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 Mali Health | Nov 9, 2024 | Mali Health
During this year’s rainy season, Mali has experienced extraordinary flooding. Several regions were hit hard, including Bamako.
Bamako is particularly vulnerable to flooding, particularly communities along the Niger river, like Kalabambougou, and communities with steep terrain and limited infrastructure to support rainwater runoff, like Sikoro. We work in both of these
peri-urban communities, and the effects of the flooding have been devastating.
Women in Kalabambougou like Mandy have made so much progress building sustainable livelihoods, and Kalabambougou is one of three sites of our Gnaman ni Sôrô ani Kènèya project.
The video below shares the experience of Tenin Diarra, who participates in one of Mali Health’s savings groups, in her own words:
The video has subtitles in French, which are translated in English below:
I’m Tenin Diarra, I’m from Kalabambougou and I’m a member of a Mali Health savings group.
This year, we really have been hit hard by the flooding. Since I have been in Bamako, I have never seen such a quantity of rainwater.
The river water overflowed, submerging the homes of families living riverside, including ours.
We have suffered two floods.
During the first, we left the house and as soon as the water started to recede, we returned.
During the second flood, we were rescued in the middle of the night by canoe because there was no way out of the house – the water had already completely invaded.
I lost my clothes, my goods, my provisions, everything.
Here is our vegetable garden where we cultivate corn for our use, as well as potato leaves and mint that we sell to support our family.
Today, everything is destroyed and we have lost everything. Even though the damage was enormous, there was no loss of life.
The place is not accessible without a canoe. Nevertheless, we have been staying in an unfinished home, waiting for the water level to drop.
Living conditions were precarious – without doors for protection, without water, electricity or latrines. We had to use the latrines of neighboring families who were not flooded for a month.
Now that the water has decreased, we have returned to our home, but we really need help, because we are going through a very difficult period.
Please consider a contribution to Mali Health to support women like Tenin. Resources are scarce and your support will make a difference helping them to rebuild their lives.
by Tara Hopkins | May 9, 2024 | Mali Health
Worldwide, we are losing ground on maternal health outcomes.
Maternal deaths are rising in many parts of the world, and we are not on track to meet SDG 3.1: Reduce the global maternal mortality ratio (MMR) to less than 70 per 100 000 live births by 2030. In February 2023, the WHO released a report indicating that nearly 800 women died every day in 2020 – about one woman every two minutes.
More importantly, maternal deaths are not distributed equally. On a global scale, most maternal mortality is concentrated in sub-Saharan Africa (69%), particularly West Africa. Pregnancy-related causes are still the leading cause of death among African women aged 15-29. In the US, black women are 2.6 times more likely to die due to childbirth than white women.
This significant equity challenge is being overlooked; the deaths of mothers deserve more attention and more resources. Within Mali, even though pregnancy is deadlier than armed conflict, the world pays far more attention to military action than the deaths of pregnant women.
At the same time, nearly every maternal death could be prevented. Though there is no standardized global data, studies from sub-Saharan Africa routinely show that over 90% of the causes of maternal deaths could be avoided with access to basic, quality maternal healthcare. In the US, more than 80% of maternal deaths could be avoided.
This contradiction is important and revealing – maternal mortality is mostly preventable, but we are still failing to prevent it. African women, and black women in the US, are dying at significantly higher rates. We must confront this truth, and its origins. We know what interventions work to improve maternal health outcomes. Our focus must stay on why all women and all communities don’t have access to them, and fix it.
Our current systems, strategies, institutions, and financing are not reaching the women most in need, because the women most in need are not represented in our current systems, strategies, institutions, and financing. In our current approaches, marginalized women and communities are usually rendered as passive recipients of services, not as actors with agency who are essential participants in the development of remedies to these deep and historic inequities.
To fix this problem, as Dr. Mary-Ann Etiebet noted, it is not just about what we do. It is about how we do it. We will not fix it by continuing to use the same approaches that have created and are maintaining these gaps in maternal health equity. It won’t be solved from the top-down, which is still how most of the world’s global public health systems work. What’s required is not developing a new technology or innovation.
If we are going to stop and reverse the increasing trend in maternal mortality, the women and the communities most affected must be at the heart of solutions.
If we do not change our approach, the result would be disastrous. By one estimate, if the reduction of maternal deaths continues at its current rate, SDG 3.1 would not be met in the African Region until 2100, after 125 million mothers died from a cause related to childbirth.
So what does it mean to change the how of our sector? What would it mean to dismantle entrenched systems designed to retain power and decision-making in certain hands? How do we prioritize and center the voices, experiences, and knowledge of those whose needs are not being met?
Instead of continuing to operate through our existing institutions and structures, and building interventions around their capacity to deliver or distribute solutions to a population, it means turning our focus to the mother who needs access to those solutions and starting to address the problem from her perspective.
It requires a complete shift towards a more fundamental question of who is invited to participate in the solving – who is invited to participate in the how. It means being willing to give up control and to pursue solutions that put power and resources into local hands.
We are trying to put this shift into practice every day. Whether it is adapting traditional quality improvement processes so they can be led by local teams of women and stakeholders, or redefining local health financing to ensure that women have the ability to build and manage their own health-financing resources, we strive to use a women-centered approach in every strategy. We convene and support women, community members, and providers in the community health system to work together to identify and solve obstacles to quality maternal healthcare in their communities.
Ending preventable maternal mortality is a problem that can be solved, but only if we’re willing to change how we try to solve it.
by Mali Health | Feb 5, 2021 | Mali Health, Women-Led Health Financing
It is Wednesday, February 3, 2021, Aminata’s 3rd day in her new position with Mali Health. In the early morning at her desk, we asked Aminata to share her feelings about her journey and new role.
I am Aminata Seydou Traoré, I’m 29 years old, and I live in Kalabambougou in Commune IV of Bamako District. I have a Master’s degree in Law with a Judicial Career Option from the Faculty of Legal and Political Sciences of Bamako.
Aminata began working at Mali Health in February 2018 as a savings group facilitator, an animatrice, in Kalabambougou in our Women-Led Health Financing (WHF) programs. While she was serving as an animatrice, Mali Health supported the launch of one of our first cooperatives in Kalabambougou. Aminata brings extensive experience implementing our WHF strategies, but she has something even more valuable. She brings understanding and knowledge from three years of listening to and directly supporting women in her community. Reflecting on her time at Mali Health, Aminata tells us:
At first I wondered how I should go about meeting the goals that were assigned to me. Then little by little, I was able to fit into a team full of diversity. The questioning gave way to confidence and enthusiasm; then I said to myself that I have a lot to learn with this organization. My personal goal was to be able to be in a management position in the program in which I work. With the position of Program Assistant opened, I thought to myself – now is the time. So I applied and was right to believe it and give it a try.
She was right to believe in herself and try, and today Aminata is ready to thrive in her new role. Ambitious and always committed to serving her community, Aminata is also active in civil society organizations, including the Coalition of African Alternatives Debt and Development (CAD-Mali) through an organization known as Association of Youth for the Development of the Municipalities of Mali. We look forward to the enthusiasm and energy she will bring to her work with thousands of women across Bamako.
*Aminata is stepping into the role once filled by Aïssata Touré Kouyaté, who was recently promoted to Storytelling Manager.
by Mali Health | May 5, 2020 | Mali Health, Women
As the COVID-19 pandemic slows in some parts of the world, the road ahead for the families we serve in Mali is still uncertain. What is clear is the impact the pandemic is having on the wellbeing of families who already faced many challenges. The health and economic impact of this disease will last for a very long time in the peri-urban communities we serve.
As we communicate with and support our partners each day, we wanted to share some of what they are experiencing with you. Since Mother’s Day will soon be here in the US, we particularly wanted to share how the moms we serve are doing.
At community health centers
There has been a significant drop in demand for primary care services at community health centers. You’ll remember that community health centers are the building block of Mali’s health system, where most mothers and children go to receive healthcare.
Dr. Thiéro is the DTC (Directeur technique du centre, or health center technical director) at our partner health center in Sabalibougou (where our WomenConnect project is located). He noted that in April of this year, antenatal care visits fell by 35%, from 289 last April to 189 this year. Postnatal care visits have fallen by 15%. Visits for other curative services have dropped off even more.
Dr. Thiéro reports they have never seen such rapid declines like this before, not even during Ebola. He attributes the change to all the rumors and fears about COVID-19: that you will contract it at the health center, be diagnosed with it if you go, or simply accused of having it if you have any of the symptoms.
At home
Our health savings groups cannot meet normally right now, but we are still finding ways to share health information. We spent the weeks before COVID-19 arrived in Mali training our team to share information with all groups and to help them prepare for its arrival. We were able to reach all 5058 women in our savings groups, and all 180 women in our cooperatives.
Korotoumou is a member of one of our savings groups in Boulkassoumbougou. At the end of March, she had a cold that was making her very tired. She did not want to go to the health center because it is said that if you go with a cold, the staff will automatically isolate you, and your family, which would lead to stigma in your community.
So Korotoumou decided not to go, until the day her group facilitator came and shared information on COVID-19 and encouraged everyone to continue seeking care as normal. The following day, she changed her mind, and went to the health center to get the care she needed, and she recovered. Just last week, she attended her scheduled antenatal checkup at the health center. Korotoumou told us:
I think it is very important to share the right information with members of the community so that families can avoid very difficult situations either due to delaying care or to stigma from COVID-19.
Fortunately, like Korotoumou, all the women in our savings program for pregnant women (SHARE) continue to complete all of their antenatal and postnatal visits as scheduled. All 10 of the women who gave birth in March or April did so at their health center.
Community health workers
Our team of 41 health workers continues to safely visit or check on the families in their care, which include 1812 mothers, 167 of whom are pregnant, and their 2701 children. You already know how hard our CHW team works to take care of families, but you may not know that most of them are mothers themselves.
Kadidiatou is a community health worker in Lafiabougou, and the supervisor for the other CHWs working in her community. She has two sons; one is 3 years old and the second is 3 months old. Like everyone in her community, she had some doubts when she first heard about COVID-19. But as soon as she attended our initial team trainings, she understood the threat posed by this disease and was able to get answers to all her questions, which she now shares with all the families she cares for.
As a mother, she is also taking as many precautions as she can to protect her family, by not visiting friends and neighbors and by closing the gate to her home so others do not stop by for a visit. Unfortunately, her niece tested positive for COVID-19, which was a difficult time for her family. Thankfully her niece has recovered, but Kadidiatou uses her experience as a way to convince others to take COVID-19 very seriously.
Last Saturday, she was checking on a pregnant mother, Sanata, to remind her that she had an antenatal visit coming up this week. But as they talked, she realized Sanata did not intend to go. When Kadidiatou pressed her, Sanata shared that she had heard it said that if someone goes to the health center, she will return with COVID-19, noting that it was only recently that health centers had any preventive measures in place, like handwashing stations. She told Kadidiatou,
I do not want to go to seek care, only to catch this illness and bring it home to my family.
Mothers like Sanata and Kadidiatou are not alone. Our team is talking with worried mothers across Bamako. As long as COVID-19 is a threat to their families, our team will continue to help mothers navigate and overcome all the challenges that prevent them from accessing healthcare in their communities. Now more than ever, it is clear that all mothers and children deserve access to quality healthcare – and just how far we still have to go.
by Mali Health | Mar 21, 2020 | Mali Health
The limited resources available in Mali make it extremely vulnerable to COVID-19. The best chance that Mali has is to prevent an outbreak before it begins, so that is our focus. If you can, we hope you will contribute, or buy a bar of soap, and together we will help make sure families and health centers have the essential resources they need, like soap, to stay safe.
Like us, you are probably receiving daily emails about the global pandemic confronting our world.
While there are no confirmed cases in Mali, we do not yet know what impact COVID-19 will have on the communities we serve.
Mali is extremely vulnerable to an outbreak like COVID-19. There are perhaps only 20 ventilators available and the health system simply does not have the capacity to manage the number of patients who would need care. In the peri-urban communities we serve, limited access to running water and soap, as well as dense populations, make many preventive measures difficult or impossible to adopt.
But we are holding on to hope. The countries surrounding Mali have several cases, including the continent’s first confirmed death to the disease, a woman in Burkina Faso. The fact that there are no confirmed cases in Mali is an incredible achievement. We are doing everything we can to support both the government and communities to prevent any cases.
Here are a few reasons why we are hopeful that we can:
The people of Mali are resilient.
The past several years have been some of the most challenging in Mali’s history. If there is anything we can say about the challenges Malians have faced since 2012, it has contributed to their strength and resilience. Malians repeatedly demonstrate their commitment to their communities and to one another; social cohesion is extremely valued and it is worked towards every day in large and small ways. Since we began our work, the people of Mali have faced a political crisis, the Ebola outbreak, and a worsening security situation. Through it all, Malians are working together to support one another and their communities. Resilience is one of the greatest strengths Mali has to get through this pandemic.
We are ready.
Even though we are a community organization, our team has experience responding to disease outbreaks and coordinating with national responses. Our community health workers continued to serve their communities during the Ebola outbreak, and have a strong desire to do so. Our team continues to reach thousands of families with the prevention information and resources they need to stay healthy. We are helping our community health center partners prepare and implement stronger prevention measures. Our dedicated team will continue serving their communities unless distancing measures are ordered by the government, or until it becomes unsafe for them to do their work. We do not know how big the task before us will be, but our team is prepared, and we are helping our partners and the communities we serve prepare, too.
Here are some of the steps we are taking:
- Our health team did a refresher training for our entire team, including over 50 community-based health workers and group facilitators, on the signs of COVID-19 and the top prevention measures
- In the homes and communities we serve, our team is emphasizing these messages in their daily visits, particularly handwashing with soap (which is always a big priority for us)
- With our CSCom partners, we have re-implemented many Ebola prevention methods, such as ensuring our health workers are stationed at each CSCom to greet and share information with all visitors and making sure all visitors wash hands upon arrival and departure
- We are making sure our partners have all the equipment they need to maintain proper prevention protocols, such as handwashing stations, and soap. Until the threat of COVID-19 has passed, all proceeds from the sales of our soap will go to equipping community partners with soap, which we will source from our cooperatives.
- We are in the process of doing a small evaluation to assess where the needs might be at our partner CSComs (in terms of facility and preparation) as well as how best to help them with health promotion and making sure prevention messages reach all patients and visitors
We are also making plans, should the very worst occur. When the health system is stressed and its resources spread thin, access to primary care will suffer. We’re doing all we can to ensure that mothers and children will still have access to quality primary healthcare, during this pandemic, and after it.
We will get through this in the same way we accomplish everything we do – by working together.
