Organizational Assessment Specialist/Health Systems Specialist,
High Impact Health Services II (HIHS), Mali
The High Impact Health Services II (HIHS) or in French, Services de Santé à Grand Impact (SSGI) project assists the Government of Mali’s Ministry of Health to improve select high impact health services and end preventable child and maternal deaths at the community level. The goal of the program is to assist Mali’s Ministry of Health by focusing on three critical health system components as they intersect at the community level – health service delivery, social and behavior change, and health system strengthening.
The large project is made up of a consortium of partners that brings together organizations with complementary strengths to achieve a common set of goals. Save the Children (SC) leads the consortium that includes Jhpiego, Marie Stopes International (MSIM), Management Systems International (MSI) and two local organizations –FENASCOM and Groupe Pivot Santé et Population (GP/SP) – a Malian National NGO.
The project is in its third year and will run through September 2018. The work will be carried out in Mali in the regions of Bamako, Koulikoro, Kayes, and Sikasso. No work will be carried out in the north.
For more information on the private health sector in Mali, see the 2011 World Bank Working Paper, Private Health Sector Assessment in Mali. https://openknowledge.worldbank.org/handle/10986/5944
In September 2016, staff from SSGI and FENASCOM, the national federation of community health associations, carried out a workshop with the Ministry of Health and Social Development to begin improving the use of mutual assistance agreements, known as Conventions d’Assistance Mutuelle (CAM). Under Mali’s decentralization policy, the private sector plays a prominent role in provision of health services. ASACOs (Community Health Associations), which are considered to be private-sector, sign a mutual assistance agreement with town councils, defining the modalities of the support to be provided to the community health centers (CSCOMs). The ASACOs own and manage the CSCOMs in association with the technical head of the health center. While Mali’s health system has been decentralized for several decades and CSCOMs have existed for as long, the application of CAMs remains unsatisfactory and enjoys limited support by the CSCOMs.
The objective of this short-term assignment is to develop a score card for assessing the utility and effectiveness of the CAMs. The score card is envisioned to demonstrate a set of scores for each CAM and through joint committees, be reviewed periodically by the municipalities and by the ASACOs, to make decisions to improve the implementation of the CAM and its planning objectives. Better implementation of the CAM may help to improve resources for CSCOMs, which end up being subsidized by the government as they cannot generate sufficient funds from service delivery. In addition, improved CAMs may allow for better management support of community health centers to provide services. A score card may also assist in strengthening the management, transparency and confidence between the two entities.
The workshop was a necessary first step to engage the MOH in the process and seek their input. The purpose of the workshop was as follows:
- Develop a CAM evaluation score card and a user guide for improving its application end strengthen the collaborative management of community health centers by community actors and improve the delivery of health services.
The consultant will develop a standardized score card that will be administered to the CAMs in all project regions. The consultant will review the two existing health capacity assessment tools previously developed under this project in order to ensure there is complementarity between the tools. The two different simplified diagnostic tools — one for ASACOs and one for the CSCOM — focus on capacity levels in key performance categories (leadership development, strategic planning, financial management, administration and governance, resource mobilization, personnel management, communications, knowledge management data sharing, etc.). These tools were developed through a participatory process and underwent a validation process with a group of stakeholders at the national level. It is anticipated that the CAM score card will undergo the same process.
As part of the preparation process for developing the ASACO and CSCOM tool, the MSI Institutional Development Framework (IDF) was reviewed and adapted. For developing the CAM score card, the consultant will be asked to review the IDF to bring forward any applicable categories.
- Review materials concerning the functioning of the CAMs as well as the ASACO, CSCOM, and the enabling community health environment, including modules to build ASACO and CSCOM performance.
- Review the ASACO and CSCOM capacity assessment tool and pull forward any key performance areas that are applicable to CAMs.
- Review the IDF to adapt key performance categories that may be appropriate.
- Lead a workshop that may include members of FENASCOM, FELASCOM, CSCOMs and ASACOs to further refine and validate the tools.
- Pre-test the tools in 2 workshops; region is to be determined.
- Adapt and finalize tools based on workshop findings.
- Draft and final score card tool
- Workshop to test the tool
- Validation workshop
Period of Performance and Location:
- October 15 through December 15, 2016
The majority of the work will be undertaken in Mali over a period of several weeks and possible multiple trips. However, preliminary review of documents and finalization may be carried out at a home base.
A five-day work week is anticipated while working in Mali.