Spotlight on Global Health Initiative Plus Countries: Mali

Spotlight on Global Health Initiative Plus Countries: Mali

Issakha Diallo, MD, MPH, DrPH

Part six of the blog series: Spotlight on Global Health Initiative Plus Countries Amid grave health statistics, the Global Health Initiative (GHI) brings hope of a healthier future in Mali.

Mali is one of the ten poorest countries in the world, ranking 173 out of 175 countries on the 2007 Human Development index of the United Nations Development Program (UNDP). Mali has highest percentage of people living on less than a dollar a day.  And, Mali has some of the worst demographic indicators in the sub-Saharan region: a population growth rate of 2.6%, a 6.6 fertility rate (the highest in the sub-Saharan Africa after Niger, at 6.8), and a birth rate of 49.8 per 1,000. The population is very young, with more than 50% of Malians under 15 years old and 17% under 5 years old.

Among the other contributing factors, there are harmful traditional practices, early child bearing, closely spaced births, unsafe abortion, and inadequate obstetrical care in Mali. The HIV prevalence rate in Mali is estimated at approximately 1.9% of the adult population, but higher in Malian women than men, 4.5 to 1. It is extremely high in the most-at-risk population groups where it is estimated at 35%.

Despite some progress made in decreasing maternal mortality from 582/100,000 live births in 2001 to 464/100,000 live births in 2006, Mali will not achieve the Millennium Development Goals (MDGs) by 2015 if its progress in health remains the same as experienced over the last ten years.

Mali fortunately has been selected among the eight countries to pilot the U.S. Government’s Global Health Initiative. Despite the very poor health, socio-economical, and geographical conditions highlighted above, Mali has a great opportunity to successfully implement the GHI strategy and as a result come closer to achieving the MDGs.

Mali is one of the few countries in West Africa that has demonstrated its commitment and determination to democracy with an open press and the largest number of private radio stations as well as a proven willingness to improve the standard of living of its citizens. Many positive initiatives are working in Mali such as the administrative decentralization and a greater public investment towards health, education, and agricultural technologies---which position it well for the GHI.

MSH works in Mali and will contribute to the implementation of the overall GHI strategy in this country. One important lesson learned from our experience in Mali is that with properly-used, small grant mechanisms, rapid results can be achieved.

With support from the William and Flora Hewlett Foundation, MSH implemented an initiative to increase the use of family planning services provided at Malian army health facilities, which are the access points for many civilians in Mali, especially in the rural areas. Within five months, 1,000 civilian and military families were reached with new family planning services. The short-term project combined information, education, communication for behavior change, and advocacy to highlight the health benefits of birth spacing and to promote the use of modern contraceptives. The advocates explained that a 36-month birth interval would eliminate 45,000 deaths in children under five. In 10 military health centers (71% civilian clients), the project increased the use of modern contraceptives.

Well-managed small grant mechanisms, along with technical support tailored to NGOs and government needs and dedicated partners, is an excellent approach to foster change, strengthen local institutions, and achieve results quickly. Small grants allow for quick startup, easy management, and local organization capacity building. As the GHI looks to Mali as a learning lab, this type of intervention is sure to attract attention.

Issakha Diallo, MD, MPH, DrPH, originally from Senegal, is the Project Director in Ghana for the USAID-funded AWARE II program, led by MSH.