by Tara Hopkins | Jun 27, 2026 | Learning
Valuable insights have arisen during the first six months of a peer-led community malnutrition prevention pilot project. As we continue to collect data to understand what is working and how improve our approaches, our primary questions relate to how communities can sustain promising initial results while ensuring community-wide reach.
Here are the highlights of what we are learning so far:
> Strong demand and consensus between health providers and mothers/caregivers
Health personnel, including nutrition officers and technical directors at partner health centers reported feeling deeply constrained by the shortage of imported therapeutic foods, with 80% of them identifying this supply gap as their primary operational challenge. Health providers noted that since running out of supplies 6 months ago, mothers have abandoned medical monitoring of malnutrition out of frustration and discouragement. Every mother we spoke to agreed, saying that the lack of supplements is the reason they no longer adhere to nutrition treatment protocols; there is no more supplementary or therapeutic food available so they have no need to go to the health center.
Both health providers and mothers were nearly unanimous in their support for alternatives. Every health provider we spoke to endorsed a shift to a local prevention approach, expressing a strong desire for what some termed food sovereignty, and independence from unstable aid networks. Both groups agreed that encouraging the use of local, seasonal produce would be a welcome change, with 95% of mothers expressing an interest in participating in collective activities to produce and prepare their own nutritious foods, like in a gardening cooperative – a strong indication of their preference for self-sufficiency over continued assistance from the health center.
There is also a shared belief about the best way to structure that local approach. Health providers identified the Demba Gnouman as the most capable and well-positioned community pillars to lead the shift to a more local and prevention-first strategy, envisioning their own clinical roles evolving into supportive supervisors and technical mentors. When asked who they trust for guidance, 82% of mothers we spoke to expressed a clear preference for Demba Gnouman over clinic staff or a community health worker, citing their shared social realities, ease of communication, and a lack of judgment or shame that would come from talking to a peer.
> An unseen knowledge gap
A common assumption is that malnutrition occurs in settings where families lack access to material resources – especially in contexts of conflict or displacement. During initial community assessments, the project discovered that most mothers and caregivers had very limited knowledge about the fundamentals of child nutrition. Perhaps most critically, they had almost no knowledge of the physical signs of malnutrition in infants. Instead, mothers frequently identified the life-threatening symptoms as other illnesses, which could delay care-seeking.
Sharing information about nutrition through relationships with their neighbors, the Demba Gnouman, could fill this gap. By listening to and watching a trusted neighbor prepare a recipe in a safe, familiar setting, mothers had a clear pathway to facilitate change in health behaviors:
Limited baseline knowledge ⤑ Practical demonstration by a peer ⤑ Increased safety, recognition, knowledge ⤑ Increased personal confidence ⤑ Household adoption ⤑ Improved child feeding practices
> Strong, comparable results
There are a variety of supplemental and therapeutic food options, many with increasingly limited availability because they are imported. We wanted to know how families, especially children, would receive a local alternative. Nutritional supplements based on local food formulations can successfully intercept acute malnutrition cases before children require more advanced therapeutic interventions at comparable cost per serving, effectiveness, and palatability.
We are seeing a very strong initial response to the recipes being used. Of more than 700 mothers surveyed during the initial 6 months of the project:
- 100% considered the recipes affordable and accessible
- Nearly 99% of mothers rated the recipes highly for taste
- 99.3% reported that their children enjoyed the recipes, and 99.1% said children consumed the entire portion served
- 99.6% of mothers reported that their children preferred the recipes to alternatives they had used in the past, including RUTF and RUSF
>> Next step: We will continue to monitor whether families and children continue to use the recipes at this unexpected level of near-universal acceptance over time.
> Community health system integration
Peer-led or community-level interventions can often be viewed as informal or “extra-clinical” activities. We do not find this distinction useful, but it is indicative of approaches to healthcare delivery that we are deeply examining. We learned from our work to improve vaccine timeliness and completion that community health outcomes improve when local care delivery approaches and facility-based or clinical care delivery approaches collaborate.
In this project, we think that integration is essential to achieving results and ensuring those results last. The pilot project is intentional about that integration, such as by ensuring nutrition information is offered during existing vaccination sessions when families are already at the health center, and by ensuring strong, mutually supportive collaboration between the Demba Gnouman and nutrition officers at the health centers. Already, that collaboration involves Demba Gnouman making referrals to the health center when they identify early warning signs, and it involves nutrition officers providing supporting supervision and technical coaching, which can strengthen the expertise and leadership of the Demba Gnouman.
>> Next step: This integration is primarily grounded in relationships, and we are interested in exploring further how those relationships can strengthen project results, and their durability.
> Local control and resource mobilization
An important definition of success is not just the project’s indicators, but the emergence of independent, community-driven action to support community malnutrition prevention. Already we observe several examples of community members building on the project activities:
- In one community, mothers established a voluntary contribution of 50 FCFA to buy ingredients and prepare the recipes collectively in their existing community groups.
- At another site, a leader collected leftover ingredients from demonstrations and, with support from the director of the health center, purchased additional ingredients to organize more sessions
- In another community, the nutrition officer voluntarily visited women’s groups, helping build trust between the CSCom and community members, consolidate ties with women’s groups, and create an environment conducive to the continued promotion of good nutritional practices.
This type of local participation and ownership is exactly what we hope this kind of approach will nurture. We believe it is a sign that community members are invested in preventing malnutrition in their community.
>> Next step: While we cannot anticipate the exact ways that local initiative and local resource mobilization will appear, we can learn more about why they did, and how to foster the flexibility that creates space for community members to adapt the approach and create local solutions tailored to the unique needs, landscape and partners in their community.
> Data in peri-urban settings
A primary data source for this project is the nutrition register at each health center. However, limitations in health data systems in peri-urban communities remain a persistent problem. Similarly, many food programmes often focus on rural areas and refugee camps; little data is available regarding peri-urban communities. Facility-based nutrition records miss an unknown portion of children impacted by malnutrition in these settlement communities, raising questions about reach and equity. Peri-urban communities are highly variable; some are densely populated, while others are more remote. If current data systems are not providing sufficient data because they cannot collect the information we need – that makes us wonder if there are other data systems that might offer a more complete picture. Are there other sources of data, outside of a clinical setting, that can help to fill that gap?
The constant community presence of the Demba Gnouman offers a unique opportunity to fill data gaps and to observe how the approach can adapt at the community level. Their daily interaction and knowledge of their communities may offer opportunities for improved community-level tracking that could help to capture children missed by formal settings.
>> Next step: We are interested to explore with our partners if there simple, replicable approaches for estimating community-level malnutrition in peri-urban areas where routine health-facility data will be incomplete.
by Tara Hopkins | Jun 26, 2026 | Health Promotion and Community Outreach, Women
While malnutrition remains an urgent challenge across Mali, the number of malnutrition cases treated at CSCom Kalabancoro Kouloubleni has been dropping. Just like at ANIASCO in Niamakoro and ASACOS in Sotuba.
Undernutrition contributes to nearly half of the deaths of children under age 5. Child malnutrition increases the risks posed by malaria and other common childhood infections – and it has been rising rapidly across Mali. At the same time, the international aid systems that have long underpinned emergency nutrition treatment are contracting.
As our team noted last year, health centers with whom we partner were left with limited treatment options and rationed their remaining stocks of life-saving nutritional commodities. Those supplies are now gone.
The disruption leaves children at risk and it has exposed a systemic vulnerability in approaches to malnutrition treatment: relying on imported commodities to manage chronic nutrition leaves communities dependent on forces beyond their control. But it also presents an opportunity to reconsider approaches that are dependent on external resources.
What would it mean to instead invest in approaches built on local resources? In ten communities across Bamako, Koulikoro and Kati, our pilot project is demonstrating what that transition could look like in practice.
> The need for change
In the early days of the US foreign aid funding freeze, our team identified two areas where the interruptions would have a significant impact: reproductive healthcare/family planning and malnutrition treatment.
Food insecurity and the severity of malnutrition cases has been increasing steadily in Mali. Malnutrition treatment became a concern because the standard treatment for the most advanced stage of malnutrition – nutrient- and calorie-dense ready-to-use therapeutic foods (RUTF) – is produced and distributed through international aid networks. RUTF was an effective, lifesaving resource that many depended on and it was now in jeopardy.
We cannot produce RUTF locally, and once it became clear this external resource was likely to run out, as it now has, a shift in strategy was needed. We turned to our mission – working with women and communities to develop local solutions.
> Developing a new community-led approach
To create a new strategy that shifts more control over children’s nutrition to families and communities, there were several resources we could draw from.
First are the lessons we have learned from our own community health worker program. Through the deployment of dozens of community health workers who have provided care to thousands of children and their families, we have over 15 years of experience working with community stakeholders to improve child nutrition. Though we have nearly eliminated malnutrition in families enrolled in our program, our task now was to extend the lessons from this work to the community-level, preventing every case of malnutrition in the population.
Partnerships are the best way to achieve that goal. An essential partner has been the Nutrition Division within the Directorate General of Health and Public Hygiene (DGSHP). As experts in the field of nutrition in Mali, they shared several insights that shaped the approach, with special attention to community-led prevention strategies. Since RUTF cannot be produced in Mali, our focus is to supplement the nutrition of children aged 6-59 months using nutritional supplements made from seasonal produce, aligned to local agricultural production, described below.
Health authorities at the regional, district, and community levels are also critical partners in this project, providing technical guidance, feedback and facilitation, especially related to identifying the communities where the pilot project might take place. At the community level, we worked to engage those involved in children’s nutrition – most directly mothers and caregivers, as well as nutrition health providers – in understanding their challenges and designing a pilot project to implement community-led prevention strategies that would address them. Read more about what we learned from the mothers and health personnel we spoke to here.
The approach that emerged is a peer-led malnutrition prevention program, centered around women leaders known as Demba Gnouman. These peer leaders were nominated by their communities and will lead the transfer of nutrition knowledge to mothers and caregivers through weekly nutrition demonstration sessions, expected to reach at least 15,000 women in the first year.
There are also nutritional education sessions organized at community health centers during their vaccination days – when mothers with children aged 6-59 months will already be at their health centers; these sessions should reach at least 5,000 women. To support this knowledge transfer, there will be close coordination between the Demba Gnouman and the nutrition officers at their health centers and we hope that community collaborations based on solidarity and mutual support will emerge.
Working together, we are aiming to reach at least 20,000 families and achieve at least a 30% reduction in malnutrition cases in 10 communities in the first year.
> Launching the pilot
In ten communities across Bamako and Koulikoro, the pilot launched in December 2025. Our partners from the Nutrition Division took the lead on training both the nutrition officers at community health centers and the Demba Gnouman during intensive workshops focused on the nutrient-dense recipes, complementary feeding practices for infants and young children, food hygiene and WASH practices, and how to use the communication materials developed for the project to ensure comprehension by all participants.
Equipped with this training and all the supplies for their nutrition demonstrations, the Demba Gnouman took this knowledge directly into their neighborhoods. In just the initial weeks, 1088 women have attended 27 sessions facilitated by the Demba Gnouman and 880 breastfeeding mothers participated in 16 sessions at the health center facilitated during routine vaccination days.
Though it is early, partner health centers are already reporting reductions in both moderate and severe acute malnutrition cases. The initial responses from mothers, but especially from children, are promising. After one demonstration, a mother shared her observation:
My child is 10 months old. I give him Vitablé [a vitamin-enriched flour for infants produced in Mali], but he doesn’t drink enough of it. I am very surprised to see him eagerly drinking the porridge prepared by the Demba Gnouman. I will gladly reproduce this recipe at home for my child.
We are also starting to see clear indications of community ownership and local resource mobilization – both of which will be essential to the long-term success and sustainability of the approach.
Read more about what we are learning, and the next questions we’re hoping to answer.
> Beyond the shelf: transitioning to nutrition supplements prepared from local, seasonal produce
Part of the pilot project’s strategy is shifting from imported supplemental and therapeutic foods to those that are grown right in their community, by their neighbors. Here’s how:
- From December to February, the focus is on abundant harvest-season produce such as cabbage, cucumber, tomato, eggplant, and guava.
- From March through May, during the hottest and driest months, recipes incorporate tubers and root crops including cassava, sweet potatoes, yams, potatoes, and onions
- From July to December, During the longer rainy-season harvest, recipes use staples like peanuts, millet, corn, beans, and peas.
This seasonal approach has several advantages that increase accessibility.
- Working with seasonal availability reduces costs, because produce can be up to 10 times less expensive during their peak production seasons.
- Seasonality also ensures reliability and availability, ensuring that there is always a local preparation method for the produce being harvested at that time.
- The use of seasonal produce strengthens local agricultural markets, like women-led gardening cooperatives.
To ensure the availability of seasonal produce in this pilot project, we are supporting the development of a gardening cooperative in each community, so that alongside sharing the knowledge of these recipes, there is sufficient local produce available to use them. Learn more about garden cooperatives, like Kolo Ni Fassa.
by Tara Hopkins | Mar 23, 2026 | Gnaman ni Sôrô ani Kènèya, Women
No more dusty street corners.
Instead, every week, the women of Kolo Ni Fassa meet around two savings accounts. One is for their gardening cooperative. The other is for their health.
They live in Sabalibougou, a neighborhood in Commune V of Bamako. For years, each member cultivated whatever small piece of land she could find in her community – backyards, small vacant plots, and even along the street. Water was limited. Their inputs were costly. But they kept gardening.
Then, at the end of 2023, they turned their shared passion into a shared opportunity. Twenty two women decided to pool their resources and organize into a cooperative. They chose the name Kolo Ni Fassa, meaning strength and tenacity in Bambara.
The name suits them well.
Collaboration to overcome shared challenges
In forming a cooperative, the members aimed to increase the level of their gardening activities and generate more revenue. It also allowed them to tackle one of the greatest challenges in a rapidly growing city: access to adequate land.
Land in Bamako is extremely expensive. It is perhaps the biggest barrier to urban agriculture in Bamako. Cultivators will often work empty plots in their community whose owners intend to return one day to build homes. Once the owner decides to start building, gardeners will lose all the time and resources they have invested to improve the soil.
Buying land was beyond the means of Kolo ni Fassa, so they found another solution. Working with a community leader, they secured a 300m2 plot to rent in the Plateau district, providing them with a stable base on which to build their garden and fulfill their vision.
With support from Mali Health, the women of Kolo ni Fassa completed a training in gardening and organic composting to refresh their knowledge and skills, and received a small grant for equipment. They started to work the land, putting in long hours to make it suitable for cultivation.
To address another constant consideration – a steady water supply – they invested nearly $100 of their own funds. Rain fluctuates with the seasons. While they take care to save every drop of water, irrigation is a necessity in their arid locale, on the frontlines of climate change. Their next goal is to increase their storage capacity so that a water shortage does not become a lost harvest.
A cycle of reinvestment
As their operation grows, so do the resources they generate and share with each other. Steadily and incrementally, they are increasing their self-sufficiency by building a system that relies more on what they can produce and manage themselves.
In one area of their garden, they produce their own organic compost using waste from their garden, their own households, and the surrounding community. Compost not only enriches the soil by adding nutrients and improving soil composition, it means they no longer need to purchase chemical fertilizers. The cooperative transforms a waste product into a valuable resource, creating a regenerative model that also restores environmental health. Composting strengthens their soil and plants, the quality of their vegetables, and the impact they have on their community.
With the care and effort they have invested, their garden now produces several varieties of vegetables.
Some of the harvest goes home with the cooperative members. By consuming some of their own produce, families have steady access to fresh, organic vegetables, which improves the nutritional quality of their meals and reduces the impact of food price fluctuations at the market, an increasingly common occurrence in Bamako.
The rest of their vegetables go to market. Each time they harvest, about every 2- 3 weeks, they earn between 30,000 and 62,000 FCFA, or between about $55 – $113. A portion of those funds go right back into the cooperative for needs like buying seeds, improving compost production, or saving for that water storage. The rest is divided between the members, providing income that helps families pay for everyday needs, including food, healthcare, and children’s education. The combination of fresh, healthy vegetables and additional income strengthens household food security and provides stability in managing daily needs.
Shared pride in their results
Their families are not the only ones benefiting. The cooperative has built up quite a following.
Because of their organic production methods, their vegetables are of a higher quality than the others available at the local market. The vegetables and leaves stay fresh longer. Customer satisfaction and trust is high. Though they began by selling directly to individual customers, the cooperative shifted to wholesale sales. Today, 41 loyal customers await each harvest.
The cooperative’s president recalls when every woman was working on her own. But through the cooperative, every element of their work, and lives, have changed. She explains the pride they feel:
Today, thanks to our collective commitment, we now have a shared workspace. We combine our efforts, produce organically, from fertilizer to seeds. We manage the entire process of our gardening activity; we are proud of what we have accomplished, we are becoming increasingly financially independent, and we are helping our families thrive.
The women of Kolo ni Fassa are not simply producing more vegetables. They have greater control over how they work, what they invest in, and what their cooperative could become.
And they have big plans. As they tend their garden, they discuss the possibilities – building their expertise by trying new vegetable varieties, maybe even expanding to another plot.
With their strength and tenacity, we cannot wait to see what they grow next.
by Tara Hopkins | May 17, 2025 | Mali Health
The abrupt shutdown of USAID and US foreign aid is having devastating effects that feel too numerous to count. In the short term, critical programs have ended nearly overnight, and we are all still wrapping our minds around the long-term effects so that we can find a way forward. We will find a way forward.
Below, we simply aim to summarize the impact on us, and that we are seeing on the ground. These firsthand observations come from our team and the partners and communities with whom we work every day.
The impact on Mali Health
We were proud to be a subcontracting partner on the USAID-funded Shifin ni Tagne project. Beginning in 2025, we were going to contribute our local, voice-based app, Kènèya Blon, to the project – helping 20,000 youth access reliable sexual and reproductive health information, connecting them to valuable resources in their language.
While we can adapt to funding losses, the suddenness of this change is what has made adjusting so difficult. There is no chance of this project proceeding without USAID funding, so we are adjusting our budgets, plans, and staffing accordingly. For the first time ever, we are having to lay of staff and reduce staff salaries in order to preserve as much of our program work as possible.
The impact on Mali
While we are figuring out how to weather the direct loss of our project funding, it is the larger context that causes us the most concern. The cessation of US funding to Mali jeopardizes vital projects for vulnerable populations. Its consequences deeply affect social sectors, including education, agriculture, health and food security.
The health system was heavily dependent on US foreign aid funding and its interruption will impact access to primary healthcare for millions of Malians. Thousands of community health workers were paid directly by foreign aid. Health programs at all levels relied on aid funding – like maternal and child health and gender-based violence prevention. Programs to combat malnutrition, to prevent, control, and treat malaria, and to prevent and treat HIV/AIDS have been profoundly affected.
In addition to health program delivery, the US was one of the largest funders of health commodities, including vaccines, contraceptives, and ready-to-use therapeutic foods.
Our partner community health centers (CSComs), the first contact communities have with the health system, are on the front lines of these abrupt and severe changes. They shared updates with our team on how they are managing, and the implications these changes are having on access to vital health services their communities, particularly for women and children. Below are some of the most alarming impacts:
- Malnutrition: A disruption of contracts for ready-to-use therapeutic foods (RUTF) used to treat severe acute malnutrition (like Plumpy’Nut) means that CSComs are experiencing shortages. In response, they are rationing the doses for these extremely vulnerable young patients from their typical 3 sachets per day to 1 sachet. Despite being a peanut producer, there are no facilities in Mali that can produce RUTF, so it remains dependent on these aid contracts. We are working with partners to develop local alternatives to prevent and treat malnutition so that cases do not escalate to the stage at which RUTF is needed, but malnutrition in Mali continues to increase.
- Vaccination: There has been a drastic reduction in vaccine doses being given to the CSComs, which are responsible for timely vaccination of children. Vaccination doses are being missed due to these shortages, especially BCG, but our partners report a shortage of all vaccines. Vaccine mobilization campaigns and community awareness raising activities are at a standstill because there are not sufficient doses.
- Prenatal Care: Due to a shortage of supplies, women are no longer receiving standard services during their prenatal visits, including HIV testing for the prevention of mother-to-child transmission of HIV (PMTCT) because the testing reagent is not available. There is also a shortage of bed nets, which increases the already high risk of malaria for pregnant women, newborns, and children under 5 years of age.
- Family Planning: Family planning supplies have almost completely run out. These products are very expensive at private pharmacies and are out of reach for most families. Lack of access to contraceptives and other supplies will lead to increases in STIs, STDs, and unwanted pregnancies.
As always, Mali Health remains committed to supporting the community health system and local actors to improve access to quality maternal and child healthcare. While we have weathered many emergencies (multiple coups d’etat, epidemics, pandemics, climate change) none have so profoundly destablized the health system as this one.
This emergency was manmade. Direct support to those on the frontlines, to those whose health systems have been dismantled, to those delivering and receiving healthcare each day – is how we will rebuild just and equitable systems and structures to ensure that pregnant women and children have the care they need and deserve, without dependence on foreign aid. Please if you can, contribute today.
by Tara Hopkins | May 21, 2024 | Quality Improvement
In a very crowded hotel meeting room in Bamako, brimming with dozens of dignitaries and officials from all levels of the health system along with a wide variety of partners, a special award ceremony recognized the winners of a unique competition.
Organized by the Ministry of Health and Social Development (MSDS), with technical and financial support from USAID’s Country Health Information Systems and Data Use (CHISU) program, this competition recognized health facilities for the quality of the data they submitted to DHIS2, Mali’s national health information system.
Data quality is a central challenge in health systems like Mali’s, which is why it is a key component of our participatory quality improvement (QI) work. Improved data reporting and data quality contribute to improved disease surveillance and informed, timely decision-making. We work alongside both community health centers (CSComs) and reference health centers (CSRéfs) to help them develop and implement data management systems within their contexts that report timely, reliable data to DHIS2.
On this occasion, the winners were being announced for the CSComs, CSRefs and hospitals who submitted the highest quality routine malaria data in 2023. Scoring was based on four indicators including completeness, timeliness, internal and external coherence of their data, as well as and the stock of malaria-related products.
This competition was actually the second organized by CHISU – the first was initiated in 2023 based on the quality of COVID-19 epidemiological data submitted to DHIS2. In that competition, two of our partners were recognized: the Commune IV CSRéf won the CSRéf competition and our partner ASACODJENEKA placed second among CSComs.
This second competition yielded even better results for our partners. The top five scoring CSComs in Bamako were ASACOKA, ASACOS, ASACOMA, ANIASCO, ASACOLABASAD – four of whom are Mali Health quality improvement partners. The Commune IV CSRéf, a partner of ours for ten years which oversees more of our quality improvement partners than any other district in Bamako, placed 2nd among CSRéfs.
The winners were recognized with certificates, a variety of supplies and equipment, and training and capacity-building support. Their efforts were rightly celebrated and the satisfaction of the winners at having their efforts recognized was encouraging.
For us, the highlight of the event was when the winning CSCom and our partner, ASACOKA, was invited to share a presentation on their best practices for improving data quality. ASACOKA, located in Kalabambougou, opened in 2019 and our partnership began in 2021. Their presentation included the processes and protocols that helped them achieve their success and it was gratifying to see how many of those practices were put in place in the context of their quality improvement work. While we helped to provide tools, methods, skills and confidence – the data quality practices, results, and success were entirely theirs.
As the ceremony concluded, other CSCom partners mentioned to our team how the data quality standards and processes they learned and implemented within the context of our QI partnership were factors in their success, as well.
These results are significant not only because of their performance – which is reason enough to celerbate – but because they have sustained that performance over time, under the leadership of their own quality improvement teams.
The key sustainability strategy of our participatory quality improvement work is local ownership and leadership from the beginning, so that CSCom and CSRef personnel develop the processes and protocols that ensure quality healthcare, or in this case, quality data.
