Impact: How have health workers had an impact in Mali?
Ousmane Koné: If I must choose just one example, I would share our experience with active management of the third stage of labor (AMTSL), an innovation that prevents post-partum hemorrhage. Severe bleeding or hemorrhage is the leading cause of maternal death in Mali. This is why we strongly adhered to the introduction and scale-up of AMTSL. Health care providers have been instrumental in its implementation. This task has been delegated to matrones (auxiliary midwives). Our goal is that all women who deliver receive AMTSL.
PSI/Mali was founded in 2001 to use commercial marketing strategies to improve reproductive health and child survival, working through both the public and private sectors, and to reduce new HIV infections. Since then, PSI Mali has added programs in malaria treatment and prevention, clean water, improved sanitation, treatment of cervical cancer and introduced programs to reduce the incidence of female genital cutting. PSI/Mali also created and supports the ProFam franchise, which is a national network of branded private health clinics that offer women high quality family planning services. PSI/Mali implements programs in partnership with the Ministry of Health and Public Hygiene, and is supported by a variety of donors including USAID; the Global Fund to Fight AIDS, TB and Malaria; and the Dutch and German governments.
AMTSL, combined with universal access to caesarean section procedures and a stronger referral and evacuation system, has helped to reduce maternal mortality by nearly 20 percent. The maternal mortality rate has dropped to about 460 deaths per 100,000 live births in 2006 from 582 deaths for 100,000 between 1995 and 2001. In 2009, the urban maternal mortality rate was at 115 per 100,000 live births – a rate below the MDG target. In rural areas, however, the rate remained high at 550 per 100,000 live births.
Impact: What are the biggest challenges Mali’s health workers face?
OK: The ongoing challenge is raising the quality and quantity of human resources to achieve a ratio of 23 health professionals (doctors, midwives and nurses) per 10,000 people. To achieve this goal, Mali will need more than 14,307 new health professionals by 2018.
The lack of human resources for health as well as health worker motivation and retention remain key issues we must overcome in order to meet the Millennium Development Goals. A program should be implemented at the country level to address the lack and inadequate distribution of health workers and to ensure universal access to high-quality health services.
Impact: How do international NGOs help strengthen your health workforce and in which areas could partners improve?
OK: We greatly appreciate the support from international NGOs.
The humanitarian NGOs help us by providing emergency assistance, especially in managing people who are displaced or in precarious situations, by supplementing our staff in order to provide appropriate care.
Development NGOs involved in long-term programs assist in our situational analyses and in the development and implementation of the Health and Social Development Plan (PRODESS). For example, IntraHealth International, through the USAID-funded CapacityPlus project, assists us in implementing health workforce information software (called iHRIS). This software will help us make decisions based on reliable data and help us decentralize human resource management to the regional level. Other NGOs support the recruitment of community health workers or training for doctors and midwives in schools.
International NGOs should support Mali’s government in implementing its health policy. They can strengthen our staff by working in all components of the PRODESS. In no case should they replace the Ministry of Health; their activities should supplement ours.
For example, we expect our partners to: adhere to national policies and programs; strengthen pre- and in-service training for health professionals; connect with universities and training centers on an international level to strengthen our capacities in biomedical research; award scholarships in technical areas where training is not locally available; introduce proven approaches and results-based financing to enable us to manage our resources efficiently and ensure equity, both in funding and in access to health care; and mobilize technical and financial resources to implement PRODESS.
Impact: Mali is a pioneer in using task-shifting strategies to increase access to maternal and child health services. How have those strategies changed the situation in rural communities?
OK: The program for Essential Care in the Community (ECC), led by community health workers, stands out. The program targets children under age 5.
From June 2011 to November 2012, the ECC recruited, trained, provided supplies to and assigned nearly 2,000 community health workers to the Sikasso, Kayes, Koulikoro, Ségou and Mopti regions. The rollout was thanks to an exemplary partnership between the state and local governments, and the technical and financial partners of Mali, and the workforce in the field. Many of these community health workers are former matrones or assistant nurses, who were recruited and assigned to their sites after completing the appropriate training and assessments.
Community health workers are responsible for basic newborn care; family planning; management of moderate malnutrition, uncomplicated malaria, diarrhea, pneumonia; and referral of complicated cases to community health centers. Each health worker cares for 1,500 people on average across several satellite villages and their assigned sites.
The program has shown positive results. From April 2011 to March 2012, community health workers treated approximately 17,000 cases of malaria, 9,500 cases of diarrhea and 12,600 cases of acute respiratory infection in children under 5 – nearly 20 percent of all cases in this age group. These health conditions would not have been channeled to the local community health centers or would have been sent late, incurring high costs and resulting in a critical prognosis for some children. This strategy has led to expanding health coverage so that health care is more accessible to rural populations, especially the poorest.
The interview with Minister Koné was conducted by Dr. Cheick Touré, IntraHealth International, Mali, and Zouboye Mariam Diaw.
Photo: Professor KALILOU OUATTARA has been head of Urology at Point G University Hospital Center in Segou for more than 30 years. He has performed thousands of fistula repair operations. Now, he is training a new generation of surgeons. Under the USAID-funded Fistula Care Project, in collaboration with IntraHealth and the Government of Mali, he trained 18 surgeons to perform basic repairs. (Credit: © Trevor Snapp/Courtesy of IntraHealth International)