Health
 Mali
Project #3185

Action For Health : Empowering Communities in Mali

by Mali Health Organizing Project
Vetted

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

CHWs from Lafiabougou
CHWs from Lafiabougou

What would you like to say to Mali Health’s supporters?

Birama: We send our supporters a big greeting. We thank you for your generosity, and we are excited to continue working with you to fight against malnutrition and maternal and child mortality.  We need your help to promote the health of our communities – to give our communities high quality healthcare. 

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How does your work help the community?

Birama: We surveyed families in the community to find those who need help paying for health services. Those who are enrolled in the Action for Health program get financial support when their children are sick, and it is our work as CHWs to find those who are sick and refer them to the health center.

Fatoumata: Our work helps reduce the cost of care for people because we help them pay medical costs and refer their children to the health center so they know when it is really necessary to go.

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How has your perspective on health and healthcare changed through your work?

Aminata: Before I started working with Mali Health, I had heard false information about the health center. But now I know it is a good center and does quality work.

Kadidiatou: Before we CHWs started working in the community, many people refused to come to the health center because they didn’t know what kind of services were provided and there were rumors that the doctors only practiced traditional medicine. But now they know those rumors are false and, because of us, the health center is highly attended.

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What skills have you learned from your work?

Kadidiatou: I have learned so much about health, including details that I never knew before, like how many prenatal care visits a woman must attend when she is pregnant.

Aminata: I enhanced my public speaking skills as I have spoken in front of large groups of people during health fairs.

Abdoulaye: I learned how to look for danger signs in children’s health and how to communicate with the motive of changing people’s behavior.

Birama: I have become more kind, sensitive, and open to the problems of others. My ability to understand people and know their needs has progressed so much. I have learned to highly value others and put myself at their service.

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How has your work affected your relations with your family and your community?

Abdoulaye: My work has greatly enhanced my relations with my family and community. I am respected now in the community; they love my work and support me personally. This job has helped me get to know the people in my community and helped them to know me.

Birama: The community knows now that there are people among them who are very interested in their health and the health of their children.

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What is your best experience with a family you visited?

Aminata: I remember at one house I visited there was a child who was very sick and malnourished. The mother was so worried. I sent the child and her mother to the health center for the child to join the malnutrition program there. The girl came to the health center each week for the program and gained weight and got better. If you had seen the girl when she was sick and saw her now, you would say she’s not the same girl because she looks so much healthier.

Birama: There are lots of stories like that!  I was at a house once where the maid’s child was sick with malnutrition and a cough. I referred the child to the health center where he joined the malnutrition program and was given nutrition supplements. He recently had a weight and height analysis at the center and has gained weight. I actually just saw him last night and he has grown so much!

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Why did you choose to become a CHW?

Aminata: We love our work because we get to help people, especially young children. The projects we work on are very good and help many.

Birama: I chose to work with Mali Health because I support them. They fight against poverty. If you support our programs, that helps us to help our own families and our own communities. I would also like to be a financial supporter of Mali Health one day when I have the means.

Fatoumata: I am very happy to be a part of this team. We work on projects that truly help the poor.

Abdoulaye: I was unemployed, but Mali Health came to our community and now I have a job. At the end of each month, I can go out and buy things for my family that I could not provide before. This job supports our daily lives. 

Kadidiatou: Mali Health taught me so many things concerning health—things that will allow me to aid my community and help my own child in the future. Even if there was another job available, I wouldn’t leave Mali Health, because I adore this organization. 

Kadidiatou
Kadidiatou
Birama
Birama
Abdoulaye
Abdoulaye
Aminata
Aminata
Fatoumata
Fatoumata

Links:

 

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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

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