Participation. One o f the strengths o f the Malian democracy i s the developing
participative framework. Over seventy political parties exist and are grouped into three major coalitions at the national level. Civil society i s vibrant with over 1,500 registered NGOs and as many as 2,500 associations. The media are free and over thirty newspapers and 120 radio stations are operating. The recently created National Council o f Civil Society Organizations o f M a l i should help channel civil society dialogue with G o M and the donor community. Inthe framework o f the PRSP, it will be critical to institutionalize participatory mechanisms that involve stakeholders inthe implementation, monitoring and evaluation o f poverty-oriented programs.
Decentralization and Deconcentration. In 1992, the G o M embarked on a
participative decentralizationprocess and there are now 703 local-level municipalities
(communes), 49 sub-regional districts (cercles), 8 regions and the district o f Bamako (with the status o f a region). While the Mission for Decentralization and Institutional Reform (MDRI) effectively piloted decentralizationthroughout the 1990s, the concomitant deconcentration process lags behind. Effective and efficient decentralized government and service delivery i s hampered by poor resource mobilization, weak capacity, inconsistency
between national sectoral programs and local development plans, poor governance and a
weak institutional framework. Inresponse, the Commissariat for Institutional Development, reporting to the new Junior Minister attached to the Prime Minister and charged with State Reform and Institutional Relations, prepared an action plan through a participatory process in
January 2003 with the objective o f improving: (icentral state reform and public sector management; (iidecentralization and deconcentration; (iiihuman resource capacity building; and (iv) communications and partnerships with service users.
PRSP Pillar 2: Develop Human Resources and Improve Access to Quality Basic Services
Health. Progress has been made inhealth since 1998 (Table 3). The G o M has
reinforced i t s accountability and management capacity, notably through the preparation o f a medium-termexpenditure framework (MTEF) which costs programmed investments and links activities to results in order to more effectively allocate resources towards achieving the PRSP objectives and MDGtargets (see Attachment 1). The attainment o f Original HIPC and Enhanced HIPC Initiative targets encouraged an acceleration inreform implementation (e.g. health personnel recruitment and a rise inbudget allocations to the health sector). While Mali’s health indicators are among the poorest inthe world, the implementation o f the first phase o f the ten-year health and social development program (PDDSS), which targets basic health care and decentralized community management, has led to a significant improvement inaccess to health care. The results are most notable for the poorest quintile, where infant and child mortality rates dropped 23% and 24% respectively from 1996 to 2001.
However, health service utilization i s still low and the quality o f health care i s s t i l l
poor due to: (iunavailable and poorly trained personnel inregional and rural health centers; (iia lack o f supplies; (iiiinaccessibility o f health centers outside o f Bamako; (iv) high transaction costs for dealing with multiple donors which has exacerbated the Ministry o f Health’s low absorptive capacity; and (v) poor resource allocation, including over-emphasis
on infrastructure investmentwithout taking into account operating costs.