The Future of Health Care in Mali Starts with Women
More than half of Mali’s residents live in rural areas. Add to that the country’s shortage of health workers and high-quality training programs, plus political instability, and high-quality health care becomes much harder to access.
But over the past two decades, IntraHealth International’s Mali country director Cheick Touré and his team have worked to change that. We sat down with him to discuss the changing landscape in Mali and what the future holds for better health care in the country.
What accomplishments are you and your team most proud of in Mali?
I’ve been working at IntraHealth for 20 years and I have seen this organization grow and make progress around the world. In Mali, we’ve seen more people getting access to modern contraception, more births at health facilities, and reductions in malnutrition.
But there is a lot of insecurity and very few health workers in Mali, especially in the northern part of the country—about 6 health workers per 10,000 people. So we developed a national training policy and strategy with the Ministry of Health to help rural regions develop their own health workers, starting with nurses and midwives, and helped open the Gao nursing school in 2001.
A lot of people were skeptical because they thought teachers wouldn’t want to go to rural areas. But we started a scholarship fund that requires students to work for rural clinics and health facilities for five years after they graduate. Now, the Gao nursing school is self-sustaining and 89% of students pass their annual tests. So far, the school has produced 1,681 health workers including midwives, nurses, and lab technicians. It’s such a successful program that USAID asked us to scale it up and now we are supporting 10 more schools in other parts of the country.
Mali has really made strides in providing life-saving services for women. What kind of everyday changes have you seen as a result?
When I was young, every family had experienced death from postpartum hemorrhages. Thanks to programs like IntraHealth’s, that’s no longer the case. My own grandmother died from a postpartum hemorrhage and my mother became a midwife because of it. She is the reason I became a doctor—I wanted to follow in her footsteps and create change in our health sector.
So we developed a program for active management of the third stage of labor with funders and partner organizations. The maternal death rate in Mali used to be very high—836 deaths per 100,000 live births and 25% of those deaths were due to postpartum hemorrhages. We introduced postdelivery oxytocin, a uterotonic drug that is critical for women in the third stage of labor. We developed training materials and trained everyone involved in a delivery to make postdelivery oxytocin a routine practice. The Ministry of Health decided to scale-up the intervention, extending it to auxiliary nurses and birth attendants as well. This program, in addition to other key interventions (family planning promotions, a free c-section policy, emergency operations center programs, and skilled attendants at childbirth), reduced the maternal death rate in Mali by 33%.
Another project we are proud of in Mali is our fistula project. Before IntraHealth’s projects, there was only one place women could get comprehensive obstetric fistula services and it was in the capital city. But two of IntraHealth’s projects supported by USAID provided 1,674 surgeries, significantly decreasing the number of women waiting to receive the surgery. We trained surgical teams in four additional regional hospitals and now fistula operations are routine procedures all over Mali.
What investments will be most important for women’s health over the next decade?
One of the best investments will be improving access to family planning methods. Because in Mali, women have six to seven children on average—that’s very high. Contraceptives are not available everywhere, so we need to increase access to reduce maternal and child mortality.
We also need to focus on our shortage of health workers. We know that the density of health workers is high in the cities but in the rural areas it’s very low. We need to recruit nurses and community health workers there to provide services for women in their communities.
What does the future of health care look like in Mali?
In the last couple of years there have been a lot of security concerns. The health centers in northern and central Mali and some schools have closed due to those insecurities. That will really affect health care accessibility. But we remain optimistic because of the government’s commitment to health care and self-reliance.
To strengthen the long-term effectiveness and durability of projects we work closely with the Ministry of Health and Social Affairs, training institutions, and civil society organizations. For example, our Civil Society For Family Planning project is helping civil society organizations support the government and make them accountable for their commitments. We are working with religious leaders, youth, and women’s associations organized to advocate together at the local level and better use resources.
We’re also helping more girls to be leaders. Because we know that women are the leaders of tomorrow. We know that the future of health care in Mali starts with providing women with access to services and contraception, giving them support and comprehensive sexual education, and making sure they have the financial resources they need to make informed decisions.
But without health workers there is no health care. So we are implementing iHRIS—IntraHealth’s free, open source software that helps countries around the world track and manage their health workforce data—to provide decision-makers with timely and more accurate information to make decisions related to the health workforce. iHRIS now has 89% of all registered health workers in Mali in the system and the Ministry of Health can see real-time data on who is working where with what profile and experience. This information allows Mali to manage the health workforce efficiently and strengthen the health system, improving health and moving toward high-quality health care for all.
Dr. Touré leads IntraHealth’s work in Mali, which is funded by the US Agency for International Development, the William and Flora Hewlett Foundation, the Bill and Melinda Gates Foundation, and the Dutch Embassy.