Mali health system
Mali’s health system is made up of all the public (state and local authority), private, community (association, mutual society and foundation) and religious facilities and bodies, and professional organisations for health workers, whose activities contribute to the implementation of the national health policy.
It is organised in a pyramid structure, with decentralised governance of the community health centres and the referral health centres/district hospitals.
The public health sector comprises:
- 7 tertiary referral public hospitals/university hospitals at the central level
- 8 secondary referral public hospitals at the intermediate level
- 65 referral health centres and 1,404 community health centres at the operational level.
Institutional responsibilities are organised on three levels:
- The national administration is responsible for the overarching strategy, defining the roadmap and making investment and operational decisions;
- The regions provide technical support to the local level; and
- Health districts are the operational unit, responsible for planning health development, budgeting and management at the local level.
The national administration also defines the efficiency, equity and sustainability requirements; oversees the application of the relevant rules and standards; and mobilises public resources, technical and financial partners (TFPs) and the private sector to fund quality care that is accessible to all.
Authorised private sector facilities in Mali include medical, paramedical and pharmaceutical facilities. There are 1,679 for-profit private facilities, more than half of which are based in Bamako. There are also semi public facilities, including 20 intercompany medical centres, 60 military infirmaries and 34 faith-based facilities. In terms of pharmaceutical facilities, there are 567 private pharmacies, 14 medical analysis laboratories, 64 import and wholesale facilities and 3 pharmaceutical manufacturers. There are 16 private laboratories. In total, for-profit facilities account for 24% of points of contact between patients and health care facilities.
The for-profit private sector is still inadequately involved in the implementation of health programs. Partnerships with private sector actors, including professional associations of health workers, need to be strengthened. In late 2020, the Global Fund commissioned a robust evaluation of the sector. The main findings of this evaluation were:
- Linkages between the private sector and the public sector are weak, which hinders the former’s participation in public health initiatives.
- Cases are not routinely confirmed using biological testing due to the unavailability of free RDTs.
- Protocols are not followed.
- Private sector data reporting is weak.
Following this analysis, the National Malaria Control Programme launched an initiative to integrate and involve the private sector in the national policy by including its members in training programs and engaging the private sector in the workshop to revise the guidelines.