One week from tomorrow, the Mali Health office will be full, our new cadre of Community Health Workers reporting for duty for their first days of training, a two week course designed and led by local medical staff and our own Medical Advisor. The hiring of these 12 new frontline field workers is the latest step in a nearly yearlong process of preparing for our next month’s expansion – the organization’s largest in its history. By the end of October, we’ll be supporting 1,600 children under 5 years old with free care for 90% of all childhood infirmities (like diarrhea and malaria), and nearly 8,000 individuals in the Sikoro-Sourakabougou community with subsidized prenatal services, health education modules, and malnutrition prevention programs. Additionally, the upcoming extension will be rolled out in tandem with a rigorous program evaluation performed by Brown University and implementing partner Innovations for Poverty Action (IPA), measuring the effectiveness of our Action for Health interventions through a multi-year randomized control trial, elevating further our excitement – and the potential impact – surrounding this expansion.
As proud as we are to be able to support and develop a population of this size, equally impressive has been the process to arrive at this point, meticulously undertaking a number of steps that ensure Mali Health is reaching the populations we target – the poorest and most vulnerable women and children – and using our resources most effectively.
Preparation for this expansion began months ago, commencing with a meeting with the region’s traditional leaders in January, 2012. Together, we identified a number of potential zones to work in – those poorest and most geographically isolated from access to basic and governmental services. Specifically, criteria for inclusion included:
Having originally identified 8 areas, our general criteria helped us limit it to the following five within the greater Sikoro-Sourakabougou area:
Once the areas were selected, we undertook a massive survey to identify which households and families would be eligible for the expansion. Working closely with Brown and IPA, we to structured the survey carefully to attain the large amount of information we needed, while making it as logistically feasible to administer and keeping reasonable the amount of time each survey took. In the end, we focused on a wealth index that indicated just how much each household spent on food, per person per day. Under a certain amount, and that family would be eligible for program participation
Upon completion of the design of the survey, we hired and trained a team of 12 to implement it within each zone. Trained in specific capacities like GPS systems and obtaining consent while working in teams of two throughout the community, surveyors spent two months undertaking the laborious process of interviewing thousands of families to collect the pertinent consents and household status information, and bringing that data back to the Mali Health team. One supervisor was responsible for monitoring the work, accuracy, and accountability of the team.
Finally, the last phase of the survey was selecting eligible households given all of the data and cases collected. Our analyst calculated the average food costs to determine how much was spent on each person (weighted for age). Any household where the daily food expenses were less than 475 Francs CFA (roughly $0.93) per adult were considered eligible. In the end, over 2,500 households were surveyed with nearly 1,900 children.
Not without challenge, the survey was implemented in the context of one of Mali’s most challenging and uncertain periods. During a coup and its aftermath, that included a bloody counter-coup in downtown Bamako, just miles away, Mali Health’s local staff applied each step with the dedication and rigor necessary to achieve accurate results. As the staff now prepares to welcome into the program the fruits of this labor, requiring a larger team and larger demands on our existing coordinators, the precision of the process itself warrants recognition of those who implemented it, and gratitude to the many contributors that have continued to support us during such a volatile time for the country. It’s only through this dedication on both sides that we stand ready. And ready we are.
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