Mali Health

Mali Health

Abbreviation	MHOP
Formation	2006
Type	NGO
Legal status	501 (c)(3)
Location	Bamako, Mali Cambridge, Massachusetts
Region served	West Africa
Official language	Bambara, French, English
Key people	Caitlin Cohen, Founder Kris Ansin, US Executive Director Mariam Fofana Diallo, National Director Diakardia Traore, Medical Advisor
Mission	To reduce maternal and child mortality in resource-poor communities in West Africa
Website	Mali Health

Mali Health, established in 2006, is a non-governmental organization with 501(c)(3) status that strives to empower impoverished peri-urban communities in Mali, Africa to transform maternal and child health sustainably. Mali Health works to enable communities to design, build and implement their own health care systems through:

• Fostering the agency of residents to address community health needs
• Promoting health education, prevention, and early care-seeking
• Enhancing financial, geographic, and cultural access to quality health care for poor families^[1]

Mali Health envisions a world where poor urban communities have the power to mobilize to address their evolving maternal and child health needs.^[2]

Maternal and child health in Mali

One of the 10 poorest countries in the world, Mali's life expectancy at birth is 55 years.^[3] Nearly 50% of the population of 16,455,903 is under 14 years of age and Mali has the second highest birth rate in the world,^[4] making high maternal and child mortality a national crisis. In Mali, 1 and 5 children die before their 5th birthday, mostly from five treatable, preventable diseases: malaria, diarrhea, acute respiratory tract infections, measles, and malnutrition. The infant mortality rate (death before 1 year of age) is 104.3 deaths/1000 births, the second highest in the world.^[4] Only 27% of children under 5 sleep beneath insecticide-treated mosquito nets—one of the most effective ways to treat malaria—and only 34.8% of children under 5 years with fever receive treatment with any type of antimalarial medication.^[5]

In 2014, high maternal mortality (1 in 22 women die in childbirth) led Save the Children to rate Mali the 3rd worst country to be a mother in 2014.^[6] Only 52% of births among women aged 15–19 are attended by a skilled health professional.^[5]

Mali is dependent on international development organizations and foreign missionary groups for much of its health care. The total expenditure on health makes up only 7% of the national GDP and Mali has 0.1 hospital beds per 1,000 people.^[4] This health crisis is compounded by high levels of poverty—over 50% of the population lives on less than $1 a day (PPP)^[7]—and low levels of literacy, with a literacy rate of 39%.^[4]

History

Mali Health was founded in Sikoro, a slum community on the outskirts of Bamako, Mali by Caitlin Cohen, Lindsay Ryan and Erica Trauba, students at Brown University who had previously volunteered in Bamako.^[8][9] The organization began as a partnership between these Brown University students, local government leaders, health officials, local residents, and grassroots donors.

Cohen, Ryan and Trauba believed that the role of an international development organization is to foster rather than replace local groups and government action. Similarly, Mouhammadoun (Modibo) Niang, Rokia Savané (vice-president of Coordination Des Associations Et ONG Feminines Du Mali), Siriki Coulibaly (adviser to Sikoro's chief and the town’s official representative to Mali Health) and numerous other leaders in Sikoro were frustrated by a history of failed projects, including a huge aid-agency water project that left the community without water, without the $30,000 they had contributed, and without many children, as many died due to iron contamination.^[10]

Since 2006, Mali Health has grown enormously, with volunteers all over the United States and a continued partnership with a dedicated Mali Health student group at Brown University. The Malian staff has grown from a few committed individuals to over 60, many of whom are from the very neighborhoods in which Mali Health works.

In 2009, the Health Radio program (part of Communications & Advocacy) broadcast its first show. The radio show covers disease prevention strategies as well as governance and community organizing issues affecting health access and health outcomes.

In 2010, Mali Health launched two of its flagship projects: the construction and opening of a public clinic that serves over 10,000 people annually, and the Action for Health program.

In 2013, Mali Health also helped to construct a maternity ward to expand and facilitate maternal health services at the clinic. This project’s success marked another important step towards significantly improving maternal and child health outcomes.

Programs

A graphic showing Mali Health's programs.

Action for Health

In 2008 the international NGO Médecins Sans Frontières (Doctors Without Borders) estimated that free malaria testing and treatment dramatically increased the number of people surviving the disease,^[11] and the World Health Organization's 2010 World Health Report concluded that direct payments are a major obstacle to health coverage in low income countries.^[12]

However, user fees—in which patients pay money for services at a clinic or hospital—remain one of the largest barriers to health care for the poor in developing countries.^[13] Through its program Action for Health, Mali Health seeks to help families who are unable to afford health care for their children. Focusing on the first 1,000 days of life, when development is the most critical and the most vulnerable, Action for Health children receive subsidized primary care. Mali Health’s Community Health Workers visit enrolled families to monitor children's health and provide health education on issues such as malaria and malnutrition.^[14]

After launching in 2010, the program grew quickly and now serves almost 2,000 children. The program has had success in increasing care-seeking and childhood survival rates: while the average Malian child visits a doctor once every four years, children in Action for Health average 2-3 visits per year.^[15]

Communications & Advocacy

The Communications & Advocacy Program aims to bring health education to the masses and incite relevant and productive discussions about health topics that directly affect communities. Mali Health employs a number of media to generate these discussions. Health Radio (included in Sustainia's 2014 list of 100 of the most sustainable solutions to community development) mobilizes community members around health and promotes health education and prevention. The show is broadcast by local announcers on Bamako’s most popular radio station, which serves one million listeners weekly.^[16] The show provides independent coverage of community health challenges and success stories on issues including malaria prevention, prenatal care, and illegal dumping in public spaces. Mali Health also organizes public events to capture community attention and engage local residents in conversations about the most pressing health concerns they face.

Advocacy Groups for Health consist of active and committed individuals from Mali Health's partner communities. Group members are trained in techniques of community organizing and given the tools they need to advocate for better health conditions for their own neighborhoods. In 2014, group members successfully lobbied the community health committee in Sikoro (a slum on the outskirts of Bamako, and Mali Health's original partner community) to begin selling membership cards for the first time in seven years in order to increase access to medical care within the community.

Health Savings

Economic access and healthcare are inextricably linked. Health costs in Mali remain high, and for many families, these costs prevent them from seeking health care. Through Health Savings, local women’s groups pool small amounts of their savings in collective accounts. From these accounts, members can withdraw no-interest loans to cover unexpected healthcare costs, thereby relieving the financial burden from a single family, allowing them to seek care as soon as symptoms appear.

Members are also eligible to apply for loans from the group to pursue income-generating activities, such as starting a small business, which will help increase their family’s economic stability even further. With greater economic stability, these women are reducing their dependence on aid programs. At weekly group meetings, Health Savings members also receive training on financial management, budget creation, revenue-generating activities, and information on how to prevent common illnesses. Health Savings empowers women, fostering their independence by increasing their ability to contribute to family finances.

Saving for Health and Reproductive Empowerment (SHARE) is a new Mali Health initiative for pregnant women. Like Health Savings, women enrolled in SHARE meet weekly as a group to facilitate community-building and to receive important health information. However, unlike Health Savings, the SHARE program does not involve any loans, and each woman puts money into her own savings fund. Starting early in the woman's pregnancy, these savings will provide the necessary funds to cover pre-natal care, delivery, and post-natal care. The Community Health Workers lead each group meeting, providing medical information related to pregnancy, offering support to each member of the group, and connecting the women to professional care services at the local health clinic.

Health system strengthening

Since its founding, Mali Health has worked at the health systems level to improve not only access to basic healthcare, but the quality of care itself. Today, Mali Health partners with four community clinics to improve the capacity and quality of the services they provide to the residents of partner slum communities, using participatory strategies and years of experience to identify areas in need of improvement. Using quality improvement techniques such as kaizen and PDCA, Mali Health seeks to instill a culture of continuous improvement within the organization.

Mali Health also assists in building health infrastructure. In 2010, it helped construct a clinic in Sikoro to improve geographic access to care for the neighborhood’s thousands of residents. Later, a wall was added to provide privacy for patients, and in 2013, Mali Health helped to construct a dedicated maternity ward, giving women a safe, private space in which to give birth under the supervision of a health professional. The Sikoro clinic has been fully integrated into the Malian healthcare system and is run by a local health committee so that, despite continued collaboration, it operates independently of Mali Health, ensuring its sustainability.

Ebola response

In late October 2014, the Ebola outbreak in West Africa spread to Mali. In early November, a second outbreak occurred, in and near the communities in which Mali Health works, infecting several people and putting hundreds more at risk.

Mali Health acted quickly and in coordination with government and other NGO actors, as one of the few organizations with staff prepared to address an outbreak like this on the front lines. Since September 2014, Mali Health had been working with its Community Health Workers and partner clinics to educate and prepare for a potential outbreak in Mali. The organization installed sanitation kits and deployed health workers in each of its partner clinics; trained doctors, women's groups, and community leaders in prevention techniques; and used its Health Radio show and dozens of community events to disseminate information to the public to prepare them for the very real possibility of an outbreak.

After the virus reached Mali Health's communities, the organization worked in concert with the World Health Organization and the US Centers for Disease Control to deploy its health workers to trace and monitor potential cases of the disease, ready to isolate and treat patients if necessary.

Six patients succumbed to the virus, and two were successfully treated at Malian health clinics. After 42 days without another case, Mali was declared free of the virus on January 18, 2015.^[17]

References

• Cohen, Caitlin (2008). "Jenzabar Foundation Grant application."