector in Mali includes:

Private Community and NGO-based Health Care: Community Health Associations (ASACOs) and Community Health Centers (CSCOMs) are a significant feature of the health system, with 990 CSCOMs established since the 1980s.
Private Commercial Health Care: Includes 250 medical and nursing practices and 80 hospitals, mostly concentrated in urban areas.
Pharmaceutical Sector: Dominated by private players, accounting for 80% of pharmaceutical turnover.
Health Insurance: All mutual insurance schemes are privately organized, with 128 approved programs.
Education: Private institutions contribute significantly to the training of health professionals, with 50% of TSS graduates and 90% of TS graduates coming from private schools.
Traditional Practitioners: Active in the health sector, organized under a federation.

Key Findings

Governance and Regulation

The private sector is not sufficiently involved in health policy-making and regulatory discussions.
There is a lack of inclusive forums for dialogue and consultation, which hampers the development of a more integrated and effective regulatory environment.
Regulatory texts need to be revised to ensure transparency, fairness, and inclusivity.

Private Medicine

The distribution of private health care is uneven, with a heavy concentration in Bamako, which limits market absorption and promotes an informal sector.
Communication between the public and private sectors is weak, limiting the integration of private services into public missions like education and vaccination.
Young medical professionals face challenges in starting their practices due to limited financial support and inadequate training for private and rural practice.

Rural and Community Health

Despite high coverage, CSCOMs suffer from low productivity, insufficient demand, and high costs, often relying on subsidies.
The current policy to strengthen CSCOM services does not fully address the demand gap.
Public health decisions, such as free health care, should incorporate the principle of cost recovery, which is essential for community health sustainability.
Strategies to improve rural health require support for physicians who choose to settle in CSCOMs.

Pharmaceuticals

The irregular distribution of pharmacies limits market absorption.
Training for pharmacists is inadequate, and the skills required to start and operate a pharmacy are not well taught.
Private wholesalers cover a significant portion of public entities' pharmaceutical needs, but the sector lacks regulatory oversight and clear guidelines.

Health Insurance

Private mutual insurance schemes cover only about 5% of the population by 2015, indicating a need for expansion.
A scale-up could begin with pilot regions and the creation of 100 new schemes to meet rural needs at an affordable cost (CFA F 300 per month).
Expanding mutual insurance would increase contact rates and activity volumes of CSCOMs and alleviate financial constraints on households.

Key Recommendations

Governance and Partnerships

Establish a public-private dialogue and consultation committee to improve collaboration and ensure private sector input in policy-making.
Create a public-private partnerships entity to formalize and support joint initiatives.
Assign technical advisers to handle private sector-related questions, enhancing coordination and expertise.

Regulatory Reforms

Tighten requirements for private school authorization to ensure quality and capacity.
Strengthen wholesaler licensing criteria to ensure valid and ethical practices.
Introduce zoning rules for physicians to ensure better geographic distribution.
Revise qualifying exams for health technicians to be more competitive and relevant.
Create a state monopoly for awarding health care diplomas to ensure standardization and quality.

Education and Training

Expand training capacity for physicians and pharmacists, particularly in private and rural settings.
Introduce continuous training programs for health professionals entering the private sector, focusing on management and practice skills.
Enhance educational modules for private and rural practice to better prepare professionals for the challenges they face.

Financial and Incentive Strategies

Improve access to funding during the start-up phase for private health providers.
Implement partial guarantees for bank funding up to 50% of the asset portfolio (CFA F 1 billion) to support new practices and pharmacies.
Introduce fiscal incentives for investments in less densely populated areas.
Consider pricing agreements among private practitioners participating in compulsory health insurance (AMO).

Conclusion

This assessment highlights the critical role of the private health sector in Mali and the need for a more integrated, supportive, and regulated environment. It emphasizes the importance of public-private dialogue, regulatory reform, and financial incentives to enhance the sector's contribution to public health objectives. The findings are particularly relevant for the development of the new Ten-Year Health and Social Development Plan (2012-21), providing a roadmap for improving the private health sector's performance and sustainability.

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