Qualification of staff, organization of services, and management of pregnant women in rural settings: the case of diema and kayes districts (mali).

In Mali, a poor sub-Saharan country, maternity referral systems were implemented to combat the still-high rates of maternal mortality. This qualitative study was aimed at understanding the relationships between the qualification of staff in community health centres, the organization of services, and the management of pregnant women in the maternity referral system in Kayes, a rural region of Mali. Physicians who managed CHCs actively or passively modified work organization, the level of technology, their obstetric skills, and staffing. They also created a competitive environment and developed relationships of trust with patients and with the district health centre. These findings are helpful in orienting decision-making for better personnel management.