Coulibaly S O, Keita M
Institut national de recherche en santé publique, Bamako, Mali.
Sante. 1996 Nov-Dec;6(6):353-9.
From the results obtained regarding the financing of health care in Mali, we emphasize two important points. First, there is a lack of criteria for the distribution of finding in the health care sector, resulting in a waste of resources. Secondly, there is an absence of adequate pharmaceutical policies. The field studies led in 1987 provided the following observations. The rate of occupation of the beds is very low. Also, the numerous new investments are not yet put into service because of the lack of necessary equipment of qualified personnel. In addition, this does not consider the excessive investments occurring in certain localities where neither the rate of frequentation nor the economic conditions will ever allow the use of the capacity created. Among the possible solutions for the crisis of health care funding in Mali, the following should be priority: first, to fight against the complete lack of organization of the activities at the health care centers; secondly, to fight against the waste and misappropriation of money resulting from the behavior of the medical and paramedical personnel: and thirdly, to clarify the management of the resources coming from the charges for each service. The pharmaceutical policies adopted and implemented in recent years Largely contributed to, first, the creation of competition between essential generic medications and nongeneric medications that can be replaced, and then, the destruction of the public network of drug distribution. These conditions considerably limited the distribution of essential medications; yet, this is the only manner of reducing the pharmaceutical expenses and accordingly, allowing more funding for other medical services. As the distribution network is disorganized, the only alternative for the population to obtain the medications at the lowest price was to create centers of purchasing and distribution and to multiply the number of retailers of essential medications. Extensive work has been conducted in the health care sector in Mali, accompanied by concrete proposals allowing for improved functioning of the system. However, despite these improvements, these conclusions are rarely considered by the health policy makers. This is because behind the financial aspects of health services, there is an important political stake. Also, the governments of many countries, including Mali, had to resort to adjustment programs that reduce their maneuverability of economic policies in general, and of health care policies in particular. The sponsors "give" large sums of financial aid to the health care sector, but are not interested in the results. The promotion of the health care sector requires a courageous political will. In contrast, microeconomic studies allowed the creation of the first community health centers in Mali. These examples, now followed in many village throughout Mali, constitute the hope of the health care sector.
从关于马里医疗保健融资的结果中，我们强调两个要点。第一，医疗保健部门资金分配缺乏标准，导致资源浪费。第二，缺乏适当的药品政策。1987年进行的实地研究得出了以下观察结果。病床占用率非常低。此外，由于缺乏合格人员所需的必要设备，众多新投资尚未投入使用。此外，这没有考虑到某些地区出现的过度投资，这些地区的就诊率和经济状况都永远无法允许利用所创造的能力。在马里医疗保健资金危机的可能解决方案中，以下应列为优先事项：首先，应对医疗保健中心活动完全缺乏组织的情况；其次，应对医疗和准医疗人员行为导致的资金浪费和挪用；第三，明确每项服务收费所产生资源的管理。近年来通过并实施的药品政策在很大程度上首先导致了基本通用药品与可替代的非通用药品之间的竞争，进而破坏了公共药品分销网络。这些情况极大地限制了基本药品的分销；然而，这是降低药品费用并相应地为其他医疗服务提供更多资金的唯一方式。由于分销网络混乱，民众以最低价格获得药品的唯一选择是建立采购和分销中心，并增加基本药品零售商的数量。马里医疗保健部门已开展了大量工作，并提出了具体建议以改善该系统的运作。然而，尽管有这些改进，卫生政策制定者很少考虑这些结论。这是因为在卫生服务的财务方面背后，存在着重要的政治利害关系。此外，包括马里在内的许多国家的政府不得不诉诸调整方案，这总体上降低了它们经济政策的灵活性，特别是卫生保健政策的灵活性。资助者向医疗保健部门“提供”大量财政援助，但对结果不感兴趣。促进医疗保健部门需要勇敢无畏的政治意愿。相比之下，微观经济研究促成了马里首批社区卫生中心的建立。这些例子如今在马里的许多村庄得到效仿,构成了医疗保健部门的希望。
