Sokona Sangaré could rightfully use the title President Sangaré if she wished; after all, her savings group companions have elected and re-elected her to serve as president of their savings group since they started meeting in 2014. But she’s too humble for that — “It’s because I can read and write. That is why they chose me to be President,” she says — but she recognizes the important role she plays: “They continue to vote for me every year because I have won the trust of the group.”
Sokona and her friends live in Lassa Faranida, a small hillside community on the northwest edge of Bamako. It’s very remote, and infrastructure is weak; potholes dot the dirt roads, drinking water comes from wells, and only a handful of houses are wired for electricity. It’s no wonder that the women of Ben Kadi savings group (a Bambara phrase meaning “mutual understanding”) used to have great difficulty paying for their families’ health expenses.
Sokona explains:
” Before Mali Health helped us start this savings group, when my children or I would become sick, we didn’t have the money to get to the doctor quickly. It was difficult, sometimes impossible, to get loans from family or friends. Now all of us women in Ben Kadi can get a quick loan to get ourselves or our children to the doctor at any time day or night because I keep the healthcare lock box and key in my house. Whenever there is an emergency or urgent medical need the women know to come to me to get a health loan because the money belongs to all of us. “
As president, Sokona is responsible for protecting the lock box containing all of the money they’ve saved to support healthcare expenses; another group member holds the lock box containing funds that women can draw on to support activities that help to build their income. Sokona also facilitates every group meeting, tracking attendance, and supporting group members as they request and repay loans.
Sokona has worked hard her entire life, not only for herself, but for her community. While most women living in peri-urban communities like Lassa Faranida did not have a chance even to complete primary school, Sokona graduated from high school and then college before becoming a teacher at the local primary school. In the past, she earned extra money by selling charcoal from her home, and she looks forward to learning how to make soap to sell to local families. Ben Kadi is another outlet for her to support her community and the women around her, and she speaks proudly of her groupmates:
“I really enjoy being president of this group because we are all women, we all help each other and we all work together.”
While reflecting on progress, accomplishments, and goals yet to be achieved after her 15 years of community health and development work, Aïssata Touré, Mali Health’s SHARE project manager, tentatively says, “we’re doing the maximum, but we can still do more.” SHARE is a component of our savings group program aimed specifically at bolstering perinatal care and assisted births among pregnant women.
As a lifelong resident of Sikoro, the community where Mali Health was born, Aïssata has been an intimate witness to, and a driver of social transformation within her community. While growing up, her mother founded L’Association Muso Kalanso, The Association of Women’s Education. It was a grassroots community savings and education group in Sikoro, and simultaneously ran a nearby kindergarten. So working directly with pregnant women as Mali Health’s SHARE project manager, Aïssata feels right at home.
At only 26-years old, experience and ambition don’t fully describe the path Aïssata has blazed thus far. “Since I was the first child in my family,” she explains, “I had to believe that I could do anything boys could do.” Aïssata’s parents frequently tasked her with chores and errands usually associated with boys, so she quickly developed a thick skin and personal resolve with which she navigates complicated gender norms today. “The worst,” she laughs, “was carrying huge batteries across Sikoro to get recharged for nighttime electricity. I think those experiences pushed me to do more, to expect more,” she says.
Mali ranks among the countries with the highest gender discrimination in the world. Aïssata consciously lives her life as a positive example for other young girls in Sikoro, especially her own 9-year old daughter. She was the first in her family to attend university, receiving a degree in Economics from the University of Bamako. “Women can do anything. We just have to be brave.”
Since I was the first child in my family, I had to believe that I could do anything boys could do…Women can do anything. We just have to be brave.
– Aïssata Touré
At 13 years old, Aïssata volunteered as a peer-educator throughout her district’s school system to perform theater skits about about HIV prevention and treatment. “Oh yeah! I was terrified before my first performance,” she remembers. Within a few years she was running health advocacy radio programs throughout Bamako as assistant director.
By 2013, Aïssata was already on a list of community surveyors that Mali Health contracted to conduct various impact evaluations of our programs in Sikoro. At the time, she was working on her radio program, women’s savings groups, and maternal health volunteer work with the Red Cross. When she saw a job posting for Mali Health’s Assistant to the Advocacy and Radio Program, she took the opportunity. From then on, “every year I wanted more. In my performance reviews I would push for more responsibility.” The following year Aïssata transitioned to Communications and Public Relations Assistant, and the year after to become project manager for SHARE, her current position.
What’s the connection between her mother’s lifelong work with women’s groups and Aïssata’s own career choices? “Just a coincidence.” And between Aïssata and her own daughter: “I’m not sure, we’re very different—she’s super ambitious!”
Mah Diarra lives in Lassa, a small community that feels remote, even though it sits in the hills on the western edge of Bamako, Mali’s bustling capital.
Last year, nearly four months into her pregnancy, Mah hadn’t yet seen a doctor because she couldn’t afford to. One day, a friend told her about Mali Health’s new SHARE savings groups, which help women during their pregnancy. SHARE, or Savings for Health And Reproductive Empowerment, helps mothers to save for all the costs associated with their pregnancy, including prenatal care and delivery at a community health center.
Mah met with one of Mali Health’s animateurs, the community members who support and coordinate the savings groups. She enrolled and immediately started to save money to pay for the costs associated with her maternal care and delivery.
Women in savings groups save and lend their own money for group activities. Mali Health encourages them to use funds for health purposes and offers health education sessions at each meeting. Women learn about the most common and dangerous diseases, including malaria, malnutrition, diarrhea, and respiratory infections, plus effective techniques to prevent them. They learn about the benefits of prenatal and postnatal care, and of giving birth in a health center. Women also learn financial management skills that can help them to build greater financial independence.
Today, Mah is the mother of a beautiful, happy little girl. Mah knows that her daughter’s health is due in part to her ability to receive all her maternal care. She was relieved to deliver safely in the health center, but knows most women do not have the same experience. In fact, only 56% of women in Mali have a skilled attendant when giving birth.
Because of her experience, Mah now reaches out to other women in Lassa, encouraging them to enroll in SHARE. She speaks proudly of her experience, with her daughter at her side:
Following my prenatal care sessions with a doctor, I carried my pregnancy to term in good health! Before I joined my savings group, I had no knowledge about my pregnancy, the danger signs, and everything else that comes along with motherhood.
I joined the SHARE group four months into my pregnancy. The doctors advised me to attend all of my prenatal care (ANC) visits. With the help of other women in my group, I saved 750 CFA (~$1.30) every other week to help pay for my care. Meanwhile, Mali Health gave me a grant of 5,000 CFA (approximately $8-9 USD) to support my delivery in a health center.
These many benefits of the Savings for Health program allow all of us to be satisfied, happy mothers.
Mah encourages other women in her community to join SHARE
In 2014, Mali Health launched an mHealth program to help monitor the health of families in our care. The app guides our health workers through a standard set of questions and helps ensure consistent and efficient care. For example, the technology helps to accurately identify the severity of malnutrition by calculating a child’s height-to-weight Z-score. It can also help detect early warning signs to encourage intervention before a child falls into undernourishment.
As we roll out the technology and help our team become accustomed to it, they recently learned how powerful this new tool could be. During a routine visit, our community health workers found a child urgently in need of care. But when she didn’t receive it, they used their training, backed by their mHealth data, to become her advocate. Here’s what happened:
Last week, one of our community health workers visited a mother whose 20-month-old child was underweight. Using her training, our health worker instructed the mother to seek treatment at their health center immediately.
The next day, four CHWs returned to the home to learn how to do a malnutrition follow-up using their new mobile application. The follow-up requires the CHW to recheck the weight and the brachial measurement of the child. The brachial measurement is the circumference of a child’s bicep, a common method of identifying malnutrition, and is indicated by a range of green, yellow, and red levels. This child’s brachial measurement was red, and the weight-for-age calculated by the mHealth app indicated severe malnutrition. The child only weighed about 6 kg.
The mother explained she had gone to the health center that morning for the malnutrition program, but was sent home. The staff said her child didn’t meet the criteria for the program; the young girl was not malnourished “enough” to receive treatment. Our team then decided to accompany them back to the health center, because the child was clearly in need.
However, as soon as they arrived, they encountered intense resistance from the staff. One claimed she remembered the child from earlier and that she weighed 10 kg — far more than the 6kg our health workers had measured. Our team insisted they check again.
The staff measured the girl again and placed her on their scale, determining this time that she weighed 7kg. Looking at their weight-for-height chart on the wall, the health center staff stated the child was only mildly malnourished. Our team insisted they weigh the girl again on our scales (which every community health worker carries on home visits). The staff agreed.
When they did, everyone saw the child only weighed 6 kg based on the scales of two different health workers. The staff claimed the scales were not correct, so our team insisted they take the girl’s brachial measurement. After more protest, a staff member finally took the measurement, but did not fully secure the measuring tape. She left a small gap between the tape and the child’s arm, so the result was yellow instead of red. When our team pointed out the error, the staff member stated that was how she learned to conduct a brachial measurement.
At this point, still determined to demonstrate the young girl needed care, one of our CHWs took the child to weigh her on the health center’s scale herself and, contrary to the staff’s measurements, and measured her at 6 kg. They continued to push for the child’s inclusion in the malnutrition program. After several minutes of discussion, the staff relented. A staff member retrieved several sachets of Plumpy’Nut, an effective nutrition supplement, and gave them to the girl’s mother.
Once home, our health workers explained how to deliver the supplement to her daughter most effectively. They encouraged the mothers to return to the health center each Wednesday to have her child weighed and to receive more of the supplement until she reached a healthy weight.
It took guts for our four health workers to stand up to the team at the health center. Without their intervention, the little girl never would have received care. Without care, a child with such severe malnutrition could die; in fact, it happens often. Mali Health CHWs are well-trained and they demonstrated their knowledge with confidence, even going against higher authorities in the health system when they knew those authorities were at fault.
Their story illustrates why a strong team of community health workers are so essential to advocating for mothers and children in their community. We are so very proud that ours had the courage to do exactly what they are trained to do: to make sure every mother and young child in their community has access to the best care possible.
As president, Sokona is responsible for protecting the lock box containing all of the money they’ve saved to support healthcare expenses; another group member holds the lock box containing funds that women can draw on to support activities that help to build their income. Sokona also facilitates every group meeting, tracking attendance, and supporting group members as they request and repay loans.
