24
World Bank Working Paper
COMMERCIAL PRIVATE SECTOR
The main laws liberalizing the health care professions were adopted in 1985; the application texts, between 1989 and 1992. They are:
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Law 85–41/AN-RM concerning the authorization of the private practice of health professions Decree 89–2728/MSP.AS/CABn se ing the details of the granting of authorization of private practice of sociosanitary professions Decree 91–106/P-RM concerning the organization of the private practice of health professions modified by decree 92–106/P-RM Decree 91–4319/MSP.AS.PF/CABn se ing the modalities of the organization of the private practice of medical and paramedical professions Law 02–050 AN-RM organizes cooperation between private and public health facilities and their participation in public service missions.
PHARMACEUTICAL INDUSTRY
The two main documents addressed to the pharmaceutical sector are not binding:
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Master Plan for the Supply and Distribution of Essential Drugs (SDAME) The national pharmaceutical policy of Mali.
The zoning rules are defined by Decree 98–0908 MSPAS SG (number of inhabitants required for a pharmacy or a depot). Pharmaceutical pricing is free in the private sector,10 except for a list of 107 essential drugs that are subject to ceilings. The relevant laws are:
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Decree 07–087 regulating essential drug prices in the private sector Decree 03–218 regulating essential drug prices in the public sector.
COMMUNITY PRIVATE SECTOR
The texts supervising community health were adopted between 1994 and 1995. There is no law governing community health care. The main law is the Cross-ministerial Decree 94–5092/MSSPA.MATS.MF se ing the conditions for the creation of the CSCOM and the management modalities of sociosanitary services in districts, towns, CSCOM, as amended by Cross-ministerial Decree 95-1262/MSSPA.MATS.MFC.
Business Environment Access to credit, tax payment, and permits and licences delivery are considered barriers to the development of the private sector in health care. Access to Credit
Both credit availability and credit demand are underdeveloped. CREDIT AVAILABILITY
Due to the macroeconomic environment, Banks estimate that their long-term resources are limited, and interest rates are high (between 12 percent and 15 percent). In addition, because credit institutions are risk averse, Bank funding consists mainly of short-term, low-risk loans (such as lines of credit for shopkeepers). Young physicians just starting out in practice find it difficult to obtain the required guarantees.