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Community-Based Health Program Reduces Child Mortality in Mali

Malian children sing at a Koranic school in Gao, northern Mali, Feb. 13, 2013.
Malian children sing at a Koranic school in Gao, northern Mali, Feb. 13, 2013.
An innovative new health model run in Mali since 2008 has dramatically reduced the number of children dying from common diseases. A group of American university researchers wanted to find out why.

Researchers from the University of California, San Francisco (UCSF) said that the rate of child mortality in a community outside of Bamako, Mali, fell tenfold between 2008 and 2011 - to just 17 deaths per 1,000 children under the age of five.
During that period, Mali’s Ministry of Health and international NGOs began piloting what researchers were calling "innovative intervention measures.”

A UCSF researcher, Dr. Ari Johnson, co-authored a study on the program. He attributed much of its success to earlier, faster care for sick children.

“The idea there is that the primary causes of child mortality, both in Mali and around the world, are extremely time sensitive. They progress rapidly. Most children killed by malaria, for example, die within 48 hours from the moment they say: ‘Mommy, I’m sick.’ Diarrheal disease, pneumonia and neonatal illnesses as well all progress and kill rapidly, and so these are conditions in which hours matter, days matter,” said Dr. Johnson.

Instead of waiting for patients to come to them, about two dozen specially trained community health workers in Yirimadjo, Mali, began going door-to-door in 2008. They visited more than 7,000 households each month, looking for sick children or those showing any of 16 danger signs for childhood disease, such as difficulty breathing or diarrhea.

Health care workers either treated the sick child in the home, or in some cases, referred them to a clinic. Follow-up visits were made after 24 and 48 hours.

Health workers also have been training families to recognize the early symptoms of some of the most common diseases. Malaria can start with a mild fever, or headache, that seems to go away on its own. A mild cough can progress to pneumonia.

Johnson said community empowerment has been key to the program’s success.

“The health system aimed to reach patients not only early in the course of their illness, but also even before they got sick, including interventions in education, community organizing and employment opportunities. All of which aimed to empower community members to overcome the root causes of what made them vulnerable to disease in the first place: conditions of poverty,” he said.

Health care was also made free for children under age five so that money would not be a deterrent for seeking treatment. The program was described as relatively “low-cost” - but no figure was given.

The program in Yirimadjo was created and is run by the Mali-based NGO Muso and the Dakar-based NGO Tostan. Executive director and founder of Tostan, Molly Melching, said that this kind of integrated approach to health and development was most effective.

“Tostan’s major goal has always been to educate, to get people at the grassroots the information they need to make important decisions and become really involved in development efforts themselves and actually own their own development. And you can only do this, if people not only have the information they need, but also the organizational skills they would need and management skills that they would need, not only to lead their own development, but then manage them themselves and be so fully and totally involved that they would sustain any projects that would be started during the course of an intervention," said Melching.

Researchers said more study was needed, but that this kind of intensive community-based intervention showed quite a bit of promise.