In the past year, Mali Health has focused on further improving the already significant impact of its programs. In Action for Health, this meant training our Community Health Workers (CHWs) in new communication methodologies to improve their skills in adult education and behavior change. Since the training, we’ve seen more families adopting the healthy behaviors they discuss with their CHW.
According to Adama K., Coordinator of the Department of Communications & Public Affairs, the greatest achievement this year has been the increase in the number of women giving birth in health centers. In 2014, 107 women in our Action for Health program gave birth at the clinic, compared to 78 women in 2013.
Our CHWs are a vital link between our partner communities and the health system, encouraging families to seek professional care at local clinics when they need it. Moustaph, one of our CHWs, believes in the importance of building strong relationships within the Sikoro community. “I chose to become a CHW to help my community grow,” says Moustaph, “to meet the people who don’t have access to care and to help them stay safe and healthy.”
“I was working with a pregnant woman, Sanata, this past year,” he said. “She was in her third pregnancy, but she was still very afraid of what could happen. I visited Sanata often, especially in the final months of her pregnancy. I talked to her about her experience, what she was feeling, and about what resources were at her disposal, and I actually escorted her to a couple of her prenatal appointments.” Moustaph’s commitment paid off, and Sanata is one of the 107 women to give birth at the Sikoro maternity ward. She gave birth to a healthy baby girl at the end of 2014.
Awa, another Action for Health mother, values what she has learned from the program and from Moustaph. She considers him to be part of the family, and appreciates the honest discussions she has with him about important health issues. “When my kids get sick from a simple fever, he wakes up even if it is late to accompany me to the community health center,” she said. “This is very important for me.” The health prevention information provided through Action for Health has also been valuable to Awa. “Since I joined Action for Health, my life has changed a lot,” she said. “Thanks to Mali Health, things are a lot better now because I implement what my CHW has suggested that I do and my family has fewer cases of disease.”
We are grateful for Moustaph and all our CHWs, as they empower communities with the knowledge and skills they need to improve their own health.
I was afraid. When I first heard that Ebola had reached my country, I was afraid. I have worked for Mali Health for four years, so I have better knowledge than most about diseases like this. While many people in my community didn’t believe (and still don’t) that Ebola existed, I knew different, and I was afraid. What if I got sick? What if my family got sick? My friends? My neighbors? Ebola does not discriminate — we were all susceptible, and I knew it.
So I volunteered. I have been supervisor to Mali Health’s Community Health Workers for a long time now — I’ve provided guidance and support as they visit the families in Mali Health’s programs, offering education and health monitoring. But now, I have joined them. I am a part of this incredible team, visiting people who have come into contact with Ebola patients, monitoring them to make sure that if they have contracted the disease, we can get them treatment and protect others from infection. I volunteered because fear moved me to action; I could not stand by, letting others charge into the fray. I have the skills and the knowledge to contribute, and I knew I had to use them.
In truth, providing education and monitoring to these Contacts is not much different than providing education and monitoring to anyone else enrolled in Action for Health. We meet, we talk, I run some basic tests, and we make plans for the next time I will visit them.
The difference, though, is the stigma around Ebola. Many people still don’t believe in this disease, but those who do hold the same fear that I feel; Ebola is far more deadly than other diseases we face in Mali. When we started this work, the people we monitored resisted — many faced rejection from their families, born of the fear we all were feeling, and the people we monitored thought that we, too, would stigmatize them. But we’ve taught them otherwise. It’s true that Ebola is not like other diseases; it is far more dangerous. But it can be beaten, if we all know how to prevent it and how to treat it.
I am still afraid, but I’m proud, too. Proud of my community for being willing to learn how to protect themselves. Proud of my fellow Health Workers for taking on this dangerous, utterly necessary work. And I’m proud of you for the compassion you’ve show, for raising your voice and declaring, “I stand with Mali Health, and we can turn the tide of this outbreak.”
So I say: Thank you. Thank you for your support yesterday, today, and tomorrow. You make more of a difference than you realize. You may sometimes feel distant from the work that we do thousands of miles away. But know that every time I pull on my gloves before visiting one of my contacts, it’s like you’re right there with me, holding my hand, keeping me safe while I help my community heal.
In August 2013, Mali Health and its partner One Day’s Wages inaugurated a new maternity ward built on the campus of CSCOMSiSou, the clinic that Mali Health helped to build in 2010. This maternity ward provides a safe and private space for expecting women to receive professional peri-natal care from midwives and nurses. In the year since the ward’s opening, we have seen promising improvement in maternal health indicators.
The maternity ward significantly increased the number of beds and health professionals available to help women during delivery. It also provided a space separate from the rest of the clinic, away from patients with contagious illnesses, where women could give birth in privacy. Since the ward’s opening, the number of clinic-based births has risen slightly, and we expect to see that number continue to rise as the ward’s capacity continues to improve.
Critically, prenatal consultations (which are essential to a healthy pregnancy) have also risen since the maternity ward’s inauguration. The number of women who are attending their first, third, and fourth or more consultations, has increased significantly. The ward also offers crucial vaccinations for mothers and newborns, and the rate of vaccinations, too, is rising. The next challenge we aim to tackle is to increase the availability of particular vaccines and the variety and quality of equipment available to the ward’s staff. The most significant improvement is in the rate of family planning consultations – the availability of professional midwives has led many more women to visit the ward to speak with midwives about their options.
Community Health Workers in the Action for Health program meet with over 900 expecting mothers on a regular basis to monitor their health and development. Since the opening of the maternity ward, the health workers also encourage these mothers to seek consultations at the clinic, where they can receive counseling, as well as most of the necessary medications to ensure a healthy pregnancy.
The impact of the maternity ward is perhaps best represented by the story of Assa. One year ago, Assa fell ill and decided to go to CSCOMSiSou, As soon as the clinic's doctor informed her that she was pregnant, the midwives gave Assa helpful advice about her pregnancy and prescribed her the medications she would need at the clinic's newly constructed maternity ward. A Mali Health Community Health Worker ensured that Assa received pre-natal consultations and met with the clinic’s midwives, from whom she received constant support and valuable assistance. In June of 2014, she gave birth to a son, Yaya without any complications or difficulties. Yaya is now a healthy and happy three-month-old boy, and Assa still receives regular visits from Oumou. In her words, “I am so grateful for the support of the clinic’s midwives and my community health worker throughout and after my pregnancy.” She continues to go back to the maternity ward when her son falls ill and for his vaccinations.
In early 2011, Djeneba, a resident of peri-urban Sikoro, became pregnant. Identified as eligible through a local survey, Djeneba was recruited and enrolled in Mali Health’s Action for Health program. Impoverished and isolated, Djeneba would not have had access to vital health services without the help of our program, but through it, she received counsel, education and monitoring by one of Mali Health’s Community Health Workers, Fanta.
That November, Djeneba gave birth to a healthy boy, Ali. Mali Health continued to monitor and aid Djeneba and Ali after birth – Fanta made frequent home visits and ensured Ali was immunized against the preventable diseases that all too often keep Malian children from reaching their fifth birthday.
Six months after Ali’s birth, Djeneba left Sikoro to spend several months in her family’s rural village. Immediately after she returned, Fanta made a visit to their house to check on mother and child and was met with an alarming sight: Ali had lost significant weight during his time away and exhibited signs of severe malnutrition. Fanta took action immediately, rushing Djeneba and Ali to the closest health center.
Through Action for Health, Ali received lifesaving medical care and access to qualified health workers. He remained in the hospital for 10 days, during which time he regained enough weight to be returned to his mother’s care. Though Ali was no longer in immediate danger, Mali Health’s work was far from over, knowing Ali would continue to require close monitoring to ensure his complete recovery.
Even after his release, Fanta observed that “Ali was so weak initially that he could no longer support the weight of his head.” Neither Djeneba nor her husband had jobs at the time, however, so Ali’s recuperation was in jeopardy. In response, Mali Health provided Djeneba with milk, grains enhanced with vitamins, fish, fruits, and legumes for Ali for the next two months. Fanta continued her close care, sometimes visiting Djeneba every day to check on Ali’s progress.
Today, Ali is 3 years old. He is no longer malnourished and lives a happy and healthy life with his mother in Sikoro. Djeneba is enrolled in our Health Savings program, where she can borrow pooled money for future health expenses or to earn a small income. Mali Health’s Action for Health program has helped 2,000 children like Ali, employing community-based solutions that not only provide for short-term health successes but also long-term improvements in education and care. Mali Health believes that everyone has the right to experience childhood without the looming threat of illness or death. Ali’s mother thanked Mali Health, stating, “I think God has sent Mali Health to help poor persons like us… May God accompany those who fund Mali Health’s activities.”
One of the primary reasons Malian families don’t seek care at the clinic is the high cost of treatment. Though we work with the clinic and other partners on initiatives to bring down the cost of a visit, the price remains out of reach for many families. Thus, through Action for Health, we provide free care to nearly 2,000 children under age 5 and subsidized care to over 900 pregnant women. Through the program, these children and mothers receive the care they need when they need it without the worry of financial burden. However, it is also our aim to create models in which families can better support themselves. We want to foster independence so that all families can access the care that they need with or without our assistance. So, in 2013, we launched the innovative Health Savings program.
Through the program, groups of women from across the community come together weekly to learn about preventive health care and financial management. These women also deposit small amounts of money into two collective accounts. In the first, members draw loans to support revenue-generating activities, such as starting a small business. From the second, women access no-interest loans in order to cover health costs at the local clinic. At the end of a cycle, women are returned their savings, along with the dividend through interest earned, and encouraged to make good on initial commitments to allocate funding saved to preventive health products. By removing the burden of cost from a single family, these women can now ensure that they and their children seek treatment as soon as they need it and can afford to follow the treatment as long as necessary.
Assan O. is a recent beneficiary of one of these health loans. When she fell sick, she was unable to carry on her business, and stopped earning an income. At first, she was afraid to take out a loan from her Health Savings group because she feared she wouldn’t be able to pay it back in time. She sought treatment at the clinic with the little disposable money she had, but it didn’t cover the medicines the doctor prescribed. Assan couldn’t afford the medication, and so she went without it for days, her condition worsening.
When the Health Savings coordinator visited Assan, he could see that her health was not improving. When she told him why she didn’t take a loan from the group, he assured her that she need not worry – they would find a way to help her repay her loan. She borrowed enough funds to purchase her medication. Her health improved very quickly after that, and at the next Health Savings group meeting, she explained the situation to her fellow members. They understood her predicament and granted her 60 days to repay her loan, rather than the usual 30, enough time for Assan to return to her business and earn an income once again. After 47 days, she repaid her loan in full.
Asked afterward how she felt about the Health Savings program, Assan said, “This is very important to the women of this community. With initiatives like this, we will not be afraid to reach out for care for a lack of money because with the health fund, there is hope.”
Dozens of women have benefitted from the loans they withdrew from their savings groups since the program began. Some, like Assan, have paid for health costs. Others have used their loans from the general fund to start or expand their businesses. Aicha S. from Bandiagara Coura used her loan to build on her already-successful small business selling earrings. She put the funding toward expanding her collection to include beads, necklaces, bracelets, and makeup kits. With the extra money she has earned from her new products, she paid back her loan within a month and now is earning more than ever.
Health Savings drew its first cycle to a close earlier this year, and group members and non-members alike made it clear they wanted a second cycle to begin immediately. Over 130 women participated in the first round. Between them, they withdrew nearly 75 loans, 17 of which directly subsidized health care costs. Over the course of the first cycle, group members learned not only about managing their money, but also about the importance of seeking early treatment for their illnesses, how to recognize danger signs in children, and what a woman can do to ensure she has a healthy pregnancy.
With International Women’s Day this month (it was March 8th this year), we are reminded of how much power women possess to be change agents in their communities. The health and education of women has a direct and irrefutable impact on the wellbeing of their children, and thus on the future of the entire community. Through Action for Health, we are ensuring that mothers receive the care and education they need so that they can keep their families healthy. And through Health Savings, we will help those same women to build the independence they need not only to support their families, but to have the power and resources to shape and change their communities for the better.
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