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Aiming for Universal Healthcare in Mali

Universal Healthcare is Saving Children in MaliBeing a child in the impoverished, conflict-riddled country of Mali is not easy. Lack of healthcare is one of the major factors contributing to the issue of child poverty. One in 10 children does not live to see their fifth birthday. The primary causes of death are pneumonia, diarrhea and malaria. All these diseases are completely preventable. Children who survive must often work to help provide for their families instead of getting an education. The Malian government is aiming for universal healthcare in Mali, starting with a focus on pregnant women and children under 5.

Conflict in Mali

Mali is a landlocked country located in West Africa and one of the most poverty-stricken nations in the world. The U.S. Agency for International Development (USAID) reports that 49% of Malians live below the extreme poverty line. With more than half of the country’s entire population under the age of 18, child poverty is an ongoing crisis.

Mali gained its independence from France in 1960 and has since struggled for stability. Decades of conflict have wreaked havoc on the people living within Mali’s borders.The most recent conflict began in 2012 when a group of rebels, backed by several Islamic militant groups, overthrew the government in a military coup. These alliances did not last long, and as a result, sparked violence that spread across the country. The struggle for land and power continues to this day. In 2018, nearly one-third of Mali’s population lived in areas directly affected by the conflict. As war wages on, child poverty in Mali continues to increase.

A Child’s Life in Mali

Mali’s youth have taken the brunt of the devastation caused by the continuing violence. Many lack necessities like access to clean water, food, education and healthcare. Children under the age of 5 are most vulnerable, and without accessible healthcare, many preventable diseases turn deadly.

Before the 2012 conflict, great strides were being made in the development of programs and policies to improve the conditions of child poverty in Mali. Infant mortality was on the decline, the number of children enrolled in school increased by 10% and there was a dramatic rise in birth registries. Registry of birth is extremely vital because when a child is unregistered, they do not carry the same rights and protections as those who are. Registration at birth assists in securing a child’s access to human rights protections under laws against child marriage, labor and recruitment into armed forces before the legal age. Without documentation to prove identity, education, healthcare and the right to vote become inaccessible.

UNICEF’s Efforts

The country’s instability has halted much of the progression. However, humanitarian organizations like UNICEF, continue to work toward the goal of ensuring every child’s rights are upheld. UNICEF is currently working on four key elements of child welfare in Mali:

  1. Vaccinations: UNICEF targets communities with the highest number of unvaccinated children and uses proven strategies to supply vaccinations for the most common diseases.
  2. Malnutrition Prevention: Educating families within the first 1,000 days of life on proper nutrition, vaccination benefits and hygiene has been successful in decreasing infant mortality rates.
  3. Education: Distributing learning materials and helping train teachers to ensure children have the best quality education possible is a high priority.
  4. Child marriage: UNICEF is assisting the Malian government in developing policies to end the practice of child marriage. This entails encouraging leadership on local levels to adopt progressive policies that promote social change for the betterment of the female children in their communities.

The Good News

The Malian government says it wants to see improvement in the lives of its people. For this reason, it is actively working to ensure free healthcare is available to all citizens. The ultimate hope is for universal healthcare in Mali.

Data obtained through a lifesaving pilot program that began in 2008 provides promising news. This trial program provides door-to-door healthcare in the town of Yirimadio, which is located just outside Mali’s capital city of Bamako. When the trial began, the child mortality rate was 154 deaths per 1,000 births. Upon the trial’s completion, the child mortality rate had decreased by a staggering 95%.

This free door-to-door health care program was so successful that Mali’s government has committed to having this healthcare program available nationwide by 2022. At this time, the plan is offered to pregnant women and children under the age of 5. Mali’s health minister, Samba Ousmane Sow, said, “We are trying to make Mali be great again, to improve our healthcare system and save lives and we are hoping this will help us reach universal healthcare with a very powerful, improved system.”

The Road Ahead

The primary concern is ensuring healthcare professionals have the training and provisions to provide the service. The Malian government is seeking ways to become self-sustaining in its quest for universal healthcare as it is saving children in Mali. Currently, it is reliant on external donors to supplement government funding. Nonetheless, amid conflict, there lies hope for the future.

– Rachel Proctor
Photo: Flickr

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The Beginning of Universal Healthcare in Mali

Universal Healthcare in Mali
In early 2019, the government of Mali made an announcement that shocked the global health world: it would make healthcare free at the point of service to pregnant women and children younger than 5. The country had achieved universal healthcare in Mali.

The Situation

In a country where poverty and healthcare outcomes were in dire straits, the move to provide universal care for the most vulnerable demographic in Mali was welcome and necessary. Previous to the 2019 decree, Mali had disastrous health outcomes.

About 106 children out of 1,000 live births would not survive delivery. Adding to the issue was the fact that 587 per 100,000 mothers would not survive delivery either, one of the highest rates of maternal mortality in the world. Only malaria and digestive diseases claim more lives in Mali.

In order to diagnose the problems with Mali’s healthcare, a historical context is necessary. With that understanding, the new approach reveals itself to be necessary, positive and inclusive.

Post-Colonialism

After Mali’s liberation from France in the 1960s, the nascent country fell back on the healthcare system that was already in place. That system emerged 50 years prior and had not evolved with the needs of the populace. It would not change until the 1980s.

The Bamako Initiative

Launched in 1987, the initiative came under recommendation from both UNICEF and the World Health Organization (WHO). Named after the capital city of Mali, the initiative proved problematic, pushing Mali’s people into poor health outcomes.

The initiative called for patients to pay for things like health services and drugs to offset costs and insufficient funds. The system requirements led the impoverished to avoid seeking care.

Post-Implementation

The free to pregnant mothers and children younger than 5 policy has already yielded benefits. The new model re-centers care away from costly hospital services to community-based care.

Nurses can now travel door-to-door to service mothers and children younger than 5 without fees. The results have been stunningly effective, with infant mortality rates dropping by 95% in the Bamako district.

Dr. Ari Johnson, a professor of global health sciences at the University of California, San Francisco heralded the approach: “The ministry of health [in Mali] has taken a very brave and bold political move to make real, evidence-based healthcare change.”

The approach serves as a model example; One that Mali hopes will become the standard across Africa. Johnson continues with optimism, stating that he hopes the new approach will: “make Mali a leader in health sector reform on the African continent.” Universal healthcare in Mali was no longer out of reach.

The COVID-19 Pandemic

Although Mali has experienced strain due to the pandemic, U.N. Secretary-General António Guterres has noticed Mali’s new model of healthcare. He called on nations to implement Universal Health Care for all nations in order to beat COVID-19. He stated that “The pandemic has revealed utterly inadequate health systems, yawning gaps in social protection, and major structural inequalities within and between countries.”

Guterres continued on to make the connection between robust systems and access, stating that “… we cannot wait 10 years. We need Universal Health Coverage, including mental health coverage, now, to strengthen efforts against the pandemic and prepare for future crises.”

Foreign Aid

A number of Western nations have come to Mali’s aid. The impoverished nation, just starting on its new policy, has found itself hobbled by the current crisis. Experts see support for the nation, and its new health policy, as crucial.

The Netherlands

The Project to Accelerate Progress Towards Universal Health Coverage (PACSU) is a joint effort between the Dutch Embassy and the Global Financing Facility, the World Bank and the Ministry of Health in Mali. Learning from the impact of previous health crises in the region, the Netherlands’ support will focus on pregnant mothers and newborns.

When the Ebola crisis hit the region in 2014, a startling trend of infant and maternal mortality gripped Mali. Resources became scant and pregnant women were unable to secure the necessary health services to ensure a successful birth. PACSU will provide facilities, professionals, equipment and any other resources necessary to the ailing system during COVID-19.

USAID Takes Action

The United States Agency for International Development (USAID) will join the fight as well, supplying $45 million to Palladium, an international development firm. The organization will provide support to reinforce Mali’s health systems and financing, providing access to high-quality care. Two programs, the Human Resources for Health 2030 (HRH2030) and the Human Resources for Health Strengthening Activity (HRHSA), have not been successful and will undergo expansion.

These programs, in concert with Mali’s Ministry of Health, will focus on the decentralization of health services. Training, motivation and safety for new medical professionals, particularly in the prevention of illness among both patients and healthcare workers are crucial to the program’s success.

Universal healthcare in Mali is critical from many standpoints. Not only does it provide relief for the historically impoverished Sahelian country itself but it serves as a model for the rest of Africa. The refocus on community health improves access and financing. Once again, Africa leads the way in methodology, access and care during the struggle against COVID-19.

– Christopher Millard
Photo: Flickr