Meet ASACO BAKON

Meet ASACO BAKON

by | Aug 10, 2022 | Quality Improvement

In Mali’s decentralized health system, ASACOs (community health associations) are instrumental to not only the delivery of primary health care services – particularly maternal and child healthcare – but they are also the primary structure that ensures community participation and local ownership.

Created in 1994 by community members in Commune III, ASACO – BAKON serves five neighborhoods (Badialan I, II and III – Kodabougou and Niomérambougou) in Bamako. Though two neighboring communities often collaborate to create an ASACO, and some communities have multiple ASACOs to serve the needs of large populations, it is unique for five communities to come together to do so. But ASACO-BAKON’s leaders recognized the significance of the ASACO’s role and decided to pool their resources to ensure a greater chance of success.

ASACO – BAKON was one of the first community health associations created in Mali. Though it has faced challenges over its nearly 30-year history, in September 2019, a new group of young leaders were elected to lead the ASACO management committee and they have been dedicated to improving the performance of their health center. They began seeking out partners to assist them in their efforts, and four months after the new ASACO chair, Mr. Aboucar Maiga, was elected, he met with Mali Health as their first technical partner.

Through the partnership between ASACO – BAKON and Mali Health, both the health personnel working at the CSCom and ASACO members have participated in Mali Health’s trainings on the elements of our participatory quality improvement approach. The trainings have covered maternal, neonatal, and child health topics, including basic emergency obstetric and newborn care (BEmONC), as well as the role and function of the ASACO and its management bodies. Following these training sessions, both staff and ASACO members report improved confidence and alignment across the health center, which they have not experienced before. The new skills in the health center staff have resulted in improvements in key indicators, which they have maintained every year, as well as increases in consultations and assisted deliveries at the health center.

The ASACO meets regularly and in accordance with the statutes. Each leader understands his or her role. Mali Health was also able to provide some equipment to support the improved quality of the health center’s services, including a microscope so the center can perform lab work and a warming table for newborns.

The vice president of the ASACO, Mahamadou Sissoko, describes the changes that are taking place at the health center: “The partnership with Mali Health has brought a radical change in the practices at our health center. We have made patient satisfaction our absolute priority, and the community now sees us differently. Today, we are having much more success.”

To further support the health of the communities served by the health center, Mali Health is partnering with women in the community through our Women-Led Health Financing strategies, including helping them to organize health savings groups, develop income-generating activities, and become voting members of the ASACO.

ASACO – BAKON’s leaders continue to seek partnerships to improve the quality of their health center. In one exciting collaboration to improve their infrastructure, they worked with partners to construct a much-needed maternity.

Reaching under-immunized children missed during COVID-19

Reaching under-immunized children missed during COVID-19

by | Jun 4, 2022 | Health Promotion and Community Outreach

In the first quarter of 2022, Bamako recorded nearly fifty suspected cases of measles. Public health officials collected samples and fourteen cases were confirmed at the national reference laboratory.  Several of the 14 positive cases were concentrated in Communes I and IV of Bamako. This distribution of cases meant that Bamako had reached an epidemic threshold, which required a response in both communes and the surrounding areas. Measles is extremely contagious, and unfortunately, Mali registered in the top 10 countries for the highest number of cases reported from September 2021 – February 2022.

The primary reason for the measles outbreak is that thousands of children missed their routine vaccinations due to the COVID-19 pandemic, though the exact number of under-immunized and “zero-dose” children is unknown. But Mali is not unique in experiencing a measles outbreak. Just as we saw with Ebola, the interruption of routine primary healthcare caused by the pandemic could be as or more deadly than the coronavirus itself.

In order to support the regional health authorities in containing the epidemic, the Mali Health team initiated and supported a vaccination campaign to reach unvaccinated children in partner communities across Bamako.

The vaccination campaign mobilized more than 200 vaccination teams over a period of five days to vaccinate children age 9 – 59 months. Each vaccination team was composed of three agents including one agent for the mobilization and organization of the community, one agent to conduct the injections, and one agent to maintain the documentation and records. Though we requested 120 000 doses of VAR vaccines, only 45 000 doses were made available, along with 4,000 vaccine registry forms.

A member of the vaccination team completes the vaccine registry
A member of the vaccination team completes the vaccine registry

The vaccination campaign included the following activities:

  • Communication and outreach: The vaccination teams shared health information messages about measles and vaccination throughout 17 communities by working with the ASACOs (community health association) in each community, as well as a network of women leaders to whom we connected through our partners in the Service Local de Développement Social et de l’Economie Solidaire (SLDSES). Some of the concerns among the community included hesitation and misinformation about vaccines in general, as well as mistrust related to COVID-19 disinformation and rumors.
  • Case identification and management: The vaccination team actively searched for suspected measles cases in each community. Of those suspected, 12 cases were confirmed through the collection and analysis of samples.
  • Monitoring of adverse events following immunization (AEFI): Some minor AEFIs (fever, vomiting, pain at the injection site in older children) were reported during the campaign, which were referred to the CSCom (community health center) teams, who provided treatment and case management.
  • Safe waste disposal: The proper treatment of medical waste is one of the many areas we work on in our participatory quality improvement program, but resources can often be limited at CSComs. All injection and vaccine materials during this campaign were disposed of in safety boxes and packaged in waterproof cartons to hold them safely until they could be incinerated.
  • Sharing results: To ensure transparency and build tryst, Mali Health shared the results of the vaccination campaign with community leaders and community members from the areas served.
  • Monitoring and field supervision: To support each vaccination team, 5 additional agents in each community (85 total) were deployed alongside them to help support and manage the flow of vaccination activities, ensure the vaccination teams remained fully equipped, coordinate with the community health system (CSCom), and assist in any other needs that arose for the vaccination teams. They monitored results and progress each day and were in the field with the vaccination teams for all five days of the campaign.
During the campaign, Dr. Bathily reviews the day's progress with a vaccination team
During the campaign, Dr. Bathily reviews the day’s progress with a vaccination team

The vaccination teams deployed across 17 communities over five days achieving the following results:

  • 44,685 children vaccinated
    • 16,082 under age 1 (between 9-11 months)
    • 28,603 age 1 – 5 years
  • 94.6% of children under age 1 (15,211) received their first dose of measles vaccine (VAR)
  • 90% of children age 1- 5 years (25,754) received their first dose of measles vaccine (VAR)

Despite these results, we estimate that there are approximately 117,795 children under age 5 across the 17 target communities, leaving tens of thousands of more children in need of vaccinations. Based on the results of this vaccination campaign, it is likely that the majority of these remaining children are also unvaccinated.

While every child enrolled in our community health program received their vaccines on-time throughout the pandemic, and we worked very hard to support our partner health centers in maintaining the continuity of care for women and children in their communities, tens of thousands of children across remain unreached and under-immunized. We hope to continue vaccination activities as we search for more funding to meet urgent needs and as more vaccines are made available.

Vaccine Confidence: Results and Lessons Learned

Vaccine Confidence: Results and Lessons Learned

by | May 9, 2022 | Health Promotion and Community Outreach

Our project to assess and address vaccine confidence using a local, women-designed technology demonstrated that the use of participatory methods and tools to develop and disseminate voice-based social media messages improved both knowledge of, and confidence in, vaccination against COVID-19 in underserved peri-urban communities in Bamako, Mali.

The project used a mix of qualitative and quantitative evaluation methods, including individual interviews and focus groups discussions. The project relied and built on a participatory evaluation of social and gender norms conducted in the target community before the project began.

The key results of this project include: 

  • 100% of women who accessed voice-based health messages demonstrated improved knowledge about the benefits of vaccination against COVID-19
  • 75% of women who used the application expressed confidence in vaccination against COVID-19
  • 73% of women who used the application shared the information they learned with others
  • 60% of women who used the application felt better equipped to convince others to get vaccinated against COVID-19
A woman in Kalabambougou shares her experience using Keneya Blon

Part of the purpose of the project was to generate lessons for how to use social media tools and messages to address vaccine hesitancy and misinformation. Our particular focus was on hard-to-reach populations in marginalized communities, especially women. Drawing from both our work to develop Kènèya Blon, and its application to COVID-19 vaccination, we summarize our lessons learned as:

  • Community driven: A tool designed by women living in peri-urban communities to increase access to health information proved to be relevant and impactful, despite limited access to information technology; when trying to meet the needs of hard-to-reach or marginalized communities, they should be involved at every step, including data collection and technology design
  • Targeted: Technology and digital interventions must be adapted to the realities of each community or population it is trying to serve; this adaptation can include the form and function of the application or the types of content used (language, images, etc.), but also contextual factors such as social/gender norms, the kinds of misinformation circulating, etc.
  • Coordination: When coordinating with offline health or vaccination services, ensure the quality and availability of a respondent for interactions with users, as well as the quality and availability of the vaccination service at the health center level; when possible, train these providers in the use of digital tools/messages being used in their communities
  • Ongoing: Campaigns implemented once or over a limited period of time will lose impact over time; the dissemination of messages relating to COVID-19 must be ongoing and consistent until public health and vaccination targets are reached
  • Accessible technology: Though access to technology is increasing, it will continue to be a limiting factor for millions, especially for women who have limited skills or experience that allow them to use it effectively. This project recommends the integration of relevant, local digital tools into mobilization strategies around vaccination against Covid-19 while also continuing the search for strategies that can share voice-based messages on the types of phone and technologies that are most available to marginalized communities
  • Mixed methods: Promote the use of the digital tools within target communities with on-the-ground and face-to-face strategies to build trust
Improving community awareness and confidence in COVID-19 vaccines with local women-designed technology

Improving community awareness and confidence in COVID-19 vaccines with local women-designed technology

by | May 9, 2022 | Health Promotion and Community Outreach

As the world has seen and experienced during the pandemic, vaccinating populations requires much more than a vaccine. While the availability of a vaccine is one important component, a variety of factors can influence vaccination rates and coverage. Some, like geographic, logistical, and health system factors have been a challenge to ensuring complete and timely vaccination of children for underserved communities for decades; the pandemic has exacerbated these problems. Other factors can be related to gender, social norms, or misinformation.

From October 2021 to February 2022 with funding from the Vaccine Confidence Fund, Mali Health worked with women and communities to understand the factors influencing knowledge of and confidence in COVID-19 vaccination in underserved peri-urban communities. We then developed and tested messages for Kènèya Blon, the local, voice-based smartphone application that we developed with women in Sabalibougou, a peri-urban community in Bamako.

Collecting data directly from community members was essential to understanding the factors that influenced confidence in the vaccine, and therefore how to address them. The end users were involved in every step of the original development of the Kènèya Blon platform. When assessing how to use it to address vaccine confidence as a part of this project, their participation was vital again.

We used participatory methods to understand attitudes and behaviors related to vaccination, and the norms which govern them. At the beginning of project, 95% of those surveyed did not trust COVID-19 vaccines and had no intention of getting vaccinated. According to the same survey, the primary reason given was a lack of access to trusted health sources that could provide accurate information, or correct misinformation. A lack of access to health professionals and reliable health information was a key factor in acting on misinformation and the adoption of positive behavior changes.

These findings reinforced what we learned earlier during our work as a part of the WomenConnect Challenge, Then, we learned that access to reliable health information is one of the highest priorities and biggest challenges for the women we serve. Access to information was even linked to gender equality, not only in the minds of women, but in the minds of men and community leaders. Because women living in peri-urban communities had limited opportunities to go to school where they could gain reading and writing skills, they face barriers to accessing reliable information.

The Kènèya Blon platform was designed to address this primary challenge. During the project, users had access to accurate public health information about COVID-19 and that addressed rumors and misninformation circulating in their community. They were also able to access health personnel to express their concerns related to COVID-19 vaccination and receive responses to their questions. These features were designed by women, for women – using a what we call women-centered design approaches – but its impact extends far beyond its users.

We attribute the significant short-term results of the project to this rapid access to trusted information, because it met the primary need community members expressed. To learn more about the results and lessons we documented about vaccine confidence, please continue reading our next post.

Meet Bintou and her twins

Meet Bintou and her twins

by | Apr 25, 2022 | Women, Women-Led Health Financing

In West Africa, and especially in Mali, it is customary to go door-to-door when multiples (twins, triplets, etc.) are born, collecting support from neighbors. The birth of multiples can be a significant challenge for families with limited resources. Through this porte en porte tradition, communities provide tangible support to families in need, but it is also a sign of solidarity and social cohesion. Indeed, this custom is also often followed even by families with multiples who are not in need, in which case it is said to ensure that the children will live a long life.

Bintou migrated to Bamako about eight years ago, settling in Sotuba, a peri-urban community in Bamako’s Commune I. She and her husband separated when she was 3 months pregnant with her twins, so she decided to leave her village, along with her three other children. A move to Bamako gave her a better chance of earning an income that would allow her to support all her children on her own.

When she arrived in Bamako, things did not go as she had imagined and she had difficulty finding a place to live. She stayed with a friend throughout her pregnancy, and though her friend didn’t have much, she took care of Bintou until she gave birth. After her twins arrived, Bintou did not want to be a burden, so she and her five children settled in a home that was unfinished. That’s when she began to go porte en porte with her twins.

Bintou carries her tray with all the items she sells.

But as the twins grew, Bintou decided to start selling earrings to make her living. Her friend encouraged her to join a Mali Health savings group in order to get the funds to start her project. So she did. Then Bintou was able to take a loan from her group to purchase what she needed, and started selling. She walks throughout her community each day, selling earrings and other items that can be difficult to find in her community, like toothbrushes and toothpaste, from a large tray that she made.

Now age 7, the twins are doing well and are enrolled in school. For the past year, Mali Health has been working with mothers like Bintou to ensure that the interruption caused by the pandemic does not push families further into poverty, or pose an additional risk to their health. Bintou received support to grow her business, and she has been able to expand into selling a wider variety of items. In the future, her goal is to move her small business into a shop of her own.