_50_ PHN 1991 Sector Review Health Surveillance Assistants into outreach-oriented and village-based PHN promoters and service providers; rehabilitation and/or construction of rural health centers; provision of rural housing where needed to attract essential personnel; and provision of some vehicles to improve the effectiveness of district level services.; (b) for malaria, improvements in logistical support, in the supply of anti-malarial drugs, and in support for drug resistance monitoring, (c) for AIDS, acceleration of efforts in education and prevention campaigns and in acquisition of blood screening equipment; (d) for child spacing, launching of a Family Welfare Council to promote family planning and expansion of the MOH's program; (e) for women in development, institutional strengthening, upgrading of training activities, and testing of small scale demonstration projects on appropriate technology dissemination and credit provision; and (f) for nutrition, extension of a community-level food security approach developed and tested by UNICEF, and a micronutrient deficiency program. The component on strengthening of support services will include: (a) for staffing issues, upgrading of training programs and facilities for health cadres currently in critically short supply, and enhancement of personnel management information and planning capabilities; (b) for the IEC program, expanded activities for training health workers, and provision of resources for conveying population, health, and nutrition messages to communities; and (c) for pharmaceuticals, technical assistance and training on drug procurement, distribution and production, and improvement of facilities and equipment. The component on efficiency improvements will include: (a) rehabilitation of three urban health centers and construction of two others to shift more outpatient care away From the more costly and overcrowded hospitals, (b) rehabilitation of one district hospital, construction of another, and replacement of worn-out equipment in selected other hospitals; (c) introduction of reforms in patient fees; and (d) budget reforms involving increases in the MOH budget and the share of it devoted to outreach and peripheral health services. The component on the social dimensions of adjustment initiative will include support for a "social support program fund" to assist small z"ale pilot interventions derived from felt needs of communities and expressed through Government or NGO channels.

## **_Mali_** _- Second Health, Population and Rural Water Supply Project_

Through an integrated program of policy/institutional reforms and investments, the project will support the Government's efforts to improve the health status and well-being of the Malian population, notably women and children, implement its emerging population policy, and broaden access of deprived rural communities to health services and safe water.

lb attain these objectives, the project comprises three components. The health component will increav: the coverage and quality of health care: (a) directly in four Regions and the capital area of Mali throue,h the development of a decentralized, District-based health development program involving the construction/rehabilitation of primary and referral care centers, as well as active community, NGO and private sector participation; and (b) indirectly by improving the planning and management of the sector's personnel, physical asud financial resources as well as the provision of essential drugs. The population component will: (a) strengthen the institutions in charge of disseminatingrlimplementing the national population policy and of planning, managing and evaluating family planning (FP) programs; and (b) Increase the demand for, availability and quality of FP services nationwide. The rural water supply component will: (a) increase the supply of safe drinking water for the rural populztion in the project area; (b) support the Government's policy of community participatio& in the financial and technical management of rural water supply; and (c) implement an iodination program in areas where iodine deficiency is prevalent.

# _Ngia_ - _Health System FRnd Project_

The primary project objectives are to finance Improvements in State health systems by the establishment of a wholesaling mecWanism utilizing PFIs to appraise, supervise and co-finance State health