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.

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.

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.

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. »

But since 2018, we have worked with women to develop more accessible livelihoods through activities which they can control and are closer to their homes. With resources in their hands, women can make decisions that improve the health and wellbeing of their children and families. They can purchase nutritious food, buy soap and other prevention measures, seek healthcare, and enroll their children in school.

While our savings groups could not meet safely at this critical moment, the cooperatives, already equipped with PPE and operating in open outdoor spaces, could. Now, they are not only operating, they are growing.

In those early days as COVID-19 began to spread globally, we encouraged the soap-producing cooperatives to begin making as much soap as they could. Whatever they did not sell to their neighbors, we purchased and provided to our partner health centers and distributed to families most in need.

As the threat of COVID became clear, we decided to help women start sewing masks, using local cotton fabric. Our team quickly identified 30 women who already had basic sewing skills. We helped them to incorporate their cooperative and secure 5 sewing machines, along with the materials they would need. A very big thanks to Women International Leaders of Greater Philadelphia for the funds to purchase the equipment and materials.

The cooperative got started quickly and set the prices of adult masks at about $2 (1000 FCFA) and child masks at about $1 (600 FCFA). Mali Health was one of their first order; we purchased more masks for the staff at our CSCom partners in Bamako and Sikasso. As with the other cooperatives we have supported, the sewing cooperative not only provides much-needed revenue to families during the pandemic, they are also making very valuable resources available and accessible to peri-urban communities were resources are extremely limited.

We are even taking steps forward in helping the women who will lead a new union to support the cooperatives. In collaboration with the Direction Régionale du Développement Social et de l’Economie Solidaire du District de Bamako, women will receive training in leadership and management skills to help them develop and lead a resource of their own. Creating an association allows them to support and grow their cooperatives, while helping more women in peri-urban communities to launch cooperatives of their own. Stay tuned for more details!

Getting to Lassa requires a bit of a climb. Like Sikoro, it is north of Bamako, where the hills turn into cliffs. It is a different landscape.

On our way to visit a savings group, we started with a call on the village elders. Traveling with more Americans than usual, they received our small delegation graciously in a thatched-roof building that is surely often occupied by important community meetings and discussions.

Seated on the ground on an animal skin, the eldest offered very warm and customary greetings. We offered a traditional gift of kola nuts. Interpreting the exchange for our guests – Bambara, French, English – English, French Bambara – makes it feel more profound and ceremonial. Receptions like these are an honor and a social performance of respect – and I will never tire of them. I’m unsure if Mariam (our Mali Director), or the rest of our team, share my enthusiasm and awe. They always represent Mali Health with the immense Malian graciousness that is gratifying to this Southerner to watch.

Accompanied by two of the elders, we continued a bit farther up the slope. Noting very large piles of firewood (and suddenly realizing the lack of trees), they inform us that the production of charcoal was the primary revenue-generating activity. The informal economy is how most of those living in peri-urban communities, especially women, get by. They tell us that Lassa used to be like a rainforest – a small oasis above the city – but the dust the characterizes the rest of Bamako now seems to dominate here, too.

But as we continued, mango trees began to appear and grow in size. When we turned the corner to where the group was seated, we encountered one of the largest mango trees I’ve seen in Bamako. Mango trees provide very welcome shade here along the edge of the Sahel; thousands of women’s groups meet beneath them across the continent every day. They are amazing trees – thriving in even the harshest of conditions.

Again our small delegation is welcomed graciously, this time with song. We observe the opening ritual of the meeting – the diligent taking of attendance, reporting, counting, and recounting of the amounts saved in their two accounts: one for health expenses and one for income-generating activities.

Then, one at a time, every woman rises and brings her contribution, 100 FCFA, or about $0.18. The status of loans is reported. The funds are counted, recounted, and reported to the group to be held in the collective memory. At the beginning of their next meeting, the group will be asked how much should be in the accounts. The funds will be counted and the numbers will agree.

At the conclusion of their savings activities, the visitors are welcomed to ask questions. This Director, eager to report back to our wonderful supporters, asks a few (rather standard) questions:

• How many of you have used the health fund for yourself or one of your family members? About 80% of hands go up.
   
• What kind of things do you take the non-health loans for?  Women share that here in Lassa, they are gardeners. They buy inputs and tools for their gardens with the loans. Things like fertilizer, small tools, or seeds they don’t save themselves.
   
• What can we as Mali Health do to better support your group?  They want support to form a cooperative too… word travels fast. Though we are testing the cooperatives in only two communities – not at all close to Lassa – the other 5,000 women in Mali Health savings groups are watching closely.
   
• Great – we would love to help you do that. If you had a cooperative, what would you like use the funds for? To send our children to school, they say.

Hmm… no mention of health. I say as much to Mariam and she nods – but she’s already two steps ahead of me. I ask her if I might ask about the health center, how do they find the service there? How is the quality of care? We have worked with the health center here as an advisor to another community project, but we just added the CSCom in Lassa as a full quality improvement partner a few months ago.

Thanks to our partnership with OSIWA, we are expanding our participatory quality improvement approach – this time with a particular emphasis on women’s participation at all levels. These are some of the very women who we will be relying on to provide their feedback and leadership – to participate actively in the improvement of the health center. Mariam knows what is coming, but gives me the go-ahead.

• Could you tell me about your health center here in Lassa? What has your experience been like? What do you think of the quality of the care you receive there? A few women weigh in, saying they are satisfied with the care. Many have taken their children there and have received effective treatment.

I turned to Mariam – are they just telling us what we want to hear? Do they know we want to hear their real experiences? Mariam smiles at me, knowingly, as if my understanding finally catches up to hers. We discuss that the time is late and I say that we can just let it go. But, it would be nice to encourage them to share more. Their experiences are essential for us and the health center to hear and understand. We want them to know how important they are, but is now the best time to have this discussion?

As I discuss with Mariam, the group becomes restless. We have already taken up too much time – they have households to manage, children to mind, and meals to prepare.  Having stopped interpreting our side discussions, I’m worried I’m boring our guests who are not accustomed to the dryness and heat.

But then Mariam turns to Gaoussou, the dynamic Director of our Community Capacity Building department, and says a few things in Bambara. Though her Bambara is excellent, she usually prefers to speak in French and have Gaoussou interpret for her – another process I enjoy. This time, she speaks directly and deliberately to the women in Bambara.

Mariam tells them she knows there are issues at their health center. She explains why they are so important, not only to us, but to their health center and community. She describes our strategies for sharing feedback from women with the health centers and that we need more women to become leaders in the community association that manages the CSCom to help advocate for better care.

Though we have just taken them on as a full quality improvement partner, Mariam knows the center well. She gives the names of all the personnel – including the new director. She conveys to the group that she knows what happens there – she knows what they know.

One of the visiting elders weighs in.

 Listen to her words, she knows your health center perhaps better than you – why don’t you share your experiences?

After a brief pause, one woman starts pouring out her story – sounding more urgent and frustrated with every word. After hearing about the importance of delivering at the health center from her savings group, she was finally able to convince her brother to let her take his wife to deliver at the health center. Despite going into labor in the center, her sister-in-law was never attended to. She delivered, without being touched by a single provider. She vows to never return to the health center.

Other women weigh in with similar stories of neglect, lack of respect, or poor-quality care. They say that when they take loans from their group, they take extra so they can pay for the transportation to take their children to another CSCom nearby. They avoid their own health center if they can.

Throughout their testimonies, Mariam nods, again knowingly. Their experiences are why we started our quality improvement work in the first place. What is the use of helping women overcome the barriers to accessing care if the care they receive does not help them? This is why our approach of addressing both access and quality is so important.

Mariam thanks them for sharing their stories. She says it is because of their experiences that we are now working with their health center to improve. She reinforces once again that they are a very necessary part of the process and that we will continue to support them and the health center until they are truly satisfied.

We close our meeting with exchanges of gratitude all around. We take a group photo under a branch of the grand mango tree.

Though very aware of the time we have consumed, but not wanting to leave them after such an enlightening visit, I very timidly ask Gaoussou if I might just see one of the gardens they mentioned? Maybe take a photograph of one of the cultivators in her element?

We are again graciously ushered up a hill, through the barriers that keep out renegade goats, chickens and children and into beautiful, lush gardens. Yams, peppers, tomatoes – as far as the eye can see. I’m told that nearly every woman in the savings group has a garden and they sell their excess produce in the markets. No more charcoal.

While many families we serve come from rural areas where cultivation is the mainstay, there isn’t much room for gardens in densely-packed peri-urban communities. Lassa, situated along the ridges above town, has a bit more room – so the women are growing.

After more thanks and farewells, I’m still processing the lessons this group taught us, but mostly feeling very proud of our team and their dedication to ensuring women are heard and can lead. As we descend from the gardens, the elders share that instead of cutting trees, the community is now working on replanting them. Between the trees and the gardens, they have already noticed a difference in their climate.

They say the rains, which started to pass over Lassa into the next valley when the trees were all cut, have returned.

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.”