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					DONOR MAPPING USAID - Mali September 2001

Prepared by: Ellen Lynch & Ibrahim Diallo

PRIVATE VOLUNTARY ORGANIZATIONS (PVOs)

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Helen Keller International
PRINCIPAL CONTACT: Karen Z. Waltensperger Country Representative BP E 1557 Bamako, Mali Tel: (223) 21-52-93 Tel: (223) 21-08-21

Fax: (223) 21-52-94 E-mail: kzw@hkimali.org, hkimali@hkimali.org PROGRAM DESCRIPTION: Helen Keller International receives funding from a number of foundations to support its projects and activities in onchocerciasis, trachoma, nutrition and micronutrients. The Trachoma/School Health program receives funding from both the Gates Foundation and the Hilton Foundation. The full grant is channeled through headquarters and the amount Mali receives is determined yearly. The Micronutrient Initiative is in phase II and is funded by the International Development Research Center of Canada (IDRC). The onchocerciasis program is in phase II and is funded by the Nippon Foundation through HKI headquarters and Mali receives $70,000 per year. HKI also has a child survival grant through the Bureau of Humanitarian Response of USAID of $1,000,000 covering 10/1999 – 9/2003 in the cercles of Koulikoro, Kolokani, and Kati in the Region of Koulikoro. PROJECTS: Project Name: Start and End Dates: Location: Target population: Number of beneficiaries: Life of Project funding Funding by project area Project Objectives: Trachoma/School Health 1999 – 2004 Regions of Sikasso & Kayes (24 schools) Children 6-12 years old Unknown $130,000 for 2001 Unavailable

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Fight trachoma through community-based and school health activities in two regions

Key Indicators: 1. Prevalence rate of trachoma 2. Number of teachers trained 3. Number of people trained to operate on trachoma 4. Number of trachoma cases treated 5. Number of children screened 6. Trachoma IEC developed and delivered Description of activities: Train teachers about trachoma. Establish a screening system Establish treatment for identified cases. Implementation modalities: Organizations being supported: Local NGOs: AMAD, GADS, CRAD, PFIE, National Trachoma Prevention Program (PNLC), MOH, MOE Project Name: Start and End Dates: Location: Target population: Number of beneficiaries: Life of Project funding: Funding by project area: Onchocerciasis Programme Phase II 1/1999 – 9/2001 Regions of Sikasso, Koulikoro, & Kayes Rural communities Unknown $70,000 for 2001 Approximately: $17,200 Koulikoro $15,700 Kayes $15,700 Sikasso

Project Objectives: Fight onchocerciasis through IEC in three target regions. Key Indicators: 7,000 medicine distributors trained and functioning in 13 districts affected by onchocerciasis. Description of activities: Train medical doctors, health workers and distributors. Implementation modalities: Produce and broadcast IEC messages Training Organizations being supported:

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Ministry of Health PNLO, NGOs (Sight Savers International, Organisation pour la prevention cécité (OPC).

Project Name: Start and End Dates: Location: Target population: Number of beneficiaries:

Life of Project funding: Funding by project area: Project Objectives: Reduce the morbidity and mortality of mothers and children Key Indicators:
1. 2. 3. 4.

Micronutrient Initiative Phase II 4/2001 – 4/2003 National Breastfeeding and pregnant women, children 0-5 years 2,359,285 children under five 593,929 pregnant women 593,929 breastfeeding women $178,758 (2001) Unavailable

Provide Vit A to children 6 to 59 months and postpartum women Provide iron folate to pregnant women Proportion of health agents who give IEC/nutrition according to national directives. Proportion of pregnant women in targeted villages who receive and consume iron folate. 5. Proportion of children consuming food rich in vitamin A and children 6-24 months consuming foods rich in recommended nutrients in targeted villages. 6. Proportion of students in first form receiving training in nutrition according to national directives.

Description of activities: Distribution of micronutrients, reinforcing health agents knowledge, support and provide technical assistance for nutritional activities, reinforce the abilities of community radio agents to broadcast nutrition messages. Implementation modalities: Provide technical support Organizations being supported: REFACAN, Ministry of Health, MDSSPA, MEN, URTEL, Ministry of Industry, Ministry of Commerce, SCF school health program. FURTHER INFORMATION Participation in coordination activities: Comité National Santé Scolaire, Commission de la Santé à l’École, Comité National Lutte contre la Cécité, Regular meetings with PNLC, PNLO, the International Trachoma Initiative, and other NGOs working in blindness prevention; Coordination of nutritional activities with international institutions.

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Any studies conducted in the last three years that would be relevant to health sector activities (e.g. best practices, studies on care-seeking behavior) Objectives of three years of the School Health/Trachoma program. Programmatic strategies/direction for the future (w/dates) Phase II of the Oncho program will begin in January 2003 Expand regional micronutrient days.

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PLAN INTERNATIONAL
PRINCIPAL CONTACT Dr. Nouhoum Koita Program Support Manager BP 1589 Bamako, MALI E-mail: KOITAN@PLAN.GEIS.COM Tel: (223) 22-40-40 (223) 23-05-83 Fax: (223) 22-81-43

PROGRAM DESCRIPTION PLAN International is located in Kangaba, Banamba, Kita Kourou and Kati. PLAN works in five domains one of which is “Growing Up Healthy”. Problems identified by PLAN are the high infant and under 5 mortality rates, which occur due to preventable diseases, high fertility and maternal mortality rates, inadequate mother and child healthcare services, high malnutrition rates. Also of concern are the rising HIV (AIDS) and sexually transmitted disease rates and the widespread practice of female excision (circumcision). Steps being taken by PLAN to address these issues are to increase immunization coverage, improve mother and child healthcare services, promote and provide access to modern contraceptives, increase condom use, reduce the excision (circumcision) rate amongst girls and reduce the prevalence of sexually transmitted diseases. Official programs conducted by PLAN are: Community Based Health Care, Child Survival and Development, and Reproductive Health, including Family Planning, Female Genital Mutilation prevention, and STD/AIDS prevention. PROJECTS Project Name: Start and End Dates: Location: Reproductive Health July 2000 – June 2005 Bamako, Kayes, Koulikoro, Sikasso, Segou, Mopti, Gao, Kidal and Tumbuctu (Not currently in Gao, Tumbuctu, Kidal) Youth (0 – 25 y.o.), women of reproductive age (15 – 49 y.o.), men, community leaders, excision practitioners in program intervention areas. Unavailable $5,505,630 Unavailable

Target population:

Number of beneficiaries: Life of Project funding: Funding by project area: Project Objectives:

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By the end of FY2005 the RH project will: 1. Increase the capacity of girls and boys 10-18 years old to adopt safe reproductive health behavior including delay of first sexual intercourse and negotiation of safe sexual relations including condom use for HIV/AIDS prevention. 2. Promote positive behavior and coping mechanisms including counseling, social and psychological support and referral for medical care of people affected/infected with HIV/AIDS in the program areas. 3. Increase the percentage of mothers of childbearing age who are currently using a modern family planning method from 10% to 15% in program intervention areas. 4. Reduce the percentage of girls (0-4years old) excised in PLAN communities from 41% to 38%. Key Indicators: % of girls and boys (15-19 years old) who report having their first intercourse at age 15. % of girls and boys (15-19 years old) reporting condom use for STD/AIDS prevention. Number of specialized center providing counseling, care and psychological support to people affected/infected with STD/HIV/AIDS in the program areas. % of mothers of childbearing age in program areas who are currently using a modern family planning method. % of girls (0-4 years old) excised in program areas. Description of activities: Promotion of behavior change communication messages aimed at reducing the risk of HIV/STI infection, reducing the discrimination and stigma felt by those infected and affected by HIV/AIDS. Implementation of a HIV/AIDS prevention program through 19-22 local NGOS, public and community health centers and youth associations. Promote services that provide care and support for people affected or infected with AIDS and FGM. Conduct research to develop baselines, test approaches and measure progress. Implementation modalities: Implementation of safe behavior change communication through NGOs and other partners. Organizations being supported: Government (PNLS, CNIECS, Division Centre Familiale), private specialized institutions (MACRO International - contracted to do baseline study), communitybased organizations, specialized institutions, and Malian NGOs. PLAN International collaborating NGOs: Centre Djoliba, ASDAP, AMPE, Baara Nyuman, JIGI, AMACO, COFESFA, ARAFD, GAD, ASD/DJEKAFO, APROFEM, DANAYA-SO, Kenedougou Solidarite, AID/MALI, ADAC, JAM SAHEL, AFAD, GAAS-MALI, ERAD, AMAS/VIH/SIDA, Groupe PIVOT, ACA

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Project Name: Start and End Dates: Location: Target population:

Number of beneficiaries: Life of Project funding: Funding by project area: Project Objectives: By the end of FY2005 the RH project will: 1. Increase the percentage of children aged 12 –23 months in PLAN communities who are fully immunized from 38% to 60%. 2. Reduce malaria morbidity among children under 5 from 30% to 26% in PLAN communities. 3. Increase the percentage of mothers with children under 5 years in PLAN communities who manage diarrhea with ORT from 10% to 27%. 4. Reduce moderate and severe malnutrition among children under 5 in PLAN communities from 12% to 7%. Key Indicators: 1. % of children 12 –23 months in PLAN communities who are fully immunized. 2. % of malaria morbidity among children under five. 3. % of mothers with children under 5 years in PLAN communities who manage diarrhea with ORT. 4. % of moderate and severe malnutrition of children under five years. Description of activities: Implementation modalities: Integrated IEC sessions by NGOs Organizations being supported: CENIECS, Division Centre Familiale, Private institutions for IEC development, Centre National d’Immunisation (social mobilization).

Child Survival and Development July 2000 – June 2005 Bamako, Kati, Banamba, Kangaba, Kita Children 0-5 years old in Banamba, Kangaba, Kati, Kita. Unavailable $2,062,590 Unavailable

Project Name: Start and End Dates: Location: Target population: Number of beneficiaries: Life of Project funding: Funding by project area:

Potable Water, Hygiene and Sanitation July 2000 – June 2005 Kati, Banamba, Kangaba, Kita-Kurou Families in PLAN project areas of Banamba, Kangaba, Kati, Kita. Unavailable $2,848,424 Unavailable

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Project Objectives: 1. Increasing access to potable water within 500 meters of households from 75% to 85%, through open well construction and improvement. 2. Increase the use of adequate basic sanitation facilities from 47% to 57% through construction and promotion of improved school and domestic latrines. 3. Promote appropriate hygiene and sanitation practices through behavior change communication. Key Indicators: 1. % of families with access to a source of potable water within 500 meters all year round. 2. % of families with access to adequate sanitation facilities. 3. % of families who adopt good hygiene practices. Description of activities: Implementation modalities: Collaboration with local NGOs, community based organizations and district health staff. Organizations being supported: CENIECS, MACRO International (contracted to do baseline study FURTHER INFORMATION Participation in coordination activities: PLAN International is a member of the Committee de Coordination des activities des ONG (CCAONG), Groupe PIVOT Santé, and participates in National Immunization Days with the MOH for all PLAN communities. Programmatic strategies/direction for the future (w/dates) PLAN International is at the beginning of a 15-year country plan 2000 – 2015.

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SAVE THE CHILDREN FUND
PRINCIPAL CONTACT Lynn Lederer, Director Tel: (223) 22-61-34 BP 3105 Tel: (223) 22-48-99 Bamako, Mali Fax: (223) 22-08-08 E-mail: savesahel@afribone.net.ml llfamily@spider.toolnet.org

PROGRAM DESCRIPTION Save the Children is funded by USAID BAMAKO but is also independently funded through their children sponsorship program and through grants from foundations and other institutions. Save the Children opened their office in Mali in 1987 in Kolondièba with a sponsorship program for 8,000 children. This is a $1,000,000/year program that provides support in education, health, and economic opportunity projects such as micro-credit to women and market gardens. The sponsorship program has no end date. In addition, SCF Mali began a Safe Motherhood program in 2001 through a global initiative supported by Columbia University, which supports Save the Children activities in Mali and Viet Nam. The objectives of this program are to increase the capacity of referral hospitals in Yanfolila and Bougouni to deal with obstetrical emergencies. PROJECTS Project name: Safe Motherhood: Improving Emergency Obstetric Care in the Bougouni and Yanfolila Districts of Mali 3/2001 – 3/2004 Bougouni and Yanfolila Districts Women of reproductive age 91,300 WRA, 435,000 total population $675,000 Unavailable

Start and end dates: Location: Target population: Number of beneficiaries: Life of project funding Funding by project area Project Objectives: 1. To improve quality of services 2. To improve health information system 3. To improve the system of referrals Key indicators: 1. Availability of EMOC services 2. Utilization of EMOC services 3. Quality of EMOC services provided

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Description of activities: 1. Improve technical skills of health service providers to accurately manage obstetric complications. 2. Decrease response time to manage obstetrical emergencies. 3. Ensure the availability of essential equipment at CSRef Yanfolila and Bougouni 4. Establish and maintain blood banks at the 2 CSRefs to ensure regular availability of blood for transfusion on site. 5. Ensure immediate availability of emergency pharmaceutical supplies at both CSRefs. 6. Improve SCRef infrastructure by selected renovations. 7. Develop a system of record keeping that is useful to both staff of the CSRefs and the Safer Motherhood Project. 8. Improve CHW ability (CSCom level) to accurately recognize and refer obstetric emergencies quickly to the CSRefs. 9. Facilitate faster evacuation of patients with obstetric emergencies to the CSRefs through provision of ambulances and training drivers. 10. Encourage communities to send women with obstetric complications quickly to the CSRef through radio communications. Implementation modalities: Training of all staff at both the CSRef and the CSCom levels in obstetric emergency care. Provide to all professional staff a client-centered, interpersonal workshop. Improve communication by using two way radios. Provide motorcycles to CSRefs to be used by on-call staff. Provision of obstetric equipment. Establish a blood bank. Purchase necessary equipment. Develop list of necessary medication to be acquired from the MOH. Purchase two 4*4 ambulances. Organizations being supported: CSRef in Bougouni and Yanfolila Districts. OTHER NON-USAID FUNDED ACTIVITIES SCF – Mali is funded through Johns Hopkins University and USAID Washington for a one year study of $150,000 in the Bougouni district to evaluate the impact of IMCI treatment counseling guidelines on the number of sick children seen at Community Health centers and/or obtaining drugs from community drug kits that complete a full course of antimicrobial treatment at home. Saving Newborn Lives -- Gates Foundation grant to Save the Children USA, implemented in 6 countries around the world. Five-year beginning funding with ten year expected duration of project. Mali is one of the six countries, which will implement this project. The action plan for this project will be developed in midNovember 2001.

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CDC – Malaria – Together with Johns Hopkins University, awarded a $450,000 (total) -- three year funding (beginning 1 October 2001) to implement activities in Bougouni, Yanfolila, and Kolondièba. Activities will include promoting treated bednet use (modeled on existing work with women’s associations in Bougouni), installing “caisses pharmaceutiques”, upgrading skills of ICPMs in treating severe cases of malaria, using positive deviance to promote behavior change. FURTHER INFORMATION Participation in coordination activities: Yes, through Groupe Pivot Santé Population Any studies conducted in the last three years that would be relevant to health sector activities (e.g. best practices, studies on care-seeking behavior) Joint coordination of USAID best practices workshop in January 2001. Ongoing positive deviance study; Johns Hopkins Anti-microbial Resistance Study. Programmatic strategies/direction for the future (w/dates) SCF intends to scale up efforts in IEC for malaria and treated bed nets, pharmaceutical boxes in villages and HIV/AIDS prevention activities.

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SNV
PRINCIPAL CONTACTS Evert Kamphorst Counseiller Technique Sr. Santé Publique Dramane Dao Conseiller technique gestion / planification BP 05 Koulikoro, Mali E-mail: apss@afribone.net.ml PROGRAM DESCRIPTION The Netherlands Development Organization, SNV, began working in Mali in the health sector in 1979 with primary health care initiatives at the district level. In 1988, they began to work at the regional level. Currently their health project is attached to the Regional Health Division where they provide technical support and do not implement any project. PROJECTS Project Name: Start and End Dates: Location: Target population: Number of beneficiaries: Life of Project funding: Programme renforcement de capacité des acteurs de PRODESS 1/2001 – 12/2004 Koulikoro, Gao Population of target areas Unavailable CFA 1,000,000,000 of which SNV contributes 40% and the MOH contributes 60% Not available Tel: (223) 26 23 28 Fax: (223)26 20 78

Funding by project area: Project Objectives: Develop institutional reinforcement with the goal of increasing the coordination of organizations working in the health sector. Key Indicators: Difficult to determine impact of technical support. Description of activities: Planning Monitoring & Evaluation Supervision at district level Develop supervision methodologies Examine the quality of health care services and utilization rates Financial management support of Regional Level and district teams. Develop reference systems in health districts

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Implementation modalities: Through the Regional government health offices Organizations being supported: Ministry of Health FURTHER INFORMATION Participation in coordination activities Groupe PIVOT Regional quarterly meetings Any studies conducted in the last three years that would be relevant to health sector activities (e.g. best practices, studies on care-seeking behavior) 1998 – Evaluation of the performance of the reference system from district to regional level facilities. Programmatic strategies/direction for the future (w/dates) Preparing a study on the users of the reference system in Koulikoro.

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CHALLENGES AND GAPS TO HEALTH SECTOR DEVELOPMENT AND POSSIBLE SOLUTIONS

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CHALLENGES AND GAPS TO THE HEALTH SECTOR DEVELOPMENT AND POSSIBLE SOLUTIONS Organizations interviewed pointed gaps, challenges for the development of the health sector in Mali. Specific areas concerned with those gaps are:  human resources,  training and education,  planning, implementation and monitoring,  nutrition,  donor coordination,  funding procedures,  coordination of HIV/AIDS activities,  infrastructure and equipment, Interviewees were invited to propose possible solutions. This section summarizes the opinions expressed during the interviews and do not necessarily reflect the position of the USAID Mali mission on the points under discussion. Gaps and challenges
Human Resources: In the health sector the principal problem is the low capacity of human resources at all level. There is a lack of technically qualified personnel compounded by high turnover. The career structure of the health sector is weak with very low salaries. There is a need for more human resources at the community level. There is need for specialized health service providers. The structure of the Health sector does not provide incentives to do a better job or to attract better personnel. The salary structure is unrealistically low, which increase the problem of insufficient staff levels throughout the sector. There is a reluctance to identify performance targets and implement standards. In January 2001, 228 existing CSCOM were not functioning due to a lack of personnel. There are weaknesses in number and in skills of technical/management staff; lack of motivation at the national level, lack of real political commitment and/or follow-through; and weak institutional capacity. Training and Education: The training content is outdated, trainers for medical and nursing staff are few, and there is an enormous attrition of first year medical students. Paramedical and nursing school’s training capacity is limited. Medical doctors too need to receive refresher training. The main problem lies in the education sector. The quality of education in Mali is low at all levels.

Possible Solutions
Human resources management reform in order to install a professional career structure, provide for incentives, supervision, and a salary structure that will attract Mali’s brightest students to the health field. Other possible solutions include addressing the management culture and clarifying job descriptions, increasing accountability and providing for rewards for good performance and sanctions for poor performance. The government needs to support both the public and private system in order to meet the needs for technically competent personnel. Additional resources from HIPC funds should be used in priority to recruit more personnel, especially for the operational level of the health pyramid.

Improve the quality of the medical staff through improved curricula. At the policy level, improve the situation in terms of recruitment and reinforcement of both public and private schools. To improve on the gaps identified, Mali should increase the training capacity of the schools at all levels.

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Planning, Implementation and Monitoring: The yearly planning/ budgeting/ funding implementation cycle is extremely cumbersome. Several months of each year are eaten up just in planning alone; by the time funds arrive, at least 1/3 of the year is gone. Then, before you know it, it's time to start reviewing and planning for the next year, so you "lose" several more months. There is a gap between the national and operational level, consequently the results aren’t apparent at the implementation level. The planning process is overly optimistic, not based on realistic parameters, e.g. the peripheral/district levels develop plans without adequate information about available resources, leading to unrealistic plans/budgets that in the final phase are being cut at central level without much consultation. There is also a lack of a feedback loop from the National level to the regional and district level. Geographically, the North is marginalized. There has been a lack of result oriented evaluation of Annual Action Plans at national and local levels to help the country move forward in a strategic manner and a well-coordinated way. Almost all the gaps are well known and often plan to address them are drawn, but there is no follow-up. The governmental system isn’t well integrated with the private and traditional approach. The implication of all the partners is missing, but this is improving under PRODESS facing communities’ inability to become self-financing. The community health centers lack the management capacity to plan and coordinate effectively. Projects are implemented sporadically and have no follow through such as the “one NGO one community” initiative. There is a lack of coordination of the national health plan. PRODESS allows for participation of all parties and there are plenty of financial resources but there is a gap in human resources for monitoring and evaluation of the programs. On a positive note the PRODESS allows for the organization and coordination of the entire health sector. However, there is a gap between what is on paper and what has been implemented. Certain points were underestimated in what they would require in terms of resources such as an effective monitoring and evaluation system. There is no sufficient link between rural development, health, and economic growth. The recent joint supervision of the system led by the World Bank showed that the system is not addressing the needs of the poor. There is a lack of resources throughout the system coupled with a weak economy and weak education system. This affects the

Reinforce the planning capacity and encourage realistic planning that is tied to the availability of resources. Planning has to be much more realistic and guided by clear priorities.

Local solutions to health problems need to be identified by the communities; and the resources and responses must be made available at this level.

Improve the management capacity of the health sector at all levels. Decrease the steps required to implement a project. The management structure must be improved to allow for sanctions for negligence and reward for initiative. Monitor progress of implementation at the district level. Strengthen coordination at the regional level. The supervision must be reinforced/ strengthened at all levels; a culture of accountability must be created and maintained at all levels.

We should work at increasing the quality of the health centers to garner support for the system. Decentralization can help to solve these problems by bringing the resources to the community level, establishing a system for training and supervision, and placing the responsibility of the populations for their health at the community level. The achievements of the health sector are dependent on ability of individuals to take responsibility for the health system and for their own individual health status. The role of decentralization is very important in the sense that population at local levels will be responsible for their own health.

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quality of care, resulting in utilization rates that are lower than anticipated. Beneficiaries (in particular women and youth) are insufficiently involved in the management of the services. Nutrition: The Division of Food Security (Division de Suivi de la Situation Alimentaire et Nutritionnelle) in the MOH is charged with the follow-up of the plan of action that has not been ratified. Mali has not yet ratified the National Action Plan for Nutrition developed following the International Conference on Nutrition in 1992. At this point, an assessment of the current situation is required to update the Plan. This division was intended to be a bridge to the other ministries but it has not been able to make those necessary and important connections as wished. The Division team does not have the political clout needed to carry out the Action Plan and assemble the resources needed to build a team that can coordinate between ministries and technical disciplines. Also, there is a lack of nutritionist in the MOH even though scholarships for nutrition from WHO have been offered. Many children miss the second dose of Vit A. Coordination of HIV/AIDS activities: UNAIDS has taken a strong role in coordinating HIV/AIDS activities in Mali which has resulted in the PNLS not taking a strong ownership of its coordination role. Technically, there are currently many gaps in HIV/AIDS prevention services. Few laboratories are able to provide testing and the availability of voluntary counseling and testing centers is very limited. Funding Procedures: Money is not the problem, but there is a gap in the ability to move funding through the health system which is very slow in justifying expenses and receiving the next transfer of funds. CSCOMs lack funding and resources; the lack of both human resources and equipment is a major challenge in Mali. It is unrealistic to think the CSComs can function well without outside support. The disbursement rate for IDA credit is approx. 9% after 2.5 years of implementation. The DAF was slow to become active and less than 50% of what was planned for 2000 had been implemented (32,000,000,000 FCFA planned (programme opérationnel 2000: Jan 2000) by the regions and 8,000,000,000 realized (rapport d’activités 2000: jan 2001). The procedure is clumsy and time-consuming resulting in frequent blockages of the flow of funds. Infrastructure and Equipment: There is a need for more equipment at the community level. The accessibility of care to the population is challenged by gaps in services, uneven quality of services where they do exist and the distance between

Ratification of the Action Plan would assist in building the needed communication bridges between ministries by investing more power in the Division of Food Security and to raise funds for nutrition more easily.

The nutritional activities under the decentralization plan must be organized and implemented.

Address this gap by expanding regional micronutrient days to all regions.

Increase PNLS capacity to coordinate HIV/AIDS activities. Establish a common vision between all parties on how to fight AIDS in Mali.

Improve the coordination of foreign assistance, especially given that close to 85% of the budget for development comes from external sources.

These barriers can be lifted through improvement and updating equipment, construction and equipment of community health centers, training personnel, increasing

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the population and availability of health services There is little capacity for blood donation and screening.

the efficiency of the referral system, and increasing the availability of health insurance to help cover emergency expenses and above all equip schools with potable water. Improved sanitation at the village level would do much to improve the Malians health status. The donors should attempt to increase their understanding of the reality of Mali through improved discussions with DAF and PNLS. Donor coordination meetings could be more targeted towards accomplishing specific goals. Perhaps the finalization of the donor mapping could be done through this mechanism. Improved coordination among the donors to target the identified problems. Decrease the number of meetings and training each donor is offering. Donors need to have a better coordination and clear objectives.

Donor Coordination: The steps required to implement a health program are complicated by the donor negotiations with the DAF. Donors must also improve the coordination of their activities among themselves.

Donors often are late in deciding and communicating the available resources. The coordination of the implementing partners by the Ministry of Health needs strengthening. At the national level there is a lack of data on activities implemented by partners, and the MOH does not hold regular coordination meetings. There is a lack of harmony in procedures, e.g. DAF staffs are being trained in separate specific donor reporting systems which are unnecessarily increasing the workload thereby demanding additional capacity in a situation where there is already an existing gap of technical people at the national and regional levels. Many programs are still donor driven and occur outside of the planning process. Donor agencies have a tendency to push their own agendas rather than buy into the national plan of action. Along with this, the MOH has developed bilateral relationships with donors and does not favor straining these connections. These forces can sometimes work against the ability to coordinate activities at national level such as AIDS activities.

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PARTNERS AND RESPECTIVE AREAS OF INTERVENTION TECHNICAL FOCUS AREAS PARTNERS Nutrition Bilateral Belgium Canada Coop Franç. Coop.Swiss EU Dutch* GTZ USAID
UN Agencies

Immuniz ation X

Maternal Health X X X X X X X X X

Malaria

Diarrheal disease X

ARI

FP/RH

HIV/ AIDS X X X X X X X X X X X

IMCI

IEC/ BCC X X X X X X X X

Systems

Other

X

X X X X X

X

X X X X X X X

X

X X X X X

X X X X

X X X

X X X

X X X

X X X X X X X X X

X

UNAIDS UNICEF UNDP UNFPA World Bank WFP WHO FAO PVO HKI Plan Int’l SCF SNV

X

X

X X X

X

X X

X

X X X X

X X X X X X

X

X

X

X

X

X

X

X

X X X

X X X

X X X

X X X

X X

X X

X X

X X

X X X

X X X X

X

*

Funds to all PRODESS technical areas

APPENDIX: DONOR SURVEY DATA COLLECTION GUIDE
1. 2. Name, address and telephone, main contact and person interviewed (if different). Program Description: Project Name: Start and End Dates: Location: Target population: Number of beneficiaries: Life of Project funding Funding by project area Project Objectives: Key Indicators: Description of activities: Implementation modalities: Organizations being supported (e.g. MOH, local NGOs, other organizations): Participation in donor coordination activities/ or Participate in coordination activities (for PVO) Any perceived technical/programmatic gaps on a national level Challenges or roadblocks to health sector development and improvement of health status in Mali and possible solutions to overcoming the challenges. Any studies conducted in the last three years that would be relevant to health sector activities (e.g. best practices, studies on care-seeking behavior) Programmatic strategies/direction for the future (w/dates)

3.

4. 5. 6.

7.

TECHNICAL FOCUS AREAS PARTNERS Bilateral Belgium Canada Coop Franç. Coop.Swiss EU Dutch GTZ USAID
UN Agencies

Nutrition

Immuniz ation

Maternal Health

Malaria

Diarrheal disease

ARI

FP/RH

HIV/ AIDS

IMCI

IEC/ BCC

Systems

UNAIDS UNICEF UNDP UNFPA World Bank WFP WHO FAO PVO HKI Plan Int’l SCF SNV

P.S.: In case you have interventions in other technical areas not listed, please add them

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