by Mali Health | Jul 27, 2019 | Quality Improvement
On Wednesday 10 July, Mali Health was honored by the Sotuba community in recognition of our partnership, and the impact it has had on improving community health. While we were the ones being recognized, for us, this event was actually a chance to celebrate the strong leadership in Sotuba, and the community’s investment and ownership of their health, and health system.
Sotuba is a peri-urban community on the eastern side of Bamako and Mali Health collaborates with the health center (CSCom) to improve healthcare quality and governance, as well as supporting community health workers and women’s health savings groups there.
The celebration featured staff from Mali Health, members of the community, and the president of Sotuba’s ASACO (Association de Santé Communautaire), the organization made of community members that oversees the health center. The ASACO serves as a bridge between the health center and the surrounding community, linking the organization and the people.
The ASACO has a key role in helping to improve the health of the community. When a community has an organized and efficient ASACO, the CSCom’s work is tailored to the specific needs of the people it serves, the CSCom becomes more responsive, and the amount of women and children seeking care at the health center increases.
Sotuba is one of the smallest communities with whom Mali Health collaborates. When the partnership began, the ASACO had no structure or organization and it was unclear to the community and the health center what exactly the role of the ASACO was. Unfortunately, most low-resource communities in Mali face the same challenge and one of the most important pillars of the community health system often is not able to fulfill its role of ensuring strong management, accountability and community participation in health centers.
Today, Sotuba’s ASACO is an active group of community members who are fulfilling that essential role – and they are seeing impressive results. On a measurement scale we use for transparency and accountability, Sotuba went from being one of the lowest-scoring partners to one of the highest. Sotuba’s patient satisfaction scores are consistently among the highest, over 95%, and the rates of pregnant women returning to deliver at the CSCom are the highest of any of our partners – sometimes reaching 100%.
As one of Mali Health’s first partners to implement, test, and refine our participatory quality improvement (QI) approach, their hard work speaks for itself. For several years, a QI coach has provided technical support and coaching to a QI team at the Sotuba CSCom and we are now in the process of turning the QI program over to that team, so that they can continue serving their community at this high level.
To support the efforts of the health center and extend the impact of improvements in quality, Mali Health has provided community health workers and free or subsidized healthcare to children and pregnant women with the least access. We also help women in Sotuba access more financial resources that can help them improve their family’s health. By addressing preventive healthcare, hygiene, and budgeting, these strategies aim to advance health in Sotuba by helping women gain more knowledge about their children’s health and increase their ability to act on it.
A mother and savings group member who attended the celebration shared her experience:
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.
by Mali Health | Jun 7, 2018 | Quality Improvement
Mali Health is happy to announce that we have won a Grand Challenges Explorations (GCE) grant from the
Bill & Melinda Gates Foundation. Our proposal, Using Participatory Quality Improvement Methods to Improve Vaccine Timeliness, will bring together maternal care providers, including health center staff, community health workers (ASC) and midwives (matrones), to develop local solutions for improving childhood immunization completion in the Sikasso region, in southern Mali.
Since 2014, we have been developing a participatory, team-based approach that adapts traditional continuous quality improvement tools for use in the community health system. We will bring those participatory quality improvement (QI) methods, created in collaboration with health center partners in peri-urban Bamako, to the Sikasso region in southern Mali, to improve vaccine delivery.
In Bamako, our participatory, community-based QI strategies led to significant improvement in timely vaccine completion. For example, completion of BCG vaccine delivery from 57% to 92% and retention between doses of MMR rose from 38% to 83%. With average completion of childhood vaccines hovering around 20.2% in Mali, there is room for significant improvement, in both rural and urban regions.
Our team is particularly excited about this opportunity because it allows us to continue working with partners in the Sikasso region, where we have worked to implement the Center for Disease Control’s (CDC) post-Ebola Global Health Security Agenda (GHSA). During that work, we observed significant gaps in the health system and integrated some of our quality improvement and governance strategies into the GHSA project. Our participation in that project ended in October 2017, when funding was significantly delayed during the budgeting process. We are glad to renew our relationships with communities and the health system in the Sikasso region, and to build new ones.
Through their GCE program, the Bill & Melinda Gates Foundation “supports innovative thinkers worldwide to explore ideas that can break the mold in how we solve persistent global health and development challenges.” Our project is
one of 35 Grand Challenges Explorations Round 20 grants awarded by the Foundation, out of over 1,500 applications received. This is our second GCE grant; the first, a part of Round 12, helped us to develop our QI approach.
Grand Challenges Explorations is a US$100 million initiative funded by the Bill & Melinda Gates Foundation. Launched in 2008, over 1365 projects in more than 65 countries have received Grand Challenges Explorations grants. The grant program is open to anyone from any discipline and from any organization. The initiative uses an agile, accelerated grant-making process with short two-page online applications and no preliminary data required. Initial grants of US$100,000 are awarded two times a year. Successful projects can receive a follow-on grant of up to US$1 million.
by Mali Health | Apr 28, 2018 | Quality Improvement
As a part of our commitment to strengthening community health systems in Mali, we are always looking for ways to turn control over to communities and existing structures. This year, we are taking big steps forward in integrating the participatory quality improvement methods we have been developing with partners since 2014, into the health system in Bamako.
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.
by Mali Health | Aug 17, 2017 | Learning, Quality Improvement
This blog originally appeared on the Center for Health Market Innovations blog.
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.
