Action For Health : Empowering Communities in Mali

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.” 

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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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