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Ridde V, Coulibaly A, Touré L, Ba MF, Zinszer K, Bonnet E, Honda A. Financial issues in times of a COVID-19 pandemic in a tertiary hospital in Mali. Int J Health Plann Manage 2023; 38:1676-1693. [PMID: 37507357 DOI: 10.1002/hpm.3690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/28/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND This study examines how the functioning of healthcare providers during the COVID-19 pandemic was affected by the government financing response, which was shaped by existing healthcare financing systems. METHODS The study applied a single case study design at a tertiary hospital in Bamako during the 1st and 2nd waves of the COVID-19 pandemic. Data were gathered through 51 in-depth interviews with hospital staff, participatory observation, and reviewing media articles and hospital financial records. RESULTS The study revealed the disruptions experienced by hospital managers, human resources for health and patients in Mali during the early stages of the pandemic. While the government aimed to support universal access to COVID-19-related services, efforts were undermined by issues associated with complex public financing management procedures. The hospital experienced long delays in transferring government funds. The hospital suffered a decrease in revenue during the early stages of the pandemic. Government budgets were not effectively used because of complex, non-agile procedures that could not adapt to the emergency. The challenges faced by the hospitals led to the delays in the staff payments of salaries and promised bonuses, which created potential for unfair treatment of patients. Excluding some COVID-19 related items from the government funded benefit package created a financial burden on people receiving services. The managerial challenges experienced in the study hospital during the first wave continued in the second wave. CONCLUSIONS Pre-existent issues in healthcare financing and governance constrained the effective management of COVID-19-related services and created confusion at the front line of healthcare service delivery.
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Affiliation(s)
- Valéry Ridde
- UMR 196, CEPED, The French National Research Institute for Sustainable (IRD), Université Paris Cité, Paris, France
- Institut de Santé et Développement (ISED), Université Cheikh Anta Diop, Dakar, Senegal
| | - Abdourahmane Coulibaly
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies, Bamako, Mali
| | | | - Mouhamadou Faly Ba
- Institut de Santé et Développement (ISED), Université Cheikh Anta Diop, Dakar, Senegal
| | - Kate Zinszer
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche en santé publique (CRePS), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Emmanuel Bonnet
- UMR 215 Prodig, French National Research Institute for Sustainable (IRD), Aubervilliers, France
| | - Ayako Honda
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, Tokyo, Japan
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Coulibaly A, Chabrol F, Touré L, Hou R, Dramé BSI, Zinszer K, Ridde V. Responses to Hospital Restrictions on Family Visits during the COVID-19 Epidemic in Mali and France. Health Syst Reform 2023; 9:2241188. [PMID: 37676093 DOI: 10.1080/23288604.2023.2241188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 07/15/2023] [Accepted: 07/22/2023] [Indexed: 09/08/2023] Open
Abstract
Few studies have focused on the presence of families in the hospital in the context of an epidemic. The present study aims to contribute to filling this gap by answering the following question: How did professionals, patients and their families cope with more or less drastic restrictions to family visits and presence during the COVID-19 pandemic in a French and a Malian hospital during the COVID-19 pandemic? Data were collected during the first two waves of the pandemic through 111 semi-structured interviews (France = 55, Mali = 56). Most of the interviews were conducted with staff (n = 103), but also with families in the case of Mali (n = 8). The investigators also conducted 150 days of field observations, 44 in France and 106 in Mali. Thematic analysis was applied using an inductive approach. Interviews were content analyzed to identify passages in the interviews that were relevant to these different themes. The study highlighted the difficulty for the medical-clinical system to provide appropriate responses to the many emotional needs of patients in a pandemic context. Families in France benefited from a support service to reduce stress, while in Mali, no initiative was taken in this sense. In both countries, families often used the telephone as an alternative means of communicating with relatives. The results showed that in the two contexts, the presence and involvement of the families contributed to a better response to the patients' psycho-affective demands and thus promoted resilience in this field.
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Affiliation(s)
- Abdourahmane Coulibaly
- Faculté de Médecine et d'Odontostomatologie, Bamako, Mali, IRL 3189 "Environnement, Santé, Sociétés," Agence de recherche MISELI, Bamako, Mali
| | - Fanny Chabrol
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
| | | | - Renyou Hou
- Laboratoire d'ethnologie et de sociologie comparative (LESC), Université Paris Nanterre, CNRS, Nanterre, France
| | | | - Kate Zinszer
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
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Lerosier T, Touré L, Diabaté S, Diarra Y, Ridde V. Minimal resilience and insurgent conflict: qualitative analysis of the resilience process in six primary health centres in central Mali. BMJ Glob Health 2023; 7:e010683. [PMID: 37185362 PMCID: PMC10580275 DOI: 10.1136/bmjgh-2022-010683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND In the context of universal health coverage in the Sahel, the study focuses on primary health centres and the difficulties of their implementation in the context of insurgency conflicts in central Mali. METHODS This is qualitative research through a multiple case study. We selected six health centres according to a reasoned choice to bring together contrasting situations. We conducted 96 semistructured interviews and consulted secondary quantitative data on attendance. By focusing on community health centres, the conceptual approach focuses on the process of resilience that unfolds in a dual context of chronic health system dysfunctions and armed conflict. RESULTS The resilience strategies deployed by health professionals were relatively basic and uncoordinated. In the end, it was the individuals who showed absorption. However, their room for manoeuvre was limited. In the most isolated health centres, resilience was based on subordinate, poorly trained staff, often from the locality. Degraded working conditions and fear caused a form of resignation among health workers. CONCLUSION The strategies and resources used showed a form of minimal resilience. This form is unfolding in a context marked by two structuring features. On the one hand, the Malian health system was relatively dysfunctional before the crisis, and on the other hand, the type of conflict was relatively low intensity that allowed health centres to remain open.
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Affiliation(s)
| | | | | | | | - Valery Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Senegal
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Bonnet E, Lerosier T, Touré L, Diarra Y, Diabaté S, Diarra D, Ridde V. Evolution of assisted deliveries at primary healthcare centres in an unstable security context in Mali. BMJ Glob Health 2023; 7:bmjgh-2022-010811. [PMID: 36863725 PMCID: PMC10175949 DOI: 10.1136/bmjgh-2022-010811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/28/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION In Mali, healthcare systems are severely affected by conflict. However, several studies suggest a lack of knowledge about its impact on maternal healthcare. Frequent and repeated attacks increase insecurity, limit access to maternal care, and thus represent a barrier to accessing care. The objective of this study is to understand how assisted deliveries are being reorganised at the health centre level, and how they are adapting to the security crisis. METHOD This is a mixed sequential and explanatory study. The quantitative approaches combine a spatial scan analysis of assisted deliveries by health centres, an analysis of health centre performance using an ascending hierarchical classification, and a spatial analysis of violent events in two health districts in central Mali: Mopti and Bandiagara. The qualitative phase analyses semidirective and targeted interviews with managers (n=22) of primary healthcare centres (CsCOM) and two agents of international institutions. RESULTS The study reveals an important territorial heterogeneity of assisted deliveries. The primary health centres with high rates of assisted deliveries have mainly high-performance levels. This high level of use can be explained by the movement of the population to areas less exposed to attacks. The centres with low rates of assisted deliveries are those where qualified health workers refused to practice, where populations had few financial resources, and where they limited their travel to reduce their exposure to insecurity. CONCLUSION This study confirms that combining methodological approaches is essential to explain significant use in the local context. The analysis of the number of assisted deliveries in conflict zones must consider the number of procedures, the nearby security context, the number of internally displaced persons and the presence of camps in which humanitarian organisations offer programmes.
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Affiliation(s)
- Emmanuel Bonnet
- UMR 215 Prodig, Institut de recherche pour le developpement, Aubervilliers, France
| | | | | | | | | | - Dansiné Diarra
- Geography, Université des Sciences Sociales et de Gestion de Bamako, Bamako, Mali
| | - Valery Ridde
- CEPED, IRD, Paris, France.,ISED, UCAD, Dakar, Senegal
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Touré L, Boivin P, Diarra Y, Diabaté S, Ridde V. Innovations in mutuality: challenges and learnings for the Universal Health Insurance Plan in Mali. BMJ Glob Health 2023; 7:e011055. [PMID: 36898725 PMCID: PMC10439339 DOI: 10.1136/bmjgh-2022-011055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Many Sahel countries in Africa are looking for solutions for universal health coverage (UHC). Mali is in the process of adopting the Universal Health Insurance Plan, which allows for the mutualisation of existing schemes. Its operationalisation requires numerous adjustments to the current mutualist proposal and innovations in the system. The study focuses on innovations experienced in mutuality and their conditions of scale for UHC in Mali. METHODS This is qualitative research by multiple case studies. It is based on the collection of data by interviews (n=136), at a national and local level, on the analysis of documents (n=42) and a long field observation (7 months). The analytical framework concerns the dissemination and maintenance of health innovations (Greenhalgh et al, 2004). RESULT The analysis of this innovation shows an interest in the technical and institutional viability that determines its performance and scale-up. The procrastination and scepticism displayed at the highest level of the state and the international level, the reluctance, both financial and ideological, to renew the old mutualist proposal, penalise this Malian experiment. CONCLUSION This innovation is a decisive step in ensuring the health coverage of Mali's agricultural and informal sectors. The reform will need to be amplified and supported in the future to expect the scale-up of a cheaper, technically and institutionally more efficient system. Without a political intention to mobilise national resources and accept a fundamental paradigm shift in health financing, the search for the financial viability of mutuality may, again, be at the expense of the performance.
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Affiliation(s)
| | | | | | | | - Valéry Ridde
- Ceped, Université Paris Cité, IRD, Paris, France
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Senegal
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Durand F, Ridde V, Touré L, Coulibaly A. The moderating role of support for innovation in sub-Saharan African healthcare teams: a multilevel perspective. Curr Psychol 2023. [DOI: 10.1007/s12144-023-04341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Koné N, Coulibaly T, Senin C, Touré A, Touré L, Sevidzem S, Yao-Acapovi G. 221 - Prévalences de l’échinococcose, la distomatose et la cysticercose porcine dans un abattoir à Abidjan. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Coulibaly A, Touré L, Zinszer K, Ridde V. [The resilience of the Hospital of Mali to COVID-19 in a context of penuries]. Sante Publique 2022; Vol. 33:935-945. [PMID: 35485025 DOI: 10.3917/spub.216.0935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM The objective of this research is to report the strategies of resilience mobilized by the Hospital of Mali to face Coronavirus disease (COVID-19). METHOD The data collected within the hospital covered the first months of the pandemic (April to July 2020). A total of 32 semi-structured interviews and 53 observation sessions were conducted. Data analyses were based on a conceptual framework and were conducted using a deductive approach. RESULTS The results show that, due to the multiple effects of the COVID-19 such as the aggravation of staff penuries, the high workloads, the need to create dedicated infrastructures, the drastic decrease in revenue due to the drop in hospital's attendance, the hospital and its staff implemented multiple strategies (e.g., reduction or postponement of some expenses, requisition of facilities, recruitment of contractual staff and redeployment of some healthcare workers). Those strategies generally allowed to maintain patients access to care, although there were many restrictions for non-COVID-19 patients. The hospital was able to build absorptive resilience. CONCLUSION This qualitative research provides a better understanding of hospitals' resilience processes to the COVID-19 pandemic in a hospital setting. Lessons learned from this study should help hospitals managers to design more appropriate and effective responses to future health crises.
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Moussa AK, Diallo M, Traoré L, Touré L, Traoré MB, Coulibaly T, Touré AA. [Knee dislocation at chu Gabriel TOURE : therapeutic and evolutionary aspects]. Mali Med 2022; 37:45-48. [PMID: 38196255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Dislocations of the knee are serious, involving the functional prognosis and sometimes the vital prognosis of the limb concerned. The aim of our work was to assess the functional results of our care. MATERIALS AND METHODS This were a prospective study concerning patients with dislocation of the knee, treated and followed in the Department of Orthopedics-Traumatology at the CHU Gabriel TOURE from January 2015 to October 2018. RESULTS We collected 30 patients with knee dislocation. The male sex predominated (60%) with a sex ratio of 1.5. The average age was 32.56 years. AVP was the main etiology with 83.3%. The mechanism was direct in 86.7%. Standard knee X-ray with front and side views was performed in all patients. Posterolateral dislocation was the most common type of pathology (20%). Associated lesions were observed in 56.6%. The response time was less than 6 hours in 100%. The treatment was orthopedic in 93.3%. Complications were dominated by knee laxity with 43%. At the average follow-up of 18.9 months, the functional results were good in 20%. CONCLUSION Knee dislocations are the prerogative of the young subject. Accidents due to motorcycles are the main circumstances. Associated lesions are frequent. Orthopedic treatment is still relevant but the evolution is still unpredictable despite the early treatment.
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Affiliation(s)
- A K Moussa
- Service d'Orthopédie-Traumatologie CHU Gabriel Touré
| | - M Diallo
- Service d'Orthopédie-Traumatologie Centre Hospitalier Régional Ségou
| | - L Traoré
- Service d'Orthopédie-Traumatologie CHU Gabriel Touré
| | - L Touré
- Service d'Orthopédie-Traumatologie Centre Hospitalier Régional Sikasso
| | - M B Traoré
- Service d'Orthopédie-Traumatologie CHU Gabriel Touré
| | - T Coulibaly
- Service d'Orthopédie-Traumatologie CHU Gabriel Touré
| | - A A Touré
- Service d'Orthopédie-Traumatologie CHU Gabriel Touré
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Moussa AK, Touré L, Diallo M, Traoré L, Traoré MB, Coulibaly T, Touré AA. [Acetabular Fractures at CHU Gabriel Toure : epidemiology, therapeutic and evolutinaryaspects]. Mali Med 2022; 37:40-44. [PMID: 38196260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Acetabularfractures involving the functionalprognosis of the hip. The aim of thisworkwas to determine the epidemiological, clinical, and outcome aspects of treatment. MATERIALS AND METHODS This wasa retro-prospective study of patients withacetabulum fracture treated and followedfromJanuary 2015 to June 2018. RESULTS Wecollected 49 patients with an acetabulum fracture. Acetabulum fractures made up 8.3% of all pelvic injuries during the studyperiod. The male sexprevailed (87.8%) with a sex ratio of 7.16. The averageagewas 36.14 years (range: 17 years and 77 years). The circumstances of the trauma were accidents on the public highway (69.4%), accidents atwork (14.3%), accidents in the home (10.2%), accidents in sports (4.1%), assaults (2%). The mechanismwas indirect in 87.8%.Pain with total functional impotence wasobservedin 83.7% and with a vicious attitude of the traumatized limbin 89, 8%. The standard radiographywith the incidences of the pelvis face as well as the ¾ wing and ¾ obturatorwasperformed in all patients. The transverse fracture of the acetabulumwas the mostcommonanatomo-radiological type (61.2%). Shock (34.6%) and hip dislocation (24.4%) were the mostcommonearly complications. Treatment was orthopedicin 95.9%. After an averagefollow-up of 23.24 months, the anatomicalresultsweresatisfactoryin 32.7% and the functionalresults good in 51%. Lameness (91.8%), mechanical pain (30.6%) and osteoarthritis (16.3%) were the main complications in the medium term. CONCLUSION Fractures of the acetabulum are the preserve of the adult, especially of the male. The complications are dominated by mechanical pain, lameness and early hip osteoarthritis. The anatomicalresultsthat condition the functionalresults are less good with the orthopedictreatment.
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Affiliation(s)
- A K Moussa
- Service d'Orthopédie-Traumatologie CHU Gabriel Touré
| | - L Touré
- Service d'Orthopédie-Traumatologie Centre Hospitalier Régional Sikasso
| | - M Diallo
- Service d'Orthopédie-Traumatologie Centre Hospitalier Régional Ségou
| | - L Traoré
- Service d'Orthopédie-Traumatologie CHU Gabriel Touré
| | - M B Traoré
- Service d'Orthopédie-Traumatologie CHU Gabriel Touré
| | - T Coulibaly
- Service d'Orthopédie-Traumatologie CHU Gabriel Touré
| | - A A Touré
- Service d'Orthopédie-Traumatologie CHU Gabriel Touré
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Ridde V, Gautier L, Dagenais C, Chabrol F, Hou R, Bonnet E, David PM, Cloos P, Duhoux A, Lucet JC, Traverson L, de Araujo Oliveira SR, Cazarin G, Peiffer-Smadja N, Touré L, Coulibaly A, Honda A, Noda S, Tamura T, Baba H, Kodoi H, Zinszer K. Learning from public health and hospital resilience to the SARS-CoV-2 pandemic: protocol for a multiple case study (Brazil, Canada, China, France, Japan, and Mali). Health Res Policy Syst 2021; 19:76. [PMID: 33957954 PMCID: PMC8100363 DOI: 10.1186/s12961-021-00707-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND All prevention efforts currently being implemented for COVID-19 are aimed at reducing the burden on strained health systems and human resources. There has been little research conducted to understand how SARS-CoV-2 has affected health care systems and professionals in terms of their work. Finding effective ways to share the knowledge and insight between countries, including lessons learned, is paramount to the international containment and management of the COVID-19 pandemic. The aim of this project is to compare the pandemic response to COVID-19 in Brazil, Canada, China, France, Japan, and Mali. This comparison will be used to identify strengths and weaknesses in the response, including challenges for health professionals and health systems. METHODS We will use a multiple case study approach with multiple levels of nested analysis. We have chosen these countries as they represent different continents and different stages of the pandemic. We will focus on several major hospitals and two public health interventions (contact tracing and testing). It will employ a multidisciplinary research approach that will use qualitative data through observations, document analysis, and interviews, as well as quantitative data based on disease surveillance data and other publicly available data. Given that the methodological approaches of the project will be largely qualitative, the ethical risks are minimal. For the quantitative component, the data being used will be made publicly available. DISCUSSION We will deliver lessons learned based on a rigorous process and on strong evidence to enable operational-level insight for national and international stakeholders.
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Affiliation(s)
- Valéry Ridde
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) Université de Paris, ERL INSERM SAGESUD, Paris, France.
| | - Lara Gautier
- School of Public Health, University of Montreal, Montréal, Québec, Canada
- Centre de recherche en santé publique (CRePS), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Christian Dagenais
- Faculté des arts et des sciences, University of Montreal, Montréal, Québec, Canada
| | - Fanny Chabrol
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Renyou Hou
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) Université de Paris, ERL INSERM SAGESUD, Paris, France
- Laboratory of Ethnology and Comparative Sociology, Université Paris Nanterre/CNRS, Paris, France
| | - Emmanuel Bonnet
- UMR 215 Prodig, CNRS, Université Paris 1 Panthéon-Sorbonne, AgroParisTech, Institut de recherche pour le développement (IRD), Aubervilliers, France
| | - Pierre-Marie David
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada
- Pole 1 de recherche sur la transformation des pratiques cliniques et organisationnelles, CISSS de Laval, Montréal, Canada
| | - Patrick Cloos
- School of Public Health, University of Montreal, Montréal, Québec, Canada
- Centre de recherche en santé publique (CRePS), Université de Montréal, Montréal, Québec, Canada
| | - Arnaud Duhoux
- Pole 1 de recherche sur la transformation des pratiques cliniques et organisationnelles, CISSS de Laval, Montréal, Canada
- Faculté des sciences infirmières, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Christophe Lucet
- AP-HP, Bichat-Claude Bernard Hospital, Paris, France
- IAME, INSERM, Université de Paris, Paris, France
| | - Lola Traverson
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) Université de Paris, ERL INSERM SAGESUD, Paris, France
| | | | - Gisele Cazarin
- Institut Aggeu Magalhães, Oswaldo Cruz Fondacion, Recife, Brazil
| | - Nathan Peiffer-Smadja
- AP-HP, Bichat-Claude Bernard Hospital, Paris, France
- IAME, INSERM, Université de Paris, Paris, France
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | | | | | - Ayako Honda
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Shinichiro Noda
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toyomitsu Tamura
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroko Baba
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Haruka Kodoi
- Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Kate Zinszer
- School of Public Health, University of Montreal, Montréal, Québec, Canada
- Centre de recherche en santé publique (CRePS), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
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Seppey M, Touré L, Ridde V. Defining an action-research’s content to improve a policy supporting indigents’ health in Mali: a concept mapping. Journal of Global Health Reports 2021. [DOI: 10.29392/001c.21956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Mathieu Seppey
- Université de Montréal, École de santé publique (ESPUM), Département de médecine sociale et préventive, Montréal (Québec), Canada; Centre de Recherche en Santé Publique (CReSP), Montréal, Québec, Canada
| | | | - Valéry Ridde
- IRD (Research Institute for Sustainable Development), CEPED, Université de Paris, ERL INSERM SAGESUD Paris, France
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Coulibaly K, Traoré S, Sanogo CO, Traoré L, Touré L, Tambassi SI, Keïta G, Diallo S, Traoré J, Diallo A. [Management of chronic osteomyilitis of limbs at kati teaching hospital]. Mali Med 2021; 36:32-35. [PMID: 37973601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVES the purpose of this work was to describe the epidemiological, clinical, paraclinical and therapeutic aspect of surgical treatment of chronic osteomyilitis of limbs. PATIENTS METHODS it was a retrospective study over a period of 12 years, from January 2003 to December 2014. It covered all cases of chronic osteomyelitis osteonecrosis treated our service. RESULTS The authors report the results of the surgical treatment of a series 56 patients operated on for chronic limb osteomyelitis. The mean age was 20.7 years with extremes of 6 months and 56 years. The tibia and femur were the most affected segments. Staphylococcus aureus was the most frequently found germ, 80% of the cases. We obtained complete healing with total cure in 68% of cases and recurrence of suppuration in 32% of cases. CONCLUSION Chronic osteomyelitis of limbs is a frequent pathology in Africa. Staphylococcus aureus was the most frequently found germ. Surgery in a time seems a good alternative. The rate of recurrence of the suppuration remains high.
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Affiliation(s)
- K Coulibaly
- Service d'orthopédie traumatologie du CHU de Kati. Koulikoro-Mali
| | - S Traoré
- Service d'orthopédie traumatologie du CHU de Kati. Koulikoro-Mali
| | - C O Sanogo
- Service d'orthopédie traumatologie du CHU de Kati. Koulikoro-Mali
| | - L Traoré
- CHU Mère-Enfant le Luxembourg de Bamako-Mali
| | | | - S I Tambassi
- Service d'orthopédie traumatologie du CHU de Kati. Koulikoro-Mali
| | - G Keïta
- Service d'orthopédie traumatologie du CHU de Kati. Koulikoro-Mali
| | - S Diallo
- Service d'orthopédie traumatologie du CHU de Kati. Koulikoro-Mali
| | - J Traoré
- Service d'orthopédie traumatologie du CHU de Kati. Koulikoro-Mali
| | - A Diallo
- Service d'orthopédie traumatologie du CHU de Kati. Koulikoro-Mali
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Abstract
Universal health coverage is high up the international agenda. The majority of the West Africa's countries are seeking to define the content of their compulsory, contribution-based medical insurance system. However, very few countries apart from Mali have decided to develop a national policy for poorest population that is not based on contributions. This qualitative research examines the historical process that has permitted the emergence of this public policy. The research shows that the process has been very long, chaotic and suspended for long periods. One of the biggest challenges has been that of intersectoriality and the social construction of the poorest to be targeted by this public policy, as institutional tensions have evolved in accordance with the political issues linked to social protection. Eventually, the medical assistance scheme for the poorest saw the light of day in 2011, funded entirely by the government. Its emergence would appear to be attributable not so much to any new concern for the poorest in society but rather to a desire to give the social protection policy engaged in a guarantee of universality. This policy nonetheless remains an innovation within French-speaking West Africa.
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Affiliation(s)
| | - Valéry Ridde
- IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université de Paris), Universités de Paris, ERL INSERM SAGESUD, Paris, France
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15
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Touré L, Traoré T, Diallo M, Moussa AK, Chigblo P, Traoré L, Traoré MB, Mariko ML, Dembélé G. [Operating site infection in the orthopedic surgery department at the hospital of Sikasso]. Mali Med 2020; 35:6-10. [PMID: 37978762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The objective of this study was to determine the incidence of the operating site infection, precise the etiologies and identify the risk factors. PATIENTS AND METHOD This was a prospective study conducted at the department of orthopedics and traumatology at the hospital of Sikasso. The study was conducted from January 2016 to December 2018. The infection criteria were those of CDC from Atlanta. RESULT This study was conducted on 140 patients including 105 men and 35 women with an average age of 40, 1 years old (3 and 88 years old). We have made 150 interventions including 131 osteosynthesis, 14 arthroplasties and 5 corrective osteotomies. The global incidence of the operating site infection was of 19, 3% with a 13, 4% incidence in surgery class I, 21, 4% in the class II, 26, 5% in the class III and 50% in the class IV. . It was superficial in 18 cases (62, 1%) and deep in 11 cases (37, 9%). The average post-surgery hospitalization duration was 13 days (5 and 70 days in extreme cases). The isolated germs were Staphylococcus aureus in 6 cases (37,5 %), Pseudomonas aeruginosa in 3 cases (18,7 %), Enterobacter cloacae in 3 cases (18,7%), Escherichia Coli in 2 cases (12,5 %,), Klebsiellapneumoniae in 1 case (6,3%) and Proteus mirabilis in 1 case (6,3%). They were 100% sensible to imipramine. 90% of the cases were resisting to ampicillin and penicillin G. CONCLUSION The incidence of the ISO in our department was high. The risk factors of Operating Sites Infections were: hospitalization duration beyond 2 days, ASA Score over 2 days long, the surgical intervention class and the operation duration higher than 3 hours.
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Affiliation(s)
- L Touré
- Service Orthopédie-Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
| | - T Traoré
- Service Orthopédie-Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
| | - M Diallo
- Service Orthopédie-Traumatologie, Etablissement Hospitalier Publique Ségou (Mali)
| | - A K Moussa
- Service d'orthopédie et Traumatologie, Centre Hospitalier Universitaire hôpital Gabriel Toure (Mali)
| | - P Chigblo
- Centre National Hospitalier Universitaire Hubert Koutougou MAGA de Cotonou (CNHU-HKM), Clinique Universitaire de Chirurgie, de Traumatologie, d'Orthopédie et de Chirurgie Réparatrice
| | - L Traoré
- Service d'orthopédie et Traumatologie, Centre Hospitalier Universitaire hôpital Gabriel Toure (Mali)
| | - M B Traoré
- Service d'orthopédie et Traumatologie, Centre Hospitalier Universitaire hôpital Gabriel Toure (Mali)
| | - M L Mariko
- Service de médecine, Etablissement Hospitalier Publique Sikasso
| | - G Dembélé
- Service Orthopédie-Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
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16
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Diallo A, Traoré B, Diassana M, Maiga A, Bah A, Traore A, Konaté M, Karambé A, Koné A, Touré L, Traoré T, Traoré S, Dembélé O, Kanté M, Dembélé M, Diakité ML. [Foreskin Cyst After Circumcision At The Hospital Of Sikasso (MALI)]. Mali Med 2020; 35:51-53. [PMID: 37978743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Cyst scar post circumcision of the stump of the prepuce is pathology of which we have not found any cases in the literature. The circumcision traditional is still practiced in our regions with its attendant complications, in particular, the high section, the whole or part of the gland, infections. The case we report concerns a patient 24 years of age, having a large cyst of 8cm diameter, evolving for the past 17 years. The patient has not informed his parents that when the desire to marry has become very pressing. The consultation was motivated by the psychological trauma, the discomfort and the pain caused by the infection, and the fistulisation. The treatment was surgical with bedroom suites. This observation underscores the importance of the knowledge of good surgical technique in order to minimize complications; it also sheds light on the taboo side of the pathologies the sphere uro-genitale.
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Affiliation(s)
- A Diallo
- Service de chirurgie général de l'hôpital de Sikasso
| | - B Traoré
- Service de chirurgie général de l'hôpital de Sikasso
| | | | - A Maiga
- Service de chirurgie général de l'hôpital de Sikasso
| | - A Bah
- Service de chirurgie générale CHU Gabriel Touré
| | - A Traore
- Service de chirurgie générale CHU Gabriel Touré
| | - M Konaté
- Service de chirurgie générale CHU Gabriel Touré
| | - A Karambé
- Service de chirurgie générale CHU Gabriel Touré
| | - A Koné
- Service de chirurgie générale CHU de Kati
| | - L Touré
- Service de chirurgie générale CHU Gabriel Touré
- Service de traumatologie de l'hôpital de Sikasso
| | - T Traoré
- Service de traumatologie de l'hôpital de Sikasso
| | - S Traoré
- Service d'urologie de l'hôpital de Sikasso
| | - O Dembélé
- Service d'urologie de l'hôpital de Sikasso
| | - M Kanté
- Service d'anesthésie réanimation de l'hôpital de Sikasso
| | - M Dembélé
- Service d'anesthésie réanimation de l'hôpital de Sikasso
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Ridde V, Asomaning Antwi A, Boidin B, Chemouni B, Hane F, Touré L. Time to abandon amateurism and volunteerism: addressing tensions between the Alma-Ata principle of community participation and the effectiveness of community-based health insurance in Africa. BMJ Glob Health 2018; 3:e001056. [PMID: 30364476 PMCID: PMC6195139 DOI: 10.1136/bmjgh-2018-001056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/17/2018] [Accepted: 09/22/2018] [Indexed: 02/03/2023] Open
Affiliation(s)
- Valéry Ridde
- IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Montreal, Canada
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Abena Asomaning Antwi
- Centre lillois d’études et de recherches sociologiques et économiques (Clersé), Université de Lille, Lille, France
| | - Bruno Boidin
- Centre lillois d’études et de recherches sociologiques et économiques (Clersé), Université de Lille, Lille, France
| | - Benjamin Chemouni
- Department of International Development, London School of Economics and Political Science, London, UK
| | - Fatoumata Hane
- Département de sociologie, Université Assane Seck de Ziguinchor, Ziguinchor, Sénégal
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Paul E, Albert L, Bisala BN, Bodson O, Bonnet E, Bossyns P, Colombo S, De Brouwere V, Dumont A, Eclou DS, Gyselinck K, Hane F, Marchal B, Meloni R, Noirhomme M, Noterman JP, Ooms G, Samb OM, Ssengooba F, Touré L, Turcotte-Tremblay AM, Van Belle S, Vinard P, Ridde V. Performance-based financing in low-income and middle-income countries: isn't it time for a rethink? BMJ Glob Health 2018; 3:e000664. [PMID: 29564163 PMCID: PMC5859812 DOI: 10.1136/bmjgh-2017-000664] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 01/01/2023] Open
Abstract
This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and middle-income countries (LMICs). PBF was conceived as an open approach adapted to specific country needs, having the potential to foster system-wide reforms. However, as with many strategies and tools, there is a gap between what was planned and what is actually implemented. This paper argues that PBF as it is currently implemented in many contexts does not satisfy the promises. First, since the start of PBF implementation in LMICs, concerns have been raised on the basis of empirical evidence from different settings and disciplines that indicated the risks, cost and perverse effects. However, PBF implementation was rushed despite insufficient evidence of its effectiveness. Second, there is a lack of domestic ownership of PBF. Considering the amounts of time and money it now absorbs, and the lack of evidence of effectiveness and efficiency, PBF can be characterised as a donor fad. Third, by presenting itself as a comprehensive approach that makes it possible to address all aspects of the health system in any context, PBF monopolises attention and focuses policy dialogue on the short-term results of PBF programmes while diverting attention and resources from broader processes of change and necessary reforms. Too little care is given to system-wide and long-term effects, so that PBF can actually damage health services and systems. This paper ends by proposing entry points for alternative approaches.
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Affiliation(s)
- Elisabeth Paul
- Tax Institute, Université de Liège, Liège, Belgium
- Faculty of Social Sciences, Université de Liège, Liège, Belgium
| | - Lucien Albert
- International Health Unit, University of Montreal, Montreal, Quebec, Canada
| | - Badibanga N'Sambuka Bisala
- Expert in district health systems based on primary healthcare, Groupe d'Appui à la Recherche et Enseignement en Santé Publique, Mbuji-Mayi, Democratic Republic of the Congo
| | - Oriane Bodson
- Faculty of Social Sciences, Université de Liège, Liège, Belgium
| | - Emmanuel Bonnet
- Résiliences, Research Institute for Development (IRD), Bondy, France
| | - Paul Bossyns
- Health Sector Thematic Unit, Belgian Development Agency (ENABEL), Brussels, Belgium
| | | | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | - Alexandre Dumont
- CEPED, Research Institute for Development (IRD), Paris Descartes University, INSERM, Paris, France
| | | | - Karel Gyselinck
- Health Sector Thematic Unit, Belgian Development Agency (ENABEL), Brussels, Belgium
| | - Fatoumata Hane
- Department of Sociology, Université Assane Seck, Ziguinchor, Senegal
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | | | | | | | - Gorik Ooms
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Oumar Mallé Samb
- Global Health, Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Quebec City, Quebec, Canada
| | - Freddie Ssengooba
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Laurence Touré
- Anthropologist, Research Association Miseli, Bamako, Mali
| | | | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | | | - Valéry Ridde
- CEPED, Research Institute for Development (IRD), Paris Descartes University, INSERM, Paris, France
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Touré L, Moussa AK, Traoré T, Traoré S, Sidibé O, Diallo AB, Traoré B, Diassana M, Koné A, Kéita S. [Major Causes Of Limb Amputations At The Hospital In Sikasso]. Mali Med 2018; 33:15-18. [PMID: 35897194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In this study, we aimed to determine the major causes of limb amputations to improve its treatment. PATIENTS AND METHODS We conducted a-18 month prospective study from March 2015 to September 2016 at the Hospital of Sikasso, a hospital of second reference in Mali. RESULTS We carried out 50 major limb amputations including 25 men and 25 women aged 38.9 years old on average with extremes of 3 and 80 years old. The amputed limb was the upperlimb in 38 cases (76%) and the lowerlimb in 12 cases (24%). Housewives were the most represented with 18 cases (36%), followed by farmers with 15 cases (30%). The amputation was done immediately or in delayed emergency in 32 cases (54%). Trauma was the most frequent etiology with 13 cases (26%). The post-operative complications have been met in 47 cases. They have been dominated by stump pain and delayed healing in 23 cases (49%) each, suppuration in 10 cases (21%) and the stump necrosis in 3 cases (7%). The mortality rate was 8% (4 cases). We have made prosthetic apparatus for18 patients (36%). CONCLUSION The limb amputation is frequent and youths were the most involved. Due the lack of financial support, 64% of our patients could not afford prosthesis.
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Affiliation(s)
- L Touré
- Service d'orthopédie et Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
| | - A K Moussa
- Service d'orthopédie et Traumatologie, Centre Hospitalier Universitaire hôpital Gabriel Toure (Mali)
| | - T Traoré
- Service d'orthopédie et Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
| | - S Traoré
- Service d'orthopédie et Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
| | - O Sidibé
- Service d'orthopédie et Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
| | - A B Diallo
- Service d'orthopédie et Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
| | - B Traoré
- Service d'orthopédie et Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
| | - M Diassana
- Service d'orthopédie et Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
| | - A Koné
- service de chirurgie générale, centre de santé de référence de Kati (Mali)
| | - S Kéita
- Service d'orthopédie et Traumatologie, Etablissement Hospitalier Publique Sikasso (Mali)
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Seppey M, Ridde V, Touré L, Coulibaly A. Donor-funded project's sustainability assessment: a qualitative case study of a results-based financing pilot in Koulikoro region, Mali. Global Health 2017; 13:86. [PMID: 29216877 PMCID: PMC5721604 DOI: 10.1186/s12992-017-0307-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/24/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Results-based financing (RBF) is emerging as a new alternative to finance health systems in many African countries. In Mali, a pilot project was conducted to improve demand and supply of health services through financing performance in targeted services. No study has explored the sustainability process of such a project in Africa. This study's objectives were to understand the project's sustainability process and to assess its level of sustainability. METHODS Sustainability was examined through its different determinants, phases, levels and contexts. These were explored using qualitative interviews to discern, via critical events, stakeholders' ideas regarding the project's sustainability. Data collection sites were chosen with the participation of different stakeholders, based on a variety of criteria (rural/urban settings, level of participation, RBF participants still present, etc.). Forty-nine stakeholders were then interviewed in six community health centres and two referral health centres (from 11/12/15 to 08/03/16), including health practitioners, administrators, and those involved in implementing and conceptualizing the program (government and NGOs). A theme analysis was done with the software © QDA Miner according to the study's conceptual framework. RESULTS The results of this project show a weak level of sustainability due to many factors. While some gains could be sustained (ex.: investments in long-term resources, high compatibility of values and codes, adapted design to the implementations contexts, etc.) other intended benefits could not (ex.: end of investments, lack of shared cultural artefacts around RBF, loss of different tasks and procedures, need of more ownership of the project by the local stakeholders). A lack of sustainability planning was observed, and few critical events were associated to phases of sustainability. CONCLUSIONS While this RBF project aimed at increasing health agents' motivation through different mechanisms (supervision, investments, incentives, etc.), these results raise questions on what types of motivation could be more stable and what could be the place of local stakeholders in the project; all this with the aim of more sustained and efficient results.
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Affiliation(s)
- Mathieu Seppey
- Université de Montréal, École de santé publique (ESPUM), P.O. Box 6128, Succursale Centre-Ville, Montréal, Québec, H3C 3J7 Canada
- Institut de Recherche en Santé Publique de l’UdeM (IRSPUM), 7101 Avenue du Parc, Office 3187-03, Montréal, Québec, H3N 1X9 Canada
| | - Valéry Ridde
- Université de Montréal, École de santé publique (ESPUM), P.O. Box 6128, Succursale Centre-Ville, Montréal, Québec, H3C 3J7 Canada
- Institut de Recherche en Santé Publique de l’UdeM (IRSPUM), 7101 Avenue du Parc, Office 3187-03, Montréal, Québec, H3N 1X9 Canada
| | - Laurence Touré
- MISELI (Association Malienne de Recherche et Formation en Anthropologie des Dynamiques Locales), cité el-Farako, BP E5448 Bamako, Mali
| | - Abdourahmane Coulibaly
- MISELI (Association Malienne de Recherche et Formation en Anthropologie des Dynamiques Locales), cité el-Farako, BP E5448 Bamako, Mali
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Abstract
In Mali, where rates of attendance at healthcare facilities remain far below what is needed, three user fee exemption policies were instituted to promote access to care. These related to HIV/AIDS treatment, as of 2004, caesarean sections, since 2005, and treatment of malaria in children under five and pregnant women, since 2007. Our qualitative study compared these three policies, looking at their implementation provisions, functioning and outcomes. In each healthcare facility, we analysed documentation and carried out three months of on-site observations. We also conducted a total of 254 formal and informal interviews with health personnel and patients.
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Kanté L, Togo A, Diakité I, Traoré A, Keita M, Dembélé BT, Coulibaly Y, Touré L, Diallo G, Tiéman C. [Epidemiologic and therapeutic study of amputations consecutive of the complications of the diabetes]. Mali Med 2010; 25:11-13. [PMID: 21501982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Diabetes complications constitute the 2nd cause of amputations after the sequels of traditional treatment for traumatism of the members with negative functional, aesthetic and psychological effect. The aims of this study were to determine the prevalence of the amputations consecutive to the complications of the diabetes, and describe the operating suites and the type of used equipment. MATERIALS AND METHOD 20 cases of amputations consecutive to the complications of the diabetes (ACCD), from October 1st, 2006 to September 30th, 2007 in Nianankoro Fomba hospital of Segou. RESULTS The frequency was of all the amputations with mean age of 57 years and sex-Ratio 1, 87. A history of high blood pressure was found in 18 cases (90%), the notion of addiction to smoking in 4 cases (20%). 7 (35%) patients had a body mass index included between 25 and 30 kg/m2 and 15 (75%) were of typical diabetes II. The average duration of evolution was included between 5 and 9 years. The leg and the foot was the most frequent seats 15 cases (75%). The state 5 of Wagner was the most frequent 12 cases (60%), and a glycaemia included between 3 and 4.99 g/l in 12 cases (60 %). The staphylococcus was the most frequently found germ in our taking, 12 cases (60%). The leg was the level of amputation the most frequent 35% (7 cases). 15 (75%) patients had a favourable evolution. We recorded 5 cases (15%) of death. The crutch was the locomotion's apparatus the most used in 11 cases (55%) CONCLUSION An earlier management of diabetes will avoid these complications.
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