Developing a community nutrition program from the ground up

Developing a community nutrition program from the ground up

by | 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.

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.

Keeping communities informed about COVID-19

Keeping communities informed about COVID-19

by | Aug 13, 2021 | Health Promotion and Community Outreach

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:

Two mothers at the COVID-19 caravan in Bakaribougou

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.

Students demonstrate how to wear new masks at Samè COVID-19 caravan

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.

The COVID-19 caravan travelled to 13 communities in Bamako.

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 young woman asks a question at the COVID-19 caravan in Bakaribougou

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.

Access by any other name: Equity and the COVID-19 vaccine

Access by any other name: Equity and the COVID-19 vaccine

by | Aug 4, 2021 | Health Promotion and Community Outreach

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:

  1. 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.
  2. 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.
  3. 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.