Action For Health : Empowering Communities in Mali

Halfway up the face of a steep and rocky hill in the community of Sikoro lives Fatoumata and her family. Fatoumata, a mother of four, begins to share the story of when two Mali Health community health workers first visited in 2011. Alimata, Fatoumata’s mother-in-law, adds, “the women asked about my son and whether he worked and if that work came with a monthly salary.” She told the women then that her son worked odd jobs, but the jobs didn’t come with a reliable monthly salary - passing prayer beads through her fingers as she recounts the story. With a young toddler in the home and a low, unsteady income – the family was eligible for, and joined, our Action for Health program.
 
Sonata C., a friend and neighbor, became their community health worker. Sonata shares, “The family’s first daughter, Amitou, was about three and a half years old in 2011. Since that time, I have been working with this family as it has grown from one to four children. The next three children were all enrolled into Action for Health at birth.” Fatoumata notes, “We have known Sonata for many years. Every day she comes over to greet us and the children. If the children show any sign or symptoms of illness she tells us to take them to the health center immediately.”

Amitou, now a healthy nine-year-old enrolled in school, helps to look after her three younger siblings—a brother, Seydou, age 7, and sisters Aminata, age 5, and Niekoro, age 2. Neither Fatoumata nor Alimata work, leaving Fatoumata's husband, N'Golo, the sole provider for the family. Alimata reflects on how the family agonized over what to do when their oldest child became ill: "before Amitou was first enrolled, my son would say to buy traditional medicine to treat her illnesses. Traditional medicine is cheaper, but it doesn’t always work. Now, since my grandchildren have been enrolled in Action for Health, my son tells us to take the kids to the health center right away. Now he is content, and he and my daughter-in-law don’t struggle about it anymore.” 

Amitou, Seydou and Aminata have grown up with access to basic primary care whenever they needed it – and today, they are strong and healthy. The youngest, Niekoro, is still covered and just recently became ill. Her mother describes her relief at being able to act quickly to take care of her daughter. “As soon as I recognized the signs, my husband and I agreed that I would take her to the local health center just down the hill. I bring the health card that Mali Health gave us and that helps a lot with the doctor. Before, without the card, the doctor would be scared that you would not have enough money to pay. Sometimes you would only have maybe $2 or $4 in hand, and the doctor and the medicine might be $6 - $10, or more. So, we wouldn’t be able to buy the medicine and would have to get traditional medicine instead. Now with the Mali Health card, the doctor is very nice, and he gives us the consultation and medicine, and we don’t have to wait long either.”

The benefits of Action for Health extend beyond just immediate access to healthcare for the family. “Now, with the money we would have spent on doctors and medicine, we use it to buy good healthy food, decent clothes for the children, and a bit goes to cover their monthly school fees too,” says Fatoumata. As she recounts her family’s story, she points to her daughter, Aminata, who, unprompted, grabbed a bucket and a bar of soap and is washing her hands. “Aminata learned to wash her hands with soap from Sonata. She taught everyone to do this regularly during the Ebola crisis, and Aminata has been doing it ever since.” Aminata turned five years old last June, graduating from the Action for Health program. 
 
“My son is thankful for Mali Health and for Sonata too,” says Alimata of her grandchildren’s participation in the program and the community health worker it has provided to their family. “We are all thankful.”

Kalabambougou is not far from the bustling streets of Bamako’s city center, but after leaving the paved roads behind, drivers go from dodging the moto bikes that weave in and out of traffic to skirting the car-sized pot holes formed by the deluge of the rainy season. The pot holes have recently been filled with large boulders that will be smashed into smaller pieces with sledgehammers – daunting work, made more intolerable by the relentless heat and humidity. Maintenance of these dirt roads throughout the year is vital to the community because it is their access to Bamako, the markets, and to the nearby community health center.
 
It is late afternoon and the women begin arriving at the meeting location for their weekly savings group, in the shade of an old moringa tree. Korotoumou, 25, is there with two of her six children and she is steeping the first round of sweetened green tea for the group’s members. There are freshly roasted peanuts for sale and another woman is selling chunks of juicy watermelons. One group member braids another’s hair, and a young girl is hanging brightly colored clothes on the line to dry. This is where the members of Ben Kadi and Yelen (one group with two names, translating to “Mutual Understanding” and “Light”) meet to give themselves and their families the opportunity to save for their future needs. The group has two names because there are two things the women save money for: healthcare and small business activities.
 
Korotoumou is the group’s treasurer, and when she isn’t meeting with the other women, she is busy with her small business, selling vegetables at the nearby market, or doing the never-ending work to keep her home functioning (cooking, cleaning, minding the kids). Her oldest child is eleven and her youngest is the nine-month-old girl in her lap commanding her fullest attention. She thinks education is important, so her five school-aged children are all enrolled at the nearby public school. Korotoumou and her husband, a local brick mason, had limited education when they were younger. He was schooled for eight years at a traditional Islamic school, or Madrassa, studying the Koran, and she has a fifth-grade level education from a public school.

Korotoumou was in a savings group before Mali Health introduced the idea of adding a health savings aspect. She says that contributing members feel a new sense of ownership for their family’s health needs. Before the health savings group, when one of her children fell ill and required a visit to the doctor, there was concern about how she would be able to pay for the visit and any needed prescriptions. She did not like having to ask family or friends for a loan because it made her and her husband feel embarrassed. Now, with the option of being able to take a health loan from the savings group, they feel a sense of pride in being able to do for themselves what so often they had to rely on others for.
 
There was a health center built in Kalabambougou a few years ago, but it never opened. There is a solar-powered water tower that is empty and beginning to rust, a maternity ward with gurneys and delivery areas that are collecting dust and cobwebs. The grounds are serving as a temporary farm field for the family tasked with caring for the vacant health center until whatever local political dispute preventing its opening is resolved. Korotoumou shakes her head and laughs when she talks about why the health center hasn’t ever been opened because she believes there isn’t anything she can do about it. It would be convenient to have a closer health center; the closest one with which Mali Health partners is more than three miles away, so she and her family use the one in the next town over because it is a shorter distance.

When one of Korotoumou’s children falls ill, she knows it immediately because instead of running around playing with friends, she says they remain at home asking to sleep and lay down. This is a telltale sign and she can now go to the health center with confidence that she will be able to afford the visit and any treatment. She and her husband will wait at least 24 hours after feeling ill to see if the symptoms will clear up on their own, but she doesn’t wait that long for her children because she knows they are at greater risk and require timely treatment. The most frequent illness the family encounters is malaria, which is especially prevalent during the rainy season as the mosquito population booms. She and her husband still use traditional herbal medicine to treat less severe cases of malaria because it is cheaper than western medicine, and in their opinion, just as effective.
 
The institutions that Korotoumou and her family rely on are fragile and it is difficult for her to feel secure in their future. She said what used to keep her awake at night was the fear of not being able to care for their children’s health needs, but with the Savings for Health program, she can now rest a little easier. The collective nature of the savings group gives her confidence that her community cares, and instills in Korotoumou a feeling of agency in being able to contribute to the better health of not just her children, but many other children in Kalabambougou.