Every year, 5 May is dedicated to one of the most important professions in the world – the midwife. No matter where you live, the work of midwives is at the very heart of a family’s health. Their roles are multifaceted and comprehensive, but often underappreciated.
No one knows that better than Mme. Kouyaté Haby Koné, midwife at the community health center in Boulkassoubougou. Haby has served as a midwife and taken care of families in her community for more than two decades.
As a woman, I am proud of my job because I witness all day long the role that midwives play in the health of the family. We accompany pregnant women, newborns, mothers, and families during a very sensitive phase of their lives.
– Haby Koné Kouyaté
Though she has been dedicated to caring for mothers, newborns, and families for much of her life, it can still be a daily struggle. She notes that midwives like her often lack access to technical training and ongoing updates on health standards. She wishes they had more resources to advance in the practice of their profession.
The health center where Haby works in Boulkassoumbougou is a part of our participatory quality improvement program, so she does have access to these resources. They make a difference not only in her feelings about the quality of her work, but in the outcomes for her patients. Thanks to her, more mothers are completing all their prenatal care, coming to deliver at the health center, and returning for postnatal care and their children’s vaccinations.
But as she so effectively and kindly takes care of her patients, she still thinks about all her colleagues across Mali and across the world.
Haby counsels a patient on family planning options
For Haby, the more attention that can be paid to the needs of midwives, the better. She believes more needs to be done, urgently:
I appeal to governments, civil society organizations, and partners to commit themselves to improving the technical platform and support for midwives, and to invest in building the capacity of midwives in order to save lives and improve the well-being of pregnant women, mothers, and newborns.
Together, we can hold policymakers to account and show that the numbers on the impact of midwives speak for themselves and that we need to invest in midwives for midwife-led care now and for future generations.
At the end of April, Dr. Sogoba attended a weeklong workshop in Fana. It was the latest meeting for the development of the national plan for the extension of community-based epidemiological surveillance (SEBAC). Dr. Sogoba, the director of our Health Department, is representing the needs of community health systems in this national policy process, alongside international NGOs and regional and national health authorities.
Dr. Sogoba has been helping to ensure that the surveillance priorities and strategies being developed are feasible and realistic for health workers, health centers, and partners on the ground. He is relying on our experience during both the Ebola outbreak, and the health security and systems strengthening efforts that followed it, as well as our participatory quality improvement and community health worker programs.
What is community-based epidemiological surveillance?
The Direction Générale de la Santé et de l’Hygiène Publique (DGSHP) explains why an implementation guide for SEBAC is so important :
characterized by the increasing globalization of emergencies and public health events, the evolution of diseases at the epidemiological level underline the importance of community monitoring in order to move quickly from detection to confirmation and response.
The emergence and earliest detection of infectious diseases – like Ebola or COVID-19 – often occur at the community level. The quicker that the community health system can identify and respond, the quicker an outbreak can be contained, and communities can stay safe. A strong response requires a variety of systems to be strengthened, including a trained health workforce, decentralized and accessible laboratory capacity, and clear response protocols at the local, regional and national levels.
A long-term planning process
At the invitation of the DGSHP, Mali Health has been participating as a technical partner in the development of the national SEBAC guide since 2019. First, a draft of the guide was developed at a workshop in Bamako. It was then tested in the Kadiolo health district, in Sikasso region.
At a workshop in Bamako at the end of 2019, Dr. Sogoba had the chance to present our approach to community health to the entire planning group. He also shared our experiences supporting community health partners during the Ebola outbreak and with the following Djomi project, which was a part of the Global Health Security Agenda (GHSA). We are honored by the opportunity to represent the needs of the community health system, and our efforts to support it, in this national process.
The objective of this latest workshop in Fana was to analyze results from the test in Kadiolo district and to develop a final extension plan. The next step is to submit that final plan to the DGSHP for validation and approval, and to identify a donor to finance the extension of the surveillance program. If a donor can be identified, the entire process of disseminating and implementing the plan in all regions of Mali will take 5 years.
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.
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.
In September, Madame Oumou Mariko Doumbia was elected by her peers to be the first leader of Union Kènèya Yiriwa Ton, a new association formed by women who have participated in our cooperative program. Mme Doumbia lives in Sabalibougou, a peri-urban community in Commune V of Bamako, where Mali Health has worked for several years.
Madame Doumbia 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 more women 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 then, in 2016, when Madame Doumbia learned about Mali Health organizing savings groups in Sabalibougou to help women access healthcare. She invited our animateur 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 now 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 Union Kènèya Yiriwa Ton, a women-led grassroots organization created to support the cooperatives, developed by women for women. Focusing on peri-urban communities, the union currently has five member cooperatives from three different communities around Bamako. Their name, Kènèya Yiriwa Ton means Promotion of Health in Bambara.
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 group, 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 association. 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. »
It is Wednesday, February 3, 2021, Aminata’s 3rd day in her new position with Mali Health. In the early morning at her desk, we asked Aminata to share her feelings about her journey and new role.
I am Aminata Seydou Traoré, I’m 29 years old, and I live in Kalabambougou in Commune IV of Bamako District. I have a Master’s degree in Law with a Judicial Career Option from the Faculty of Legal and Political Sciences of Bamako.
Aminata began working at Mali Health in February 2018 as a savings group facilitator, an animatrice, in Kalabambougou in our Women-Led Health Financing (WHF) programs. While she was serving as an animatrice, Mali Health supported the launch of one of our first cooperatives in Kalabambougou. Aminata brings extensive experience implementing our WHF strategies, but she has something even more valuable. She brings understanding and knowledge from three years of listening to and directly supporting women in her community. Reflecting on her time at Mali Health, Aminata tells us:
At first I wondered how I should go about meeting the goals that were assigned to me. Then little by little, I was able to fit into a team full of diversity. The questioning gave way to confidence and enthusiasm; then I said to myself that I have a lot to learn with this organization. My personal goal was to be able to be in a management position in the program in which I work. With the position of Program Assistant opened, I thought to myself – now is the time. So I applied and was right to believe it and give it a try.
She was right to believe in herself and try, and today Aminata is ready to thrive in her new role. Ambitious and always committed to serving her community, Aminata is also active in civil society organizations, including the Coalition of African Alternatives Debt and Development (CAD-Mali) through an organization known as Association of Youth for the Development of the Municipalities of Mali. We look forward to the enthusiasm and energy she will bring to her work with thousands of women across Bamako.
*Aminata is stepping into the role once filled by Aïssata Touré Kouyaté, who was recently promoted to Storytelling Manager.
