Cheikh Mbengue

MLI is conducting interviews with development partners to get their views on country ownership and leadership in MLI countries. This entry is from Cheikh Mbengue with Abt Associates. He is working with USAID’s Health Systems 20/20 to scale up community based health insurance in Mali.

Have you seen greater evidence of country ownership/leadership in Mali, and if so, in what way?

Yes. In Mali, community based health insurance is not under the umbrella of only the Ministry of Health, but the Ministry of Social Development as well. The ministries are collaborating to implement the activities related to community based health insurance. At first, there was no policy and no strategy related to that in the country. There were just some isolated activities implemented by some NGOs, nothing more than that. In 2009, the government created a steering committee and a technical committee to pilot the scale-up of community based health insurance. MLI, the World Bank and Health Systems 20/20 started working with the ministries at that time. Our role has been to assist them but not to do the work ourselves. Officials in Mali made decisions related to the design of the process and there were many, many debates among the main stakeholders in the country. The decision to do the pilot and the selection of the regions was made by the Minister of Social Development and the Prime Minister’s office. The Government of Mali is also in the process of deciding on the level of funds it will dedicate to subsidizing the premiums. If the government does put money in, it will give it more power in the process. Usually the government is weak when the process is fully financed by donors.

Health Systems 20/20, MLI and the World Bank built technical capacities among the technical committee. Now, if a country like Niger or Benin needs do the same thing, people from Mali can go and help them. It means that the technical capacity has been strengthened. It’s something we don’t underline enough, but it’s very important.

The World Bank is now in the process of designing a new program for reproductive health in Mali. They didn’t put money in the process in the last years but, hopefully, in the coming years, they will contribute a lot for the implementation of the policy.

Is more ownership a positive development?

It’s a positive development. I work in several countries in West Africa, but in Mali, there are many people who are in the system who are well educated, who have the skills to develop something, but who are not really in a position to make the best of their skills. Putting these people together and letting them do the work themselves is important and what we see now is that they have the process in their hands and they’re doing it. But I think also that they need to continue receiving assistance because this process, developing the collaboration between the two ministries, is complex.

Is the government relating to donors in a different way?

Usually, Ministries of Health in Africa have more relationships with donors than Ministries of Social Development. They work with the WHO, the World Bank, USAID, UNICEF. That’s why one of the issues we have in Mali is that the Ministry of Social Development is supposed to lead the community based health insurance process, but all the donors are partnering with the Ministry of Health. The Ministry of Health is supposed to bring its partners to the table. It’s very complex in terms of partnership. Now we need to put all these efforts together so that they fit the government policy. That’s new in terms of community based health insurance because before, the government didn’t have policies and guidelines.

What’s the most important thing development partners can do to strengthen ownership and leadership?

Community based health insurance is supposed to create dramatic change in the country.  A lot of money will be invested in this process and many things are supposed to change. Since it’s jointly implemented, I think we have to work to strengthen the collaboration between the two ministries so that they co-lead the process. For instance, there is a committee where the Ministry of Health and the Ministry of Social Development presented, but I think it’s important to have activities that gather more stakeholders from the two ministries, like having 15 people from each ministry together in one day to inform them more deeply about the policies. It’s enormous because there are many departments and each department is working on something very specific, but I think it’s important to have the capacity to inform everyone about what’s going on and let them discuss it so they can co-lead the process through the committees that are supposed to monitor the implementation of the strategy.