In an effort to appease the left brain with the right, please excuse a number-crunching update as we begin to share some important result from an exhaustive study currently being conducted on our programs. Since last year, Mali Health has been working professors of health economics at Brown University to launch a randomized control evaluation of Action for Health. The multi-year study aims to clarify the impact of free care and community health worker visits on the health of our target children, and provide analysis on health behaviors in similar communities. For us, it’s as much an opportunity to analyze our own impact as it is a chance to contribute to the greater field of international health and development.
The first step in this evaluation was a baseline survey, conducted last August 2012 with over 1,000 families, to measure indicators and conditions before any intervention has taken place. For Mali Health, the results of the baseline offer a clear picture of the financial and health status of our target families. With a focus on income, expenditures and assets, the survey showed that members of our program spend an average of $1.25 per person per day, living directly on the World Bank-defined poverty line. The average family size is 6 individuals, while half of these families live in just one room. Residing in a semi-urban area, a majority of families have access to electricity and latrines but almost none have running water. Most families get their drinking water from public taps, and close to a quarter drink well water. Additionally, 63% of the parents in our target families are illiterate, and only 15% have education beyond primary school.
Using techniques from behavioral economic research, the baseline explored Malians’ beliefs about health and health care. Here’s an example: “Suppose one day you hear about 10 children from your neighborhood, each with a fever for four days. Of these 10 children, how many do you think would start getting better the next day if their mothers sought x treatment?” In response, women estimated that only 20% would recover with no treatment, but that 75% would recover following a visit to a public clinic. (Mothers also estimated that 49% of children would recover with treatment from a traditional healer and 36% from an unlicensed pharmacy, confirming their confidence in the health system). These results indicate that our program participants see the value of medical treatment in leading to positive health outcomes.
Despite this confidence, however, related behaviors indicate an aversion to the clinic when children get sick. During the 6-week survey, when a child fell ill, nearly one-third failed to access any sort of care, one third accessed informal care, defined as traditional medicine, herbs, or unlicensed pharmacies, and a last third had some form of access to the primary health system. Under 1 in five children received care in a facility when sick. The tendency to avoid medical facilities may be related to cost, as families in the survey paid on average $2.71 for care, whereas the care for a child enrolled in Action for Health costs about $7.00 at a public clinic, indicating a significant gap in what is financially needed and what is financially accessible.
A lack of accessible and timely medical care is one of the primary causes of Mali’s high rate of child mortality and this survey indicates that children are not receiving care when they need it most. But those children enrolled in our programs are able to access care; children enrolled in Action for Health are much more likely to visit a doctor when needed and much less likely to die from treatable diseases.
The information that Mali Health gained from the baseline will allow us to better plan our programs. But this is just the start. Moving forward, this evaluation will allow us to truly understand the difference our program – and others like it – can make. The families surveyed last August began receiving services through Action for Health in December. Today, we are already preparing for the “Year-1” round of surveying in August, with the continued support of Brown University and new partners at the Aga Khan Development Network. As valued partners in our efforts to improve child survival in our own geographic footprint and beyond it, we invite you to stay tuned over the summer and into the fall as we share and build on these important lessons in global health.
By Devon Golaszewski, Programs Director. Special thanks to Anja Sautmann and Mark Dean, Professors of Economics at Brown University and co-Primary Investigators, and Samuel Brown, Research Assistant.
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