In January, our community health worker team celebrated another year of not losing a single mother or child in their care. Their achievement is remarkable in any given year, but the disruptions posed by the pandemic makes these past two years particularly extraordinary.
Community health workers are essential to our efforts to improve access to quality healthcare in peri-urban communities. Part of what makes our team so effective and resilient is their high level of knowledge and experience. Continual training and supervision are foundations of our community health worker program, but they’re not ones that we talk about very often.
Dr. Bathily oversees the medical aspects of our community health program, which includes training our entire team of community health workers (CHWs) at least twice per year. Regular training not only keeps their knowledge current, but it also offers opportunities for CHWs to talk through the different situations they face every day. Dr. Bathily helps our CHW team troubleshoot when challenges arise to help families prevent illness, or ensure that all children access care quickly when they need it.
Dr. Bathily leads a training on family planning for community health workers
Dr. Bathily, and our Monitoring & Evaluation Coordinator Boubacar Fomba, keep in constant touch with our community health center partners, including monitoring the visit information of children in the program, so that the CHW team can target their health messages and counseling when needs arise, or if there is an increase in visits. This close collaboration ensures that the ongoing training and supervision of our CHW team is addressing the most urgent needs that health centers are seeing on the ground.
Monitoring & Evaluation Coordinator Boubacar Fomba presents data during CHW training
Dr. Bathily also serves as a quality improvement coach working with partner health centers where our CHWs refer families in need of care through our participatory quality improvement program. In this role, he keeps an eye on clinical care quality, to ensure that families referred by CHWs are receiving the best care and services available.
This integration ensures that both the standards of care and the health messages that families are receiving are consistent, whether at home from their CHW or in their health center. For example, as we are working to help more families access family planning services, our community health workers are receiving the same training about family planning services that we are offering to providers at our partner community health centers.
For four years, the savings group Belle Dame, or Beautiful Lady, has met every Thursday as a part of Mali Health’s women’s health financing program. Their story begins with Mme. Koné Djénèba Ballo, the group’s founder and treasurer:
Ever since I was a little girl, I have been active and taking the lead on every activity I was a part of – whether it was organizing groups or competitions between friends in our community. One day a friend invited me to her savings group on the other side of Sikoro, but it was too far from home. So I asked if a similar group could be set up for women in our area. The animateur agreed and asked me to invite my close friends for a meeting. After 3 meetings, our group was born and we named her Belle Dame.
– Djénèba Koné
Djénèba invited other women to join the new group and soon the word spread until they grew to 25 members. Every week, they gather at their president’s home and contribute 250 FCFA (about $0.50) each – half goes to their health fund and half goes to their business fund.
Today, Belle Dame is in its fourth savings cycle, which due to COVID-19, is unlike anything they have experienced before:
The COVID-19 pandemic has profoundly affected Mali, especially us as poor women. Its arrival slowed down our activities, our children no longer go to school, our husbands are unemployed. As for our group, we could not hold our meetings. There were prohibitions related to gatherings that affected us, but because we did not have access to our small business activities, the members had trouble collecting their weekly contribution. We all sell goods and food we prepare either in the markets or on the streets, but none of that was possible for a while. In a nutshell “the country was on a answering machine” and nothing was going well.
Personally COVID-19 had a large impact on my business activity, too. Before, I could make up to 15 000 FCFA (about $30) per day. Today I find myself in the best case at 2 500 FCFA (about $6) per day.
– Djénèba Koné
But after several months, their savings meetings resumed. Now, they have regulations for distancing and handwashing with soap and water, as their animateur instructs during the health sessions with the group. To help cope with the economic consequences of COVID-19, the group has granted loans to most members to help them strengthen their small business activities, or begin new ones that are safer during COVID-19.
Women are providing each other with the support and solidarity they need to stay healthy, not only during the pandemic, but long before it.
Djénèba and her husband live in Sikoro-Sourakabougou with their six children. Before her savings group, Djénèba was afraid when a health problem arose because she didn’t know where or how to get a loan to pay for healthcare. She would ask for loans from neighbors, but didn’t want to risk gossip or getting a bad name. On one occasion, she had to use all the funds she had for her small business, forcing her to close it and losing her only source of income. She describes the stability that her savings group offers her:
Thanks to my savings in the group, I can have money to solve my family’s health problems in peace and in the utmost confidentiality. I was able to strengthen my small business, in which I was prospering a lot. As a street vendor of cosmetic products, I was able to set up a small kiosk that serves as a store for my business. Now I can provide for my little needs and that of my children.
– Djénèba Koné
In addition to having a source for loans and support for her business, her group also provides health information and help preventing illnesses:
At the end of each cycle, we buy preventive products such as soap and bleach, then we share the remaining money with all members of the group. It is a moment of joy most awaited by the members, and an opportunity for each of us to be able to achieve something like growing our businesses, take care of our children or even to have fun. There has never been a shortfall, and in our group, we are all friends. I am very happy to be part of Belle Dame and I do not intend to leave her with all the advantages that I enjoy.
– Djénèba Koné
COVID-19 continues to disrupt life in Sikoro and across Bamako, but there are no relief programs to restore what Djénèba and women like her have lost. But the networks they built to help each other stay healthy and access resources before COVID-19 continue to serve them during the pandemic. We’re committed to making sure Belle Dame and hundreds of other groups keep going strong.
It’s a Tuesday afternoon and the monthly SHARE group meeting in Sotuba is about to get started.
SHARE is our special savings program for pregnant women. At each meeting, women not only save funds for their maternal care and delivery, they also receive maternal health information, as well as sharing and receiving plenty of support. Everyone is welcomed warmly; there are plenty of chairs waiting and you can settle right into one and join the circle.
The meeting starts with the group’s facilitator sharing greetings and introductions. Today, the midwife from the Sotuba health center joins the meeting, as she often does, as well as the president of the ASACO, the community health association. The president is here to get to know the needs of women in her community and make sure the health center is responding to them. You see a few other women from the community walk over to join the circle too, just to hear the health information.
You notice that a few of the women have newborns and have already given birth. The women who participate in SHARE are at different stages of their pregnancy and the topic for discussion changes each month. The group facilitator reminds them of last month’s discussion and then she introduces the subject for this month. Because a few women are due soon, today the midwife walks women through what to expect during delivery at the health center.
She stresses the importance of planning for delivery early, advising women to think through all the details. She encourages them to choose the person who will accompany them to the health center, bring the funds they have been saving and their Mali Health card, bring at least five cotton cloths for the baby, bring soap to wash, and bring clothes for the baby and themselves to go home in. Throughout the conversation, women ask questions and the midwife occasionally stops to make sure everyone understands what to expect. She invites women who recently gave birth to share their experiences. She asks other women about their birth plans and questions they have about their preparations.
The midwife from the Sotuba health center explains what to expect when women arrive at the health center for delivery
You can feel the relaxed and friendly atmosphere in the group. Even when the presentation concludes, the group continues to chat and those who have already given birth share stories and advice. One of the women is pregnant with her first child and she seems a bit scared after listening one of the others talk about a more challenging delivery. Soon, the whole group notices her discomfort and begins to console and encourage her. She still has a few more months to prepare for her own delivery.
The purpose of the group is not just to ensure they have information about their pregnancies and make sure they are prepared financially, building relationships is just as important. Women in SHARE value the connections they make with one another and express their desire to support other mothers in their neighborhood. There is an openness among them here in this group that is unique; they don’t have many opportunities to talk with other women about their health, children, and lives. After their shared experience, they tell you how they feel like sisters.
Perhaps the most important relationship they build is with the midwife, which helps them build the trust they need to deliver at the health center with her help. The monthly talks provide a safe space to ask questions and get all the information they would not otherwise have, which also builds their confidence. Women note that their connection with her feels more like that of a trusted friend.
At the end of their meeting, you notice that saying goodbye seems to be the hardest part. Women linger and chat, checking in with those who gave birth, asking about someone who stayed home today. They all must get home to continue with their day’s chores, but they are soaking up every moment, until they meet again next month.
Mali Health is dedicated to working with communities to strengthen local health systems, so that all mothers and children can stay healthy and have access to quality care. During the past eight months, we have continued to mobilize communication events and activities to help inform peri-urban communities in Bamako about COVID-19 and how to stay safe. Since the beginning of the year, our activities have included:
1. Education talks on COVID-19
Since the beginning of the pandemic, our community health workers have continued to visit the families in their care, ensuring both the continuity of maternal and child healthcare and sharing information about COVID-19. They make sure mothers and caregivers understand what COVID-19 is, methods of transmission, how to prevent it, as well as symptoms and how to respond. Since January, they have conducted 2,810 talks in households during their home visits, reaching 4,973 people.
In addition to sharing information during home visits, our team is also sharing information at savings group meeting, which have been able to restart safely. So far, 310 talks during group meetings have reached 4,941 women.
2. COVID-19 Caravan
From mid-May to mid-June, we conducted 13 caravans in communities across all 6 Communes of Bamako, and Mandé:
Sikoro-Sourakabougou
Sotuba
Bakaribougou
Lafiabougou
Lassa
Djicoroni-Para
Kalabambougou
Sabalibougou
Niamakoro
Yirimadio
Badialan
Samè
Kanadjiguila
The messages shared during the caravan were those developed by the national health authorities, including a definition of COVID-19, its spread, its symptoms, and the risks of infection. The caravans were held in public, accessible locations, including schools, markets, and open fields. We estimate to have reached about 46,000 people during these caravans, including 18,500 women, 10,500 men, and 17,000 school-aged children.
3. Radio programming
We developed and produced two 30-minute radio programs about COVID-19 prevention on two different subjects – how to remain vigilant about COVID-19 prevention and how to manage distancing and contact with someone who is suspected to be COVID-19 positive. We also developed informational radio spots to encourage continued use of barrier measures and to combat misinformation. They also covered three key subjects being encountered in the communities we serve: stigma against recovering COVID-19 patients, protecting vulnerable populations (particularly elders), and how to manage suspected contacts. The spots are being broadcast 180 times on radio stations across Bamako.
A special thank you to IZUMI Foundation, GlobalGiving, and Fonds d’Appui à l’Autonomisation de la Femme et à l’Epanouissement de l’Enfant (FAFE) for their continued support of our COVID_19 response efforts.
This post was written by Mali Health board member, Lisa Nichols. Lisa has served on the Mali Health board since 2014 and worked in Mali for 15 years. She is a Principal Associate in the International Development Division at Abt Associates Inc.
The word “access” implies a simple physical opportunity to achieve or attain something. However, access to COVID-19 vaccines has become an equity issue with big and richer nations deciding who gets what and with countries scrambling to purchase or beg for vaccines from wealthy countries.
Fact: 85% of vaccines are being administered in wealthy countries.
On social media, in international conferences, and in diplomatic missions and negotiations, the campaign to get wealthy countries to donate vaccines to low and middle income countries (LMIC) is raging. It circulates among the Twitter-verse through #VaccineEquity and #DonateDosesNow.
Are we hoarding vaccines? Not an unlikely conclusion as we all lived through the early COVID-19 days of hoarding of Personal Protective Equipment (PPE), cleaning supplies, and even oxygen supplies. It seems to be a wealthy country reaction that totally overwhelms any high-minded equity goal — for how can we achieve equity without control of the supply chain?
Waiting for COVID-19 vaccine and supply donations is not the only solution. As countries wait, people are getting infected and dying. There is also a strong link between the COVID-19 and the interruption of routine services such as childhood immunization, antenatal care, and other essential primary health care.
Fortunately, the African continent is moving ahead on several fronts:
Fast tracking the upcoming production of vaccines Many vaccines are coming online and will be ready to ship soon. COVAX, the Gavi and donor-supported initiatives are accessing many vaccines as I write this. Countries like Mali have prepared National Deployment and Vaccine Plans to receive COVAX shipments, targeting 20% coverage of the population. Mali has received 1,332,000 doses from the COVAX facility and is in line to receive more as they become available.
Increasing vaccine manufacturing capacity on the continent Dr. John Nkengasong of Africa CDC talks about Africa’s ambitions and efforts to “future proof” itself by producing its own vaccines. Last month, the US International Development Finance Corporation (a US Government agency) announced a technical assistance grant to Fondation Institut Pasteur de Dakar, a vaccine manufacturer in Senegal that could serve the entire West African region.
Addressing vaccine hesitancy Even when the COVID-19 vaccine is available, sluggish uptake is a reality in many parts of the world. We need to emphasize the importance of vaccine understanding and acceptance. The role of NGOs and community organizations has already made a significant contribution to successful efforts like the Global Polio Eradication Initiative and reducing disease transmission during the Ebola outbreak. Countries will be leveraging this valuable community capital as we move ahead.
Community mobilization is a significant component of Mali Health’s strategy to serve peri-urban communities in Mali and strengthen local health systems. Our team continues to inform and generate demand for the COVID-19 vaccine, facilitate community vaccine delivery systems, and reduce community transmission of COVID-19. Mali Health will continue to support this historic global vaccination effort until all members of the communities we serve are protected.
