Women | Mali Health

Meet Haby Koné Kouyaté, midwife at the health center in Boulkassoumbougou

by Mali Health | Jun 2, 2021 | Quality Improvement, Women

Every year, 5 May is dedicated to one of the most important professions in the world – the midwife. No matter where you live, the work of midwives is at the very heart of a family’s health. Their roles are multifaceted and comprehensive, but often underappreciated.

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.

Haby counsels a mother on family planning options — Haby counsels a patient on family planning options

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

How a strong community health system keeps mothers at the heart of primary care

by Mali Health | Apr 29, 2021 | Community Health Workers, Women

In March, one of our health center partners, CSCOMSEKASI, reported 2 new malnutrition cases. That may not seem like many, but malnutrition is one of the leading causes of preventable deaths among children under age 5 in Mali.

One of the areas served by CSCOMSEKASI is Sibiribougou, a peri-urban community. The health center regularly sees some of the highest numbers of malnutrition cases in Commune IV. Sometimes, it has the highest number of cases in all of Bamako.

One of the children who became sick in March was Natenin, age 4. She and her younger sister, age 19 months, live with their parents in Sibiribougou and participate in our community health program.

Our team quickly got to work to organize a nutrition demonstration, a strategy used to help mothers learn to prepare foods which support their children’s development. Led by a nutritionist from the national health program, the session showed mothers how to prepare a porridge enriched with local ingredients, like carrots and pumpkin.

Nutritionist speaking to mothers — The nutritionist speaks to mothers about providing the nutrients children need to grow

The nutritionist shared that a major factor in malnutrition is repeatedly feeding children the same foods, which does not allow them to have a variety of nutrients. The porridge mothers learned to make is prepared with affordable local products that are available year-round; it provides balanced nutrition that ensures the good growth of children.

We invited 25 mothers with children under age 2 from our program to come to the health center for the demonstration. They were joined by our community health workers, the nutrition staff at the health center, and other mothers from Sibiribougou.

She began by sharing the recipe, explaining the ingredients, quantities, and the method :

Ingredients
2kg of sorghum
2kg of wheat
2kg of fonio
1kg of corn
1kg of rice
5kg of baobab flour
10 carrots
1 medium pumpkin
1 tablespoon of salt
10kg of sugar
1 small container of peanut oil

Preparation
Wash each grain well separately
Mix them in the same container and grind them
Sift the mixed flour and set aside
Sift the baobab flour well
Mix the two flours and set aside
Wash the vegetables well
Boil and mash them

Then, she got to cooking, inviting mothers to help her at each step.

Cooking
Boil 10 liters of water in a clean pot
When water is lukewarm, using a calabash and a ladle, slowly mix some water into the flour mixture until blended
Pour the solution back into the pot
Mix and stir until a homogeneous mixture is obtained
Then add the mash made of carrot and pumpkin to the porridge and simmer for about 5 minutes.
Then add the salt, sugar and a cup of oil
Let stand a few minutes before serving

Then came the best part – the tasting! All the children attending enjoyed the portions they were served, giving their full approval of this new dish. Mothers equally approved. They not only liked the taste, but appreciated that the ingredients were local and accessible. These nutrition demonstrations not only give mothers access to important health information, it also facilitates a permanent change to more nutritious meals in their households.

At the end of the session, Natenin’s mother addressed the group. She thanked the nutritionist for sharing this information and advice, and with it, vowed that her children would never know malnutrition again.

When mothers are supported with information and resources to keep their children healthy, the results are astounding. While a 2017 UNICEF study found the national rate of acute malnutrition in Mali rested at 10.7%, we had just 14 cases of acute malnutrition among the 2,350 children served by our community health program in 2020. Putting mothers at the heart of health interventions works. Strong community health systems react quickly to community needs by keeping women and mothers at the heart of local, accessible solutions.

Meet Oumou Doumbia, first president of Union Kènèya Yiriwa Ton

by Mali Health | Apr 23, 2021 | Women, Women-Led Health Financing

In September, Madame Oumou Mariko Doumbia was elected by her peers to be the first leader of Union Kènèya Yiriwa Ton, a new association formed by women who have participated in our cooperative program. Mme Doumbia lives in Sabalibougou, a peri-urban community in Commune V of Bamako, where Mali Health has worked for several years.

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. »

Cooperatives help women lead, during the pandemic and after it

by Mali Health | Sep 7, 2020 | Women, Women-Led Health Financing

When COVID-19 arrived in Mali, it quickly interrupted lives and livelihoods in the peri-urban communities we serve. Most families with whom we work make their livings in the informal sector. The first COVID-19 prevention measures put into place in Mali significantly restricted their work.

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!

How mothers in Mali are doing

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.

Women, cell phones, and innovation – Mali Health’s unlikely path to WomenConnect

by Mali Health | Feb 27, 2019 | Health Promotion and Community Outreach, Learning, Women

In November 2018, Mali Health officially became a partner in the WomenConnect Challenge (WCC) – a USAID initiative intended to “bridge the digital gender divide.”

For so many reasons, this was an unlikely place to find ourselves; it was not something we had planned. Partnership, collaboration, and learning can be funny in that sense – they often lead to unexpected places. The journey to become one of nine WCC partners has been enlightening, challenging, and meaningful. It’s a journey that we are fortunate to be on. This is new territory for Mali Health.

Perhaps you are now wondering: what is a digital divide? and what does that have to do with mothers and children, or health? Confusion, and even skepticism, are rational responses. We would be the first to admit that the connections between our community health work, this opportunity in particular, and the fascination with technology/innovation/social entrepreneurship in general, could seem tenuous. This project could be a distraction from our mission.

But, we’re learning so much on this journey – and those concerns do not keep us up at night. Here are four reasons why:

1. We’re focused on women.

Women are the heart of what we do. They are the focus of our daily work because they are at the core of our mission and strategy. Women are the key to improving maternal and child health in Mali because they are the ones who are most affected by access to and quality of care. You’ll remember that access and quality are our two top priorities in community-level maternal and child health. Women are the care-providers to children and the care-seekers for their families. They are the ones who determine where, when and how their family needs to seek healthcare.

As you may have guessed, WomenConnect is also completely focused on women. We all know that women do not have the same opportunities to reach their full potential, but have you thought about what it means for them not to have access to the same technologies? As the world becomes more digital, what does it mean for women to not have equal access to the internet? Could that impact their health and wellbeing? WomenConnect thinks these are questions worth asking and answering (so do we).

And we’re in good company. In their 2019 Annual Letter, Bill and Melinda Gates described nine of their top surprises as they have pursued their philanthropy and work. Guess what #9 was?

“Mobile phones are most powerful in the hands of the poorest women.”

– 2019 Annual Letter, Bill and Melinda Gates

Say that again? We start a project to learn if and how cell phones using a voice-based technology can help the poorest women in Bamako better meet their health needs… and two of the most towering figures in global health are talking about poor women and cell phones?! On the Colbert Late Show?!

If it makes sense to Bill and Melinda Gates, that works for us.

2.This project allows us to use technology and engage in innovation and social entrepreneurship in an appropriate, measured way.

The potential for innovation and solo social entrepreneurs to save the world is another topic for another day – but let’s just say this approach feels overrepresented in our field at the moment. Not every health problem (especially in community and/or maternal and child health) is a challenge just waiting to be hacked or solved by the right technology or business model, which can then be taken to scale to save the world.

However, there are some very amazing engineers and entrepreneurs out there who may very well revolutionize the way the world tackles certain problems. We’re not one of them, and we’re not trying to be one of them. The revolution we seek is to help communities in Mali have full ownership and control of their local health systems so that all mothers and children have access to quality care. But, that doesn’t mean we can’t partner with one of these visionaries (see #3 below) – and work together to find extraordinary solutions.

So we are. As a small community organization, everything Mali Health achieves is through partnerships. With donors, with communities, with mothers and families. This project allows us to build an exciting new partnership, which happens to include technology.

And perhaps it is through partnership – bringing together community expertise and resources, community builders and problem solvers like Mali Health, and the best of technology, innovation or social entrepreneurship like Lenali – that the real potential for transformative change using technology and innovation exists. Even social entrepreneurs need customers. Maybe it is none of these pieces alone, but working together in partnership with the others, that creates success? We’re excited to find out.

3. We are going to learn a lot. In fact, we already have.

Learning from others is very important to us. So important, in fact, that we made learning and data-based decision-making a pillar of our current strategic plan. It’s something we encourage within our team and within our organization everyday.

Participating in this process has already offered many lessons. Perhaps like me, skepticism about the appropriateness of technology to serve women living below the international poverty line, in some of the poorest peri-urban communities in the world, is still lingering in your mind. When we’re simply trying to help women and children prevent basic illness via handwashing with soap, or get to their community health center for prenatal care, malaria treatment, or to give birth – where is the role for technology? I had to learn.

My favorite line about the 9th surprise in Bill and Melinda’s letter is this: “connectivity is a solution to marginalization.” The most important part of that line is the smallest, the article: Connectivity is A solution, it is not THE solution. Perhaps the greatest lesson I have learned so far is that simply using technology should not ever be THE solution. In fact, it’s quite the opposite. Technology for its own sake almost never works. Technology is a tool, like soap or a mosquito net. And it is one that we should not overlook because the women and families we serve happen to be poor.

This lesson is also particularly evident in our baseline study, which was administered by our talented Research, Monitoring and Evaluation Department. Of the 300 women we surveyed in Sabalibougou, 100% reported owning a cell phone. Of those same women, 52% had no formal education and 37% had some primary school education. So, a full 89% of the women we surveyed had extremely limited or no formal education, meaning they are likely to have trouble with literacy and numeracy – but they all had a cell phone.

So, can connectivity be a solution to marginalization in this context? Absolutely, yes.

Our baseline study was full of other surprising results (so much learning!) but I will save those for another day. This project has already challenged my assumptions about technology – what it is, and how it can be used, it’s relevance to the poorest women – and I am ready for other assumptions to be challenged. That’s why learning is so important.

4. We’re part of a supportive WCC community.

In June last year, we had the opportunity to attend a workshop in DC as a part of the WCC application process. Mali Health was the only health organization to attend among the approximately 20 participants. Not only did we meet some fantastic people, we learned a great deal. We learned from the other projects and organizations who attended and collectively we learned together from a community of experts who shared their advice and work. There was a spirit of collegiality, not competition. For anyone who must attend professional workshops or conferences, or who have firsthand experience with USAID “co-creation” processes – you know what a rare experience that is, and can understand how much we appreciated it.

The person who is most responsible for this community is WCC Director Revi Sterling, whom we had the honor of hosting for the community launch of our project in Sabalibougou earlier this month. We are so fortunate that Revi and her vision for WomenConnect landed at USAID when she did – and we wouldn’t be participating in WomenConnect without her.

Mali Health is proud to be a part of WomenConnect – and we will be working very hard to make our colleagues in the WomenConnect community proud of us.

Thoughts of How on earth did we get here? have ceded to thoughts like What an amazing opportunity for our team!

We cannot know if this project will work – it is a pilot, after all. But as we work alongside 400 women in Sabalibougou and listen to what they think of a brand new technology and its relevance to their lives, we do know that we, and our partners, will be learning a great deal along the way.

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