A View from the Hill

A View from the Hill

This post was written by Mali Health Board Chair Dr. Joe Camardo, after his recent visit to Mali.

At 8AM I walked out of the NIH guest house at Point G, which is settled on a hill above Bamako, into the heat of the Malian morning. The terrace provides a view of Bamako on the plain below; what a place.  Just flat and sprawling as far as I can see, and from here it is just quiet. But, five minutes in the car and one joins the crowd of commuters. Cars, motorbikes, sotramas, pedestrians; courtesy and good judgement orchestrate this constant flow of movement, since there are few traffic lights. Bamako is rich in spirit and like Mandé music it seems to have a rhythm and a story.

So, we (Samba my driver and I) cross the town and arrive at the Mali Health office. This starts a week that allows me to see our team, the families we serve, and our health center partners. It also includes visits to some of the government officers who are tasked with the vision to lead the country to a place where the spirit of the people is matched by the services and material goods all of us have come to expect.   

One of our concerns about Mali Health is whether we can convey to our supporters how much of a difference they make in a place so distant, so different, and somewhat obscure, not usually the subject of news stories, except for bad news.  But there is some good news:

At CSCom SISSOU, our very first partner health center in Sikoro, there is much activity. They follow our quality improvement protocols and have improved their system for payment, their labs, their water and sanitation. In May, they delivered 100 babies. The team is motivated and they’re responding to an influx of new residents in the Sikoro area. The community health workers in Sikoro/Sourakabougou visit families on a planned schedule, with specific objectives. The health center is raising money to improve the laboratory so it can be certified for additional testing services.

In Sotuba, our community health worker spent over an hour with mothers explaining vaccination, malaria, handwashing, and other simple but important ways to keep their infants and toddlers healthy. They spent a long time in discussions and banter in a combination of French and Bambara (and some arguing with more vocal of the community). The women are illiterate. Since we cannot just provide information in writing, the discussion is one of the few ways to make an impact.

In Lafiabougou, I attended a quality improvement session (in French and Bambara with simultaneous translation by Mariam. Note to self:  learn French before next visit).   It was great discussion about vaccinations: why are families with newborns missing some of the later doses, how should we make sure the mothers know when to return, how do we make it easy for them to get back to the health center. Another lively discussion including the head physician, the sagefemme (midwife), and the staff of the health center, along with our quality improvement coaches.

In Sibiribougou, I met with a savings group. Of course, this is an opportunity to provide information to mothers. I noticed it’s also a chance to see the babies; though not a real pediatrician visit, even an out-of-practice doctor can see if the baby is thriving or not. This is a great event, lots of laughter, but also serious accountability for the contributions and their use. I contributed a very worn-out 1000 CFA note (about 2 dollars), which generated some applause and laughter and I suppose allows me the privilege of a loan if I need it. I find these sessions to be inspiring; it’s not just the money, (that is important) but it is the sense that these mothers really help each other. It is one of the activities that mothers manage themselves; our animateurs make sure they get together, but the mothers run the show.

Mariam and Joe visit the Ministry of Women, Children and Families

This visit we took the opportunity to visit the Ministry of Health and the Ministry of Women, Children, and Families. We also reminded them of our status as an INGO, recently granted. Though we are a US nonprofit organization, we are incorporated as an international NGO in Mali, under Mariam’s leadership. We visited the Minister of Defense, Honorable Tiene Coulibaly, who is a friend of Mali Health from his time as Mali’s Ambassador to the US. Though a courtesy visit, it was a reminder that one obstacle to progress in Mali is the continued threats to peace in the North, and in the Dogon region. All I could say was that, having visited Mali now three times, that I wish him the best of luck in the job, and told him that for sure the people of Mali deserve peace.  


Mali Health awarded Grand Challenges Explorations grant from Bill & Melinda Gates Foundation

Mali Health awarded Grand Challenges Explorations grant from Bill & Melinda Gates Foundation

Mali Health is happy to announce that we have won a Grand Challenges Explorations (GCE) grant from the Bill & Melinda Gates Foundation. Our proposal, Using Participatory Quality Improvement Methods to Improve Vaccine Timeliness, will bring together maternal care providers, including health center staff, community health workers (ASC) and midwives (matrones), to develop local solutions for improving childhood immunization completion in the Sikasso region, in southern Mali.
Since 2014, we have been developing a participatory, team-based approach that adapts traditional continuous quality improvement tools for use in the community health system. We will bring those participatory quality improvement (QI) methods, created in collaboration with health center partners in peri-urban Bamako, to the Sikasso region in southern Mali, to improve vaccine delivery.
In Bamako, our participatory, community-based QI strategies led to significant improvement in timely vaccine completion. For example, completion of BCG vaccine delivery from 57% to 92% and retention between doses of MMR rose from 38% to 83%. With average completion of childhood vaccines hovering around 20.2% in Mali, there is room for significant improvement, in both rural and urban regions.
Our team is particularly excited about this opportunity because it allows us to continue working with partners in the Sikasso region, where we have worked to implement the Center for Disease Control’s (CDC) post-Ebola Global Health Security Agenda (GHSA). During that work, we observed significant gaps in the health system and integrated some of our quality improvement and governance strategies into the GHSA project. Our participation in that project ended in October 2017, when funding was significantly delayed during the budgeting process. We are glad to renew our relationships with communities and the health system in the Sikasso region, and to build new ones.
Through their GCE program, the Bill & Melinda Gates Foundation “supports innovative thinkers worldwide to explore ideas that can break the mold in how we solve persistent global health and development challenges.” Our project is one of 35 Grand Challenges Explorations Round 20 grants awarded by the Foundation, out of over 1,500 applications received. This is our second GCE grant; the first, a part of Round 12, helped us to develop our QI approach.
Grand Challenges Explorations is a US$100 million initiative funded by the Bill & Melinda Gates Foundation. Launched in 2008, over 1365 projects in more than 65 countries have received Grand Challenges Explorations grants. The grant program is open to anyone from any discipline and from any organization. The initiative uses an agile, accelerated grant-making process with short two-page online applications and no preliminary data required. Initial grants of US$100,000 are awarded two times a year. Successful projects can receive a follow-on grant of up to US$1 million.