Health
 Mali
Project #3185

Action For Health : Empowering Communities in Mali

by Mali Health Organizing Project
Vetted
Mah Diarra & Daughter
Mah Diarra & Daughter

By the end of the second quarter in 2016, Mali Health began enrolling children into our Action for Health (APS) program in two new sites—Sibiribougou and Sabalibougou. These sites already benefit from our Savings for Health (EPS) program, and serve as a pilot to test the impact of a continuum of financial and health services: new APS enrollments must already be enrolled in EPS to qualify. In this way, families benefit from a complete package of care and support from Mali Health’s community health workers, facilitators, and trained medical staff in health centers. The continuum of care alleviates financial and geographic access barriers, while providing health education and information from health professionals such as medical staff, mid-wives, and our own health workers.

Enrollment is on-going, and since early-summer 2016, we have added 100 new children into the APS program. Our programs team has already discussed logistics with the new health center staff to describe the program, its benefits, and expectations for beneficiaries. Our Health Communications team, including 8 new health workers, are already conducting door-to-door visits to check in on children’s overall health and nutrition, and to teach parents about disease prevention and healthy behavior change. Our health worker supervisors have already described the benefits these families will receive as a member of the APS program while seeking care in the community health centers. The missing piece that we’re working on right now is the signing of the official legal document between Mali Health and the Community Health Associations (ASACO) that will allow Mali Health to take financial responsibility for the care of their patients in the clinics.

At a glance, the continuum of care looks like this: Mothers and pregnant women are enrolled in Savings for Health. In this program women receive weekly informational and educational sessions, including visits from mid-wives, maternal health experts, and other guest speakers to advocate for facilities-based deliveries, prenatal care, and childhood vaccinations. These women are also saving a self-determined amount of money that goes towards general health or to pay for the cost of prenatal consultations and assisted deliveries. In our new sites, these families are simultaneously enrolled in Action for Health. In this program they benefit from frequent, proactive home care visits by their Mali Health community health worker. During these sessions families discuss health and behavior education, or receive free or subsidized health care at the local clinic, depending on the age of their child.

The idea is that mothers will be saving money in their health fund for the first two years that Mali Health offers free health care. After two years, Mali Health subsidizes health care at an amount that covers the most common illnesses. Anything that exceeds that amount should be easily covered through the accumulated health savings. In the case of pregnant women who deliver, their health savings cover the cost of prenatal consultations and facilities-based deliveries, which APS does not cover. The financial shock is completely absorbed through their health savings. APS continues to follow children closely throughout the first 1,000 days, including nutrition, disease prevention, and disease treatment.

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A year ago, a coughing child might have been a serious concern for Oumou, a mother of two in Bamako’s Lafiabougou neighborhood. Pneumonia is one of the leading causes of death for children under 5 around the world, and particularly in Mali. Despite living within a stone’s throw of her community clinic, it seemed impossibly far when Oumou was forced to choose between feeding and clothing her young children for a month, or spending all of that month’s money on a single visit to Bamako’s pay-per-use health system. 

Oumou’s situation is shockingly common across Mali. Half of the population lives below the poverty line and 1 out of every 6 children dies before their fifth birthday from treatable illnesses like pneumonia. Oumou doesn’t hesitate to list several neighbors who have lost children in her neighborhood over the years, or other families who couldn’t afford to access basic health services for their children. So when Konouba, Oumou’s 2-year-old daughter, started coughing, Oumou had every reason to worry—that is, until late 2014.

Oumou’s family was identified by a team of Mali Health community surveyors for enrollment in our Action for Health program. Families are eligible for Action for Health because they fall below a set of economic and health indicators that place them among the most vulnerable members of our community. As a participant in Action for Health, Oumou now receives free health services for her children at the local clinic, still a stone’s throw away, but no longer separated behind impassable financial barriers. 

Along with free consultations and medications to treat Konouba’s cough, Oumou’s family receives regular health education counseling at her home, during Community Health Worker (CHW) home visits. Oumou says one of the most important skills she learned from her Mali Health CHW is how to prepare Oral Rehydration Solutions (ORS), which combat the devastation of diarrheal illnesses—another leading cause of child deaths worldwide. The ingredients to ORS are so deceptively simple that Oumou was surprised at how effective the home treatment actually is. Oumou welcomes these bits of knowledge that she can apply directly in her home, because she feels more independent and in control of her family’s health without having to make difficult sacrifices, like food or clothing.

Since 2010, Action for Health has empowered thousands of people like Oumou to play an active role in improving their families’ health. Through the community outreach efforts of our CHWs and increased civic engagement of our participants, clinic visits continue to increase beyond the national average and more parents seek care for their children within 24-hours of recognizing the first symptoms of illness—another set of skills CHWs include in their home visits. As a result, the child mortality rate among our Action for Health participants across six project sites in Bamako has fallen to zero. Mali Health is expanding the program to save even more lives.

Sometimes Oumou says that she feels like a health worker herself, spotting sick children around the neighborhood and advocating for the healthy behaviors she learns from her CHW, with her friends and neighbors. Oumou wants to contribute to a healthier environment so that new parents will never experience the fear that the sound of a coughing child can signal. Instead, they’ll know that the cure to a simple cough is only a stone’s throw away.

Mali Health employs a strong team of Community Health Workers (CHWs) to ensure the health of children under five and pregnant women in the most vulnerable peri-urban communities of Bamako. These CHWs are members of our beneficiary communities, which facilitates community engagement and draws on local knowledge and strengths.

The mHealth project supports our health workers in managing community-based healthcare. Through the mobile phone app, CHWs collect specific information on children’s health, including vital signs like weight, height, and temperature. Mapped against the World Health Organization’s standards for healthy growth in children, if the information registered in the app indicates even a moderate level of under-nutrition, the app automatically prompts the health worker to connect the child and his or her caregiver to the formal health care system to seek treatment to help raise the child’s weight. The app also facilitates follow-up care, reminding CHWs which children in their case load have recently been treated and require more frequent in-home visits until the regimen is complete.

The health data collected through this project also allows Mali Health to track community trends and adapt our health education initiatives to respond to the realities in each community. This information can also be shared with local health clinics and local and regional affiliates of the Ministry of Health so that it can be included in regional and national health analyses.

Our current application was developed in 2014 in collaboration with D-Tree International and is used in the communities of Boulkassoumbougou, Lafiabougou, and Sotuba. For the next phase of our mHealth project, we’ve partnered with the Center for Expertise and Research in Telemedicine and e-Health (CERTES), a Malian company that specializes in health informatics. CERTES is developing a new application for our Action for Health program that expands upon the features of the current application and adds the ability to gather health data for the pregnant women and newborns in our programs. The new system uses a hybrid of CommCare, a mobile application used globally by field workers for data collection and case management, and DHIS2, an analytic application that is used to manage national health systems in several African countries. With this new system, we expect to expand mHealth at the end of May to six communities in total and 38 Community Health Workers using the mobile app.

Student in Mali Health Shirt
Student in Mali Health Shirt

To celebrate Global Hand Washing Day on October 15th, Mali Health organized a grand celebration for children from the communities of Sikoro and Sébénicoro. Mali Health’s team welcomed the mayor of Sébénicoro, school officials from the two districts, and teachers from the two participating schools to celebrate hygiene and hand washing practices at a public school in Sébénicoro. 

Under a banner reading, “Water, soap, and hands are inseparable friends in order to reduce pneumonia and diarrhea. I wash my hands to maintain my health, and how about you?” hundreds of children packed in around an open stage to participate in the excitement of Global Hand Washing Day. Mali Health emcee and DJ Abdou got students and teachers dancing with Malian music and led the afternoon’s events. Mali Health’s medical advisor, Dr. Diak, emphasized the importance of the celebration, reminding the audience that washing hands before eating and after going to the bathroom is the most cost-effective way to prevent pneumonia and diarrhea. Nearly 30 students from the two participating schools came prepared for Mali Health’s Hand Washing Olympics, each wearing the event’s specially designed t-shirt reading, “I like the people around me. I wash my hands with water and soap in order to maintain my health AND my friends’ health.” 

The first competition was a demonstration of how to properly wash hands using soap and water. From each school, one student demonstrated and another described the proper hand washing technique in detail. To reinforce their perfect demonstration, one of our Community Health Workers also showed the crowd the correct way to wash their hands. Afterwards, Toure brought up eager volunteers from the crowd to answer tricky questions about hand washing, and many of them answered correctly to receive prizes of soap and packages of bleach.  

The atmosphere was festive and entertaining, as the students’ enthusiasm and creativity got the audience excited about the hand washing celebration. Each school presented a skit to show how easy and important hand washing is. In one skit, a group of family members sat down to eat dinner, and the daughter who forgot to wash her hands had a stomach ache afterwards. Another competition required that students write and perform a song about hand washing, and the lyrical voices of the singers got the audience humming and clapping along. Two teams also showed hand-made drawings of each step of hand washing. 

At the end of the day, the Sébénicoro students ended up winning the contest, as decided by a panel of Mali Health judges. Nevertheless, we gave out nearly 15 sets of hand washing buckets, solid and liquid soaps, and packages of bleach to both of the participating schools. All students from the two schools had also recently received free medical consultations from Mali Health. The mayor, school directors, and Mali Health staff members handed these gifts to the students and teachers, who were thrilled to receive their well-earned rewards.

Participating Students
Participating Students
School Teachers Dancing
School Teachers Dancing
4 children in Action for Health
4 children in Action for Health

This year in Mali, 1 in 8 children will die before their fifth birthdays.  That means that among the 2,256 children currently enrolled in our programs, we would have lost 282 young lives to completely preventable and treatable diseases like malaria, pneumonia, and malnutrition. 

But that didn’t happen.  You didn’t let it. 

Because of your support, we have not lost a single child to disease in nearly two years.  That’s incredible.  In a country ranked the fourth hardest in the world to be a child or mother,* not one family among the thousands in our programs has suffered the loss of a mother or child. 

They, and we, have you to thank.  Your support ensures that every family has access to the high quality care they need to stay healthy.  You allow us to train doctors to give the best care possible, and you help us send Community Health Workers to meet the hardest-to-reach families in their own homes.  Together, we’re building a continuum of care to guarantee that every child gets the healthy start she deserves. 

282 children will celebrate the new year with their families in just a few weeks because of you.  I’m sure if they were in your living room right now, they’d say “i ni ce, n terimuso.” (That’s “thank you, my friend.”)

With gratitude,

The Mali Health Team

 

*Save the Children's State of the World's Mothers Report 2015

 

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Organization Information

Mali Health Organizing Project

Location: Cambridge, MA - USA
Website: http:/​/​www.malihealth.org
Project Leader:
Stephen Muse
Operations Manager
Westminster Station, VT United States
$84,712 raised of $150,000 goal
 
1,062 donations
$65,288 to go
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