No one knows that better than Mme. Kouyaté Haby Koné, midwife at the community health center in Boulkassoubougou. Haby has served as a midwife and taken care of families in her community for more than two decades.

As a woman, I am proud of my job because I witness all day long the role that midwives play in the health of the family. We accompany pregnant women, newborns, mothers, and families during a very sensitive phase of their lives.

– Haby Koné Kouyaté

Though she has been dedicated to caring for mothers, newborns, and families for much of her life, it can still be a daily struggle. She notes that midwives like her often lack access to technical training and ongoing updates on health standards. She wishes they had more resources to advance in the practice of their profession.

The health center where Haby works in Boulkassoumbougou is a part of our participatory quality improvement program, so she does have access to these resources. They make a difference not only in her feelings about the quality of her work, but in the outcomes for her patients. Thanks to her, more mothers are completing all their prenatal care, coming to deliver at the health center, and returning for postnatal care and their children’s vaccinations.

But as she so effectively and kindly takes care of her patients, she still thinks about all her colleagues across Mali and across the world.

In 2021, the theme of International Day of the Midwife was “Follow the Data: Invest in Midwives.” The 2021 celebration was connected to the publication of a report about the state of midwifery practice around the world, and just how essential it is.

For Haby, the more attention that can be paid to the needs of midwives, the better. She believes more needs to be done, urgently:

I appeal to governments, civil society organizations, and partners to commit themselves to improving the technical platform and support for midwives, and to invest in building the capacity of midwives in order to save lives and improve the well-being of pregnant women, mothers, and newborns.

Together, we can hold policymakers to account and show that the numbers on the impact of midwives speak for themselves and that we need to invest in midwives for midwife-led care now and for future generations.

– Haby Koné Kouyaté

Dr. Sogoba has been helping to ensure that the surveillance priorities and strategies being developed are feasible and realistic for health workers, health centers, and partners on the ground. He is relying on our experience during both the Ebola outbreak, and the health security and systems strengthening efforts that followed it, as well as our participatory quality improvement and community health worker programs.

What is community-based epidemiological surveillance?

The Direction Générale de la Santé et de l’Hygiène Publique (DGSHP) explains why an implementation guide for SEBAC is so important :

characterized by the increasing globalization of emergencies and public health events, the evolution of diseases at the epidemiological level underline the importance of community monitoring in order to move quickly from detection to confirmation and response.

The emergence and earliest detection of infectious diseases – like Ebola or COVID-19 – often occur at the community level. The quicker that the community health system can identify and respond, the quicker an outbreak can be contained, and communities can stay safe. A strong response requires a variety of systems to be strengthened, including a trained health workforce, decentralized and accessible laboratory capacity, and clear response protocols at the local, regional and national levels.

A long-term planning process

At the invitation of the DGSHP, Mali Health has been participating as a technical partner in the development of the national SEBAC guide since 2019. First, a draft of the guide was developed at a workshop in Bamako. It was then tested in the Kadiolo health district, in Sikasso region.

At a workshop in Bamako at the end of 2019, Dr. Sogoba had the chance to present our approach to community health to the entire planning group. He also shared our experiences supporting community health partners during the Ebola outbreak and with the following Djomi project, which was a part of the Global Health Security Agenda (GHSA). We are honored by the opportunity to represent the needs of the community health system, and our efforts to support it, in this national process.

The objective of this latest workshop in Fana was to analyze results from the test in Kadiolo district and to develop a final extension plan. The next step is to submit that final plan to the DGSHP for validation and approval, and to identify a donor to finance the extension of the surveillance program. If a donor can be identified, the entire process of disseminating and implementing the plan in all regions of Mali will take 5 years.

While the fields of public health and medicine (among others) often invoke compassion as a grounding principle, its application to our training and practice as professionals is still developing. We recently had the chance to reflect on compassion and its role in our work, and we realize it a conversation that we want to continue. And we’d love for you to be a part of it. Share your thoughts with us on social media, or send us an email.

In mid-June, we attended the IZUMI Partners Meeting in Boston. We are so fortunate to work with IZUMI and they have been a strong, steady partner as we have developed our approach to improve healthcare quality, governance, and community participation at community health centers.

IZUMI Foundation supports global health around the world and is part of a group of foundations originating in the Shinnyo-en order. Shinnyo-en is a Buddhist denomination originally established in Japan that is grounded in values such as kindness, compassion, and caring for others. In fact, one translation for the Japanese word izumi is “heart of compassion” and in the Shinnyo-en tradition, that is represented by a deep commitment to social awareness and justice.

IZUMI Foundation is driven by the principles of hope, health and compassion and we are delighted that the one thing that stayed with us the most from their meeting was not something we learned about global health or nonprofit leadership, but something far more universal: the role of compassion.

The keynote speaker at IZUMI’s meeting was Dr. David Addiss, an advocate for compassion in global health, and he spoke about its necessity in our sector. Compassion is a familiar value for most of us, but Dr. Addiss differentiated compassion from other values and grounded it clearly in our field. Compassion is not rooted in sympathy or pity – those connote differences in power, even superiority. Instead, compassion is rooted in solidarity and an acceptance of our interconnectedness.

Though some may view it as an unscientific discourse, he noted that compassion is a skill that can be practiced and there is a growing field of neuroscience devoted to understanding it. Compassion can be taught, and learned. Dr. Addiss asked us to consider and interrogate compassion – as the desire to alleviate suffering – as the inspiration and motivation for many of us and as the ground in which our field is rooted.

Though we are now back in the busy day-to-day of our roles, the idea of compassion has remained with us. It has encouraged us to reflect on the role it plays in our organization – and in our partnerships with communities in the US, and in Mali. As a small community organization, we often think of Mali Health as generating so much of our identity from the communities we serve in Mali – the proximity of our team within them and our service to them – and the community in the US who chooses to support that work. But if we take a step back and ask ourselves why that identity has meaning for us – the answer looks much like compassion.

At its best, compassion is about solidarity, about making connections across difference out of a recognition that we are linked. While compassion might stem from conditions of inequality, those we serve are not the objects or recipients of our charity. They are equal partners in eliminating suffering and improving the wellbeing of all.

But sometimes, that distinction isn’t always clear in our sector. There can be a downside to compassion, especially when it comes to examining our motivations and choices as individuals. Helpers of all kinds can burn out and people make poor choices in the name of serving others. At its worst, those operating in the name of compassion insist on maintaining power and agency over others – blind to their own biases and the oppression they perpetuate. And we still watch with concern as the power that exists in our sector not only can allow poor leadership or poor development work, but can incentivize it. Compassion alone is not enough to solve these challenges, nor is it the only value that should direct us. But we wonder if it might not be the kind of guiding, and grounding, principle from which global health as a field, and we as practitioners within it, could benefit.

In Mali, we see many applications for compassion in our daily work. The idea of “compassionate care” in a clinical or medical setting is not a new idea, but compassion is not a term we often use in public health. Our work and the way we train our team is grounded in principles of respect and care, but compassion still seems distinct.

Yet we see it in our community health workers going out each day to tend to their neighbors – doing so out of a sense of improving their communities and protecting the most vulnerable within them. We see it in our office staff, who have a strong sense of service to others and have dedicated themselves to our mission and values.

But perhaps where the idea of compassion resonates most for us is in our work to improve the quality of primary healthcare for the most vulnerable. Within quality improvement, there is a well-defined emphasis on the delivery of respectful maternal care that ensures all mothers are treated with equity and dignity. Interestingly, compassion does not often accompany these principles in the literature. But with its insistence on recognizing the human connection between a provider and a patient, compassion seems inherent in the current quality, equity and dignity (QED) framework in maternal and child health.

But there’s more we’d like to do.

Ethiopia’s Health Systems Transformation Plan discusses the creation of a compassionate, respectful, caring (CRC) health workforce, embedding compassion not only in quality, but also a building block of health systems strengthening (HSS). HSS can be one of the “nameless, faceless” areas of global health that the call for compassion is seeking to humanize – and we’re watching closely.

We are imagining how we might facilitate conversations with our team and our partners about the role of compassion not only for their motivations as individuals, but also within their daily work. We are thinking about what connections we might make between our emphasis on the patient experience in our quality improvement work, and how compassion might further improve our partners’ ability to provide more patient-centered care. Might we help our partners build a compassionate, respectful, caring (CRC) workforce?

Our ideas for how we might integrate compassion into our work are just beginning…

We also know that members of the Mali Health community are motivated from a place of compassion. You have told us time and again that you see solidarity at the heart of our work, and that is why you support us. You share your compassion with women and children in Mali, and us, because you believe that no one should suffer because they don’t have access to quality healthcare. Beyond your participation in our community, many of you are physicians, educators, or helpers of some kind. Your compassion, your desire to alleviate suffering, emerges in all areas of your life.

For us both, reflecting on compassion has led us to some rich and thought-provoking places. We are thinking about its role in our motivations as leaders, in the organization and team we support, and in our field. We wonder if you might have similar insights?

We want to open up the conversation about compassion in our communities – both in the US and in Mali – and we invite you to be a part of it. Let us know your thoughts about the role of compassion in your life – personal and professional. We’d love to hear from you. Send us an email, or leave us a note on social media.

Two times a month, Mali Health makes contact with us parents, to see the evolution of the state of health of the children. They are really there for us; we are really grateful. They educate us about the nutrition of our children and hygiene. The savings funds that Mali Health helped us set up helps us a lot to provide hygiene products such as our soaps and other cleaners. I’m so grateful that I have tears in my eyes about Mali Health.

Mali Health’s overarching goal is to support the Sotuba community to improve access to healthcare; the partnership is rooted in the community’s desire for change. Although there is more work to be done, this celebration represented an important milestone and the core of what makes Mali Health’s approach different. While Mali Health can give support to the health center, mothers and community members to improve health and to make change, it is up to them to decide whether to adopt strategies, act on information, and to take ownership of those strategies to sustain that change in the long term.

As the president of the ASACO described it, to the community, Mali Health represents the idea that a different future is possible, and within their reach. During his acknowledgement, the president reflected:

I remember a story that was told to me by one of my teachers: a little boy from a small village became a doctor and became a source of hope for his entire community. This little boy reminds me of Mali Health which has become the source of hope for our community.

Members of the Sotuba community have seen the change they are able to make to improve the health of mothers and children. While Mali Health remains so grateful for their partnership, and their gracious efforts to recognize what our partnership has achieved, we are most excited by the real steps forward that community members in Sotuba are taking to actively participate and take ownership of their health system and its future.

Every community with whom we work will always have our support, but our role is to strengthen their ability to manage and improve health in their communities, so that they can take the lead.

When they are the ones who start giving us the certificates and the chiwaras – then we know we’re all doing something right.

In March, the Mali Health quality improvement (QI) team hosted a three-day workshop for staff at area CSRefs – the reference hospitals who oversee our partner community health centers, or CSComs. Joining the CSRef teams for the training was a representative from the Office of Community Health at the Regional Health Directorate.

Staff at the CSRef already have tools and protocols which they use to supervise community health centers in their district, so our team explored the similarities between current supervision methods and the tools we’ve created to support CSComs through their quality improvement processes. Over the coming months, we will work together to adapt these tools so that conducting supervision for QI is a manageable process for the CSRef staff, while also ensuring that health centers continue to have sufficient support and supervision for their QI efforts to remain effective.

Participants in the training attended brainstorming sessions and breakout groups, and they analyzed case studies. They learned about the participatory quality improvement techniques that our partner CSComs use, as well as how they can support health center staff in designing, implementing, and monitoring their QI processes. On the third day of the training, the CSRef teams were able to join us at the health centers to participate in meetings with the QI teams and practice what they’d learned over the previous two days.

Though the CSRef is responsible for supervising CSComs, resources are limited and most staff have received little training. For most who attended, this three-day session was their first opportunity to learn about supervision methods. They were excited about having a chance to improve their own knowledge and abilities, and to apply what they learned not only to their supervision of the CSComs, but to other areas of their own operations.

We were thrilled by the enthusiasm that members of the CSRef teams showed for the quality improvement program and for the role they will play in ensuring it continues to benefit communities for years to come. They, and we, share the belief that in order to promote maternal and child health in the long term, we must build effective and sustainable structures and processes within the community health system, led by professionals like them and their colleagues in the CSComs.

We are excited to take this first step into a new phase of our quality improvement work and look forward to increasing local ownership and management of participatory quality improvement methods.

In early 2017, Mali Health partnered with Wild4Life Health and The Ihangane Project to participate in the 2017 CHMI Learning Exchange program. Our organizations explored the different contexts in which we work, sharing successes and challenges related to our respective continuous quality improvement programs.  
 
Afterwards, Tara and Mariam returned to Bamako to share what we learned with the rest of our team. This was our first opportunity to participate in a formal learning exchange with other organizations working on quality improvement. We were eager to see how the approach that we designed with our partners in Mali compared to other quality improvement programs across the continent. The exchange led to some unexpected lessons. So we decided to reflect on why we’re determined to learn from others, and why we seek opportunities like these. Together, our entire team reflected and engaged in a conversation about learning. Below are the main points our junior and senior program managers wish to share with others:

Why is it important to participate in intentional learning opportunities and to learn from other organizations?

• People learn from those in their life – parents, teachers or friends. It’s no different for organizations. If we are committed to learning, we must interact with other organizations, learning from them and sharing our information with them.
• Above all, we care about impact, and learning from others is essential to ensuring that we’re having a high impact. We can benchmark our approach with similar strategies, asking questions like who is seeing better results, and why? We can also learn about entirely new strategies that may result in better implementation and impact than our current approaches.
• Learning exchanges may lead to new opportunities, like partnerships with organizations or funders that will allow us to extend our impact. A learning exchange also doesn’t have to end. As partners, we can continue to be resources for one another, sharing questions and results in the future, not just about program models, but about operations or any subject our organizations share in common.

  Why do we value intentional learning at Mali Health?

• In our Quality Improvement (QI) program, we bring our partner community health centers together to share their successes and challenges. It helps them learn what others have done to solve similar problems, including what works well and what to avoid. In a resource-limited setting, learning from others helps our partners be as efficient and effective as possible. The same is true for our organization as a whole.
• Not only is learning and building skills a core program strategy, capacity building is a core value of our organization. To strengthen communities and community health systems, we must always be open and eager to strengthen ourselves.
• We are committed to the professional development of our entire team; we want each team member to set goals and to continuously grow and improve. Learning opportunities enable our staff to acquire new skills and to succeed in their positions now and in the future.

  What advice would we give to other teams trying to implement a culture of learning in their organizations?

• Involve everyone in the organization, from the Director to the junior staff. Everyone has to be committed to learning, and everyone has to have opportunities to learn
• Document your goals for learning; develop a protocol for when and how it’s going to happen, and then track whether it did or not.
• Make learning a regular routine. Try not to just gather everyone in a giant meeting room once a year for a two-hour seminar. Build learning opportunities into your regular activities and supervision so that it becomes a common part of your work. Your team will understand how learning is related to and benefits your organization, your beneficiaries, and them.
• Allow for choice. Give opportunities for each employee to decide what subjects or skills are the most interesting or helpful for them, either within or in addition to your core values and goals as an organization. Choice allows individuals to take ownership of the process and gives a feeling of opportunity, rather than obligation, both of which will increase morale.

Mali Health greatly values the opportunity to learn from other organizations, programs and contexts. In our current strategic plan, we renewed our commitment to learning, not only as a means for strengthening our programs, but as a professional development opportunity for our staff. We encourage all organizations to openly and actively share and seek the knowledge and experience gained from our respective work – the communities we serve and our entire sector would benefit from less competition and more collaboration.