How a strong community health system keeps mothers at the heart of primary care

How a strong community health system keeps mothers at the heart of primary care

In March, one of our health center partners, CSCOMSEKASI, reported 2 new malnutrition cases. That may not seem like many, but malnutrition is one of the leading causes of preventable deaths among children under age 5 in Mali.

One of the areas served by CSCOMSEKASI is Sibiribougou, a peri-urban community. The health center regularly sees some of the highest numbers of malnutrition cases in Commune IV. Sometimes, it has the highest number of cases in all of Bamako.

One of the children who became sick in March was Natenin, age 4. She and her younger sister, age 19 months, live with their parents in Sibiribougou and participate in our community health program.

Our team quickly got to work to organize a nutrition demonstration, a strategy used to help mothers learn to prepare foods which support their children’s development. Led by a nutritionist from the national health program, the session showed mothers how to prepare a porridge enriched with local ingredients, like carrots and pumpkin.

Nutritionist speaking to mothers
The nutritionist speaks to mothers about providing the nutrients children need to grow

The nutritionist shared that a major factor in malnutrition is repeatedly feeding children the same foods, which does not allow them to have a variety of nutrients. The porridge mothers learned to make is prepared with affordable local products that are available year-round; it provides balanced nutrition that ensures the good growth of children.

We invited 25 mothers with children under age 2 from our program to come to the health center for the demonstration. They were joined by our community health workers, the nutrition staff at the health center, and other mothers from Sibiribougou.

She began by sharing the recipe, explaining the ingredients, quantities, and the method :

Ingredients
2kg of sorghum
2kg of wheat
2kg of fonio
1kg of corn
1kg of rice
5kg of baobab flour
10 carrots
1 medium pumpkin
1 tablespoon of salt
10kg of sugar
1 small container of peanut oil

Preparation
Wash each grain well separately
Mix them in the same container and grind them
Sift the mixed flour and set aside
Sift the baobab flour well
Mix the two flours and set aside
Wash the vegetables well
Boil and mash them

Then, she got to cooking, inviting mothers to help her at each step.

Cooking
Boil 10 liters of water in a clean pot
When water is lukewarm, using a calabash and a ladle, slowly mix some water into the flour mixture until blended
Pour the solution back into the pot
Mix and stir until a homogeneous mixture is obtained
Then add the mash made of carrot and pumpkin to the porridge and simmer for about 5 minutes.
Then add the salt, sugar and a cup of oil
Let stand a few minutes before serving

Then came the best part – the tasting! All the children attending enjoyed the portions they were served, giving their full approval of this new dish. Mothers equally approved. They not only liked the taste, but appreciated that the ingredients were local and accessible. These nutrition demonstrations not only give mothers access to important health information, it also facilitates a permanent change to more nutritious meals in their households.

At the end of the session, Natenin’s mother addressed the group. She thanked the nutritionist for sharing this information and advice, and with it, vowed that her children would never know malnutrition again.

When mothers are supported with information and resources to keep their children healthy, the results are astounding. While a 2017 UNICEF study found the national rate of acute malnutrition in Mali rested at 10.7%, we had just 14 cases of acute malnutrition among the 2,350 children served by our community health program in 2020. Putting mothers at the heart of health interventions works. Strong community health systems react quickly to community needs by keeping women and mothers at the heart of local, accessible solutions.

Meet Oumou Doumbia, first president of the cooperative union

Meet Oumou Doumbia, first president of the cooperative union

Madame Oumou Mariko Doumbia was elected by her peers to be the first leader of the cooperative union in September. She lives in Sabalibougou, a peri-urban community in Commune V of Bamako, where Mali Health has worked for several years.

She is 52 years old and is married with seven children. Though she never had the chance to go to school, she has been a leader for women in her community for many years.

As she explains,

« In my community, so many women approached me for financial support or for other social needs. I managed to help many of them through my dyeing business, which I set up to create employment to help women in my community.

In the past, I had great difficulty meeting my needs and those of my children because our resources were limited. I have tried several different income-generating activities that were not successful. Having been through all this, it was easy for me to understand the requests of my sisters because I saw myself in them. »

But with a growing number of requests, Madame Doumbia was not able to satisfy them all. In 2015, she decided to establish a tontine with women in her neighborhood, hoping it would help meet their needs.

Over time, they encountered some challenges, such as when many women in the group became pregnant at the same time. With limited contributions, it became difficult for the tontine to cover all the maternal care and delivery expenses. They also struggled to cover the costs of health care for children, but the tontine continued serving its members.

It was 2016 when Madame Doumbia learned about Mali Health organizing savings groups in Sabalibougou to help women access healthcare. She invited our animateurs to come work with her group, which is how her collaboration with Mali Health began.

She notes how the partnership greatly helped with the challenges their group encountered. Their savings activities increased. Pregnant women receive all their maternal care throughout their pregnancies, and group members can access funds 24 hours/day for health needs. They also have more funds available for their income-generating activities. Thanks to their dedication, Madame Doumbia and her group were one of the first to pilot the cooperative program. They produce and sell soap, which has increased their revenue and allows group members to afford even more basic family expenses, like school fees for their children.

Mme Doumbia describes the changes this way :

« Personally, the support from Mali Health has enabled me to set up a system of social assistance between us women. I was then able to prosper in my business because requests are taken to the group and not me personally; so I can save more money for my family’s needs.

At the same time, I have enjoyed the consideration, respect, and trust of members of my community and political leaders. Political leaders rub shoulders with me regularly for electorate needs. Also, in the health sector, when setting up the new health association, ASACOSAB3, members of my group had the opportunity to make our voices heard and to fill 30% of the elected seats in the association. »

Mme Doumbia’s leadership continues to grow. Today, she is the president of the new cooperative union, a women-led grassroots organization created to support the cooperatives, developed by women in savings groups like hers. Focusing on peri-urban communities, the union currently has five member cooperatives from three different communities around Bamako. They named their union Keneya Yiriwa Ton, which translates to Promotion of Health.

Despite her experience and passion for supporting women in her community, she describes her initial hesitance at accepting the position :

« My sisters have given me the privilege of leading this union, and I accepted it with honor. At first I was worried, wondering how I could get out of it, because I haven’t been to school. But the capacity building trainings we received on leadership and business management made me a new person. I am proud to be at the head of this union. I will work to ensure that it is well-positioned to have a greater benefit to us women. »

Mme Doumbia and the other leaders have great hope in their union’s future and are determined for it to succeed. Noting the development of her savings group and cooperative in Sabalibougou, Mme Doumbia is sure that as they support more women, their strength and power will grow.

Union leaders are already determining how to support women’s leadership in their communities as well as the economic, health, and social well being of the union members. Mme Doumbia tells us, as they see it:

« Through the role that we play as pillars in our households, it is important that we prove that we have potential and that we are capable of change. This union is an opportunity to prove it. »