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:

Tenin Diarra

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.

 

The Gnaman ni Sôrô ani Kènèya project has entered its third phase. Women and youth in three peri-urban communities are building a local, circular economy designed to create sustainable livelihoods and address environmental health and climate threats.

After extensive data collection and community engagement in Phases 1 and 2, circular economic activities have begun by establishing composting and gardening cooperatives. From our community research, we found that 57% of waste generated in peri-urban communities is organic, and can be composted, turning unmanaged waste products into a valuable resource.

Beginning in January, 180 women successfully formed 4 cooperatives In Kalabambougou, Sikoro, and Sabalibougou and started acquiring skills in gardening, composting, and cooperative management.

Our baseline data collection revealed some interesting findings.

All 180 women participating in the project have been pursuing gardening activities for subsistence and as their primary income-generating activity for at least 5 years. We expected that composting would be a new idea – and only 4 of them demonstrated knowledge of composting. But nearly half of them, 88 of 180, had limited gardening knowledge. This result indicates just how limited resources are for this group of women, validating the significant need for the project, and leading our team to focus more on mastery of basic skills. In addition, twenty women already had strong knowledge of cooperative management.

About 21% of the project participants (38 of 180 women) reported having no income, the monthly incomes for the rest of the group ranged from 3000 FCFA (about $5) to 22826 FCFA (about $38). Of those with some monthly income, only 8 women reported having enough to be able to save and set aside funds for future needs.

Most of the women participating in the project have been participating in our health savings groups, and 80% (144 of 180 women) knew what to do when there was a health need for themselves or their families. Without sufficient funds to act on that knowledge, the ability to make decisions to protect their health can be limited, but fortunately they can take loans from their savings groups to help meet these needs.

One of the most significant and immediate results of the project has been its impact on food security for women and their families. As they cultivate vegetables, women are not only able to generate income through the sale of their products in local markets, but they are also able to provide fresh produce for their households. In communities where access to nutritious food is limited and prices are often prohibitive, access to this resource is having an immediate impact on child and family health.

The composting activities are ramping up, as the cooperatives sort out their collection and distribution systems. They are already collecting organic waste where the majority of it is generated, at the local markets, and they are working out how to manage more widespread collection operations. With their full operations, women will not only have a local source of nutrients to boost soil health in their own gardens, they will also be able to sell their compost to others. Fertilizers are one of the most costly inputs for gardeners and cultivators across Bamako – and their compost will be an affordable alternative.

 

The project is fostering a sense of community and collaboration among the participants, as they work together to manage their cooperatives and share knowledge about sustainable agricultural practices. Their collective efforts are building social capital that not only improves social cohesion but increases local resilience to the economic challenges they face.

As the gardening and composting activities continue to grow, the cooperatives will begin plastic sorting and recycling activities in 2025. From our research, we found that plastic comprised 14% of all waste generated, so diverting it for recycling and reuse is the next step to building a circular, zero-waste economy.

In a very crowded hotel meeting room in Bamako, brimming with dozens of dignitaries and officials from all levels of the health system along with a wide variety of partners, a special award ceremony recognized the winners of a unique competition.

Organized by the Ministry of Health and Social Development (MSDS), with technical and financial support from USAID’s Country Health Information Systems and Data Use (CHISU) program, this competition recognized health facilities for the quality of the data they submitted to DHIS2, Mali’s national health information system.

Data quality is a central challenge in health systems like Mali’s, which is why it is a key component of our participatory quality improvement (QI) work. Improved data reporting and data quality contribute to improved disease surveillance and informed, timely decision-making. We work alongside both community health centers (CSComs) and reference health centers (CSRéfs) to help them develop and implement data management systems within their contexts that report timely, reliable data to DHIS2.

On this occasion, the winners were being announced for the CSComs, CSRefs and hospitals who submitted the highest quality routine malaria data in 2023. Scoring was based on four indicators including completeness, timeliness, internal and external coherence of their data as well as and the stock of malaria-related products.

This competition was actually the second one organized by CHISU – the first was initiated in 2023 based on the quality of COVID-19 epidemiological data submitted to DHIS2. In that competition, two of our partners were recognized: the Commune IV CSRéf won the CSRéf competition and our partner ASACODJENEKA placed second among CSComs.

This second competition yielded even better results for our partners. The top five scoring CSComs in Bamako were ASACOKA, ASACOS, ASACOMA, ANIASCO, ASACOLABASAD – four of whom are Mali Health quality improvement partners. The Commune IV CSRéf, a partner of ours for ten years which oversees more of our quality improvement partners than any other district in Bamako, placed 2^nd among CSRéfs.

The winners were recognized with certificates, a variety of supplies and equipment, and training and capacity-building support. Their efforts were rightly celebrated and the satisfaction of the winners at having their efforts recognized was encouraging.

For us, the highlight of the event was when the winning CSCom and our partner, ASACOKA, was invited to share a presentation on their best practices for improving data quality. ASACOKA, located in Kalabambougou, opened in 2019 and our partnership began in 2021. Their presentation included the processes and protocols that helped them achieve their success and it was gratifying to see how many of those practices were put in place in the context of their quality improvement work. While we helped to provide tools, methods, skills and confidence – the data quality practices, results, and success were entirely theirs.

As the ceremony concluded, other CSCom partners mentioned to our team how the data quality standards and processes they learned and implemented within the context of our QI partnership were factors in their success, as well.

These results are significant not only because of the performance of our QI partners, but because they have sustained that performance over time, under the leadership of their own quality improvement teams. The key sustainability strategy of our participatory quality improvement work is local ownership and leadership from the beginning, so that CSCom and CSRef personnel develop the processes and protocols that ensure quality healthcare, or in this case, quality data.

 

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.

Led by the Frontline Health Workers Coalition and partners, World Health Worker Week (WHWW) brings together advocates, health workers, leaders, and communities calling for more resources to support health workers.

Directed primarily at policymakers and global leaders, the goal of this week is to urge decisionmakers to follow through on global commitments and to invest in, protect, and support the health workforce, especially women.  The 2024 theme is Safe and Supported: Invest in Health Workers.

The case for investing in community health workers is clear and proven, with immense health, social, and economic returns. Though the financial return on investment for the primary health care workforce has been demonstrated to be as high as 10:1, the current funding gap for community health programs is estimated to be $5.4 billion annually.

Across the African continent, there are many contexts in which leaders and decisionmakers have made policy commitments related to investing in health, but have not yet implemented them.  In 2001, African Union countries set a target of allocating at least 15% of their annual national budgets to their health sectors, known as the Abuja Declaration. But achieving this goal has remained elusive. In Mali, before COVID-19 and the latest governance transitions, Mali’s spending on its health sector was around 4%.

How much longer will it take for more countries to be able to reach the Abuja Declaration targets?

While increasing spending on primary healthcare is necessary, investing in health workers cannot simply be a matter of increasing national spending, or increasing international donor funding.

Whatever the cause, it is clear that greater domestic and international investments in health systems and health workers have not been forthcoming. In the Sahel, even with willing policymakers and treasuries, armed conflict and transitional military governments are a growing obstacle to increased national investment in health. Furthermore, in decentralized health systems, increased national investment may not even necessarily reach primary care systems, as community health systems are not principally financed by the national government.

If not policymakers and leaders, who can do the investing in health workers that so many communities desperately need? Are there other strategies and possible investors? Especially in decentralized health systems?

Communities are being overlooked as essential partners for investing in community health programs.

The calls for increased health financing and investment usually end at the national level. Even the terms “local financing” and “domestic resource mobilization” are mostly used to refer to national budgets. But if we end our advocacy there, we neglect possible health financing that is more localized including district, community, household, and even individual health financing. 

Let us also not forget the Bamako Imitative of 1987, whose purpose was to increase the participation of the community not only in the decision making and governance of the primary care health system, but in its financing as well.

For the past several years, Mali Health has been seeking to expand the understanding of who can do the investing and supporting of health workers. In Mali’s decentralized health system, we are seeking to help build community-led solutions for investing in and supporting community health workers.

To be sure, we do not mean to suggest that primary care workers should not be a health policy priority for every national government, as they are in Mali. But as we continue to advocate for greater investment and the fulfillment of the ambitions of the Abuja Declaration, women and children need health workers now, and we can work on local solutions to support health workers now.

For example, there is already a source of health financing that is highly localized, largely due to the Bamako Initiative. In addition to external donor funding and domestic spending, out of pocket payments (OOPs) are a significant source of health financing in most African countries – matching and exceeding other types of spending in many cases. Regrettably, OOPs and user fees are inequitable and burdensome, but they are a critical component to how primary care systems are financed today, especially in decentralized health systems.

But user fees and OOPs represent just one method for community involvement in the financing of health services. As we advocate for replacements to OOPs and user fees, we have an opportunity to reallocate them and other community resources into more equitable, affordable and sustainable strategies that could channel local, community-led resources to invest in the health workforce. Rwanda provides an excellent example for how community-based health insurance can mobilize community and local resources for more equitable access to quality healthcare, alongside national and donor investments.

To improve health equity, meet urgent health needs, and overcome the expected health workforce shortage, we cannot depend alone on increased national budgets or increased donor funding. While part of a solution, they are not the whole solution. As we work with policymakers and leaders, let us also not forget those with proximity to these challenges, and who work hard to support health workers in their community every day. They have valuable perspectives and insights, not simply as the recipients of health worker services, but as investors in them.

Let us begin to think about investment so that all health workers can be safe and supported, not just from the top down, but also from the bottom up.

Since Mali Health began our participatory quality improvement work nearly ten years ago, we have worked directly with 28 community health centers (CSComs) and 11 health districts.  Though we focus on overlooked peri-urban communities, we also adapted our approach for use by CSComs in rural communities so they could address the unique challenges that affect healthcare quality in their context.

Not long ago, Mali’s health authorities developed the first national quality improvement plan, which was implemented from 2018-2022. The plan addressed all three levels of the health system – hospital, reference, and community – but the community health system has seen the least amount of progress and implementation.

The plan includes quality improvement standards and tools, which we use in our work, but nationwide there have been challenges with implementation and adoption at the community level. For example, there are standards for the representation and participation of women and youth in different aspects of the community health system, but these standards are rarely followed and there are no mechanisms for assessing them. However, these are all problems that we have been working to solve with our CSCom partners on the ground for many years and our team has been eager to share those experiences with others.

Sharing lessons learned

For the past year, we have been working on plans for how we can extend the reach of our participatory quality improvement approach so that it can be available to more CSComs and communities across Mali. That has meant working closely with the General Directorate of Health and Public Hygiene (DGSHP) and the Sub-Directorate of Health Establishments and Regulations (SDESR).

In September, we were fortunate to participate in the review of the 2018 – 2022 national quality improvement strategic plan, during a national workshop held in Koulikoro. Alongside dozens of representatives from the health system and nearly two dozen NGO representatives, Dr. Bathily participated in an assessment of the implementation of the 2018-2022 national strategy and the development of recommendations to inform the next plan. During this workshop, Dr. Bathily was able to share the successes, challenges, and insights of our partner CSComs working to implement quality improvement plans at the community level.

Charting the path forward for the next national strategy

In October, the National Committee for the Management of the Quality of Health Care and Services, the unit within the DGSHP which is responsible for overseeing the national quality improvement strategic plan, met to discuss the results of the September meeting and to develop the roadmap for the development of the new plan. In this process, our Dr. Sogoba has served as the lead representative for technical and financial partners of the DGSHP. This is not the first opportunity for Dr. Sogoba to be a voice for the community health system at the national level.

This meeting laid out a series of workshops that would comprise the process of developing the new national quality improvement plan. Again, over 20 stakeholders from the nongovernmental sector have worked alongside health authorities to collaboratively develop the new plan. For example, it gives Dr. Bathily and Dr. Sogoba the opportunity to share how our approach aims to monitor and institutionalize the core value of youth and women’s participation in the health system, from the community and CSCom perspective. It also gives us the opportunity to advocate for the inclusion of patient voices and values in the evaluation process, by recommending that a patient satisfaction survey be added as a primary evaluation tool to assess changes in quality at health facilities.

The draft of the new “Strategic Plan for the Improvement of the Quality of Health Care and Services 2024 -2028” will be finalized at a workshop that is scheduled for the end of December. Once validated, the new plan will be shared in early 2024. We remain hopeful about the new additions to the plan, especially those that may be informed by the experiences of our CSCom partners, and look forward to strongly supporting the implementation of the new plan at the community level.

Late on a Tuesday afternoon in October, when the sun descends to a favorable height, you could walk about 300 meters from a bank of the Niger River and find Mme. Mandy Tounkara, at work in her vegetable garden.

In the peri-urban community of Kalabambougou, with the help of a few other women in her community, today Mandy tends to several garden plots. But her gardening activities started modestly, by growing vegetables for her family and for sale in the local markets. She was able to maintain a garden that produced enough vegetables whose sale could bring her about 1500 FCFA, or about $2.50, every day. But her garden really began to prosper when she tapped into the resources of her savings group.

Women living in peri-urban Bamako have very few sources of income. With no access to financial services, women must create their own opportunities for economic empowerment. Women in Mandy’s community did just that in 2019, when they worked with a Mali Health facilitator to establish a health savings group. Now, Mandy is the president of that group, known as Falakono Benkadi. With 46 members, they have actually divided into 2 sub-groups.

Mandy describes how the financial resources the group provides to women has helped her personally:

In 2020, a year after the establishment of our group, I took a loan from my group which allowed me to buy more fertilizers and seeds. I was able to double my cultivation space and my income reached about 4000 FCFA, [about $6.75/day]. Today, with three times the space when I began, I grown lettuces, eggplant, celery, tomatoes, potatoes, herbs and greens used in different sauces and my income can reach 6000 FCFA [or about $10].

 

Now, with my income, I pay for my children’s schooling and I support my husband more in taking care of other household expenses. This has given me more and more the privilege of being consulted before any decision is made about the household. I like this market gardening activity because not only do I make a profit, but I also contribute to the protection of the environment.

Building on traditional practices of collective saving, lending, and risk pooling in self-managed groups, women in Kalabambougou have made progress increasing their incomes and overcoming poverty.

But several challenges remain.

Women like Mandy still face many barriers to growing and expanding the activities that help them generate income and build wealth. They generally work in the informal economy and have no access to formal financial services. They have few assets; banks do not lend to them.

And while their activities can put them on the path to building sustainable livelihoods, for gardeners like Mandy in peri-urban communities, the biggest obstacles relate to one of her most precious resources – the very land that she cultivates.

Mandy explains:

The drought period brings its share of challenges. Water shortages are affecting the well I use to irrigate my garden a lot. This situation leads to a slowdown in the growth of plants, such as lettuce and celery, and consequently, a decrease in my income. In addition, the instability of my right of use on the land exposes me to the risk of having to leave it at any time, at the request of the owner.

Like most small-scale peri-urban gardeners, Mandy cannot afford the extremely high price of land in Bamako, especially in Kalabambougou, with its desirable location along the river. She negotiates to garden on vacant land that is owned by families who will one day build homes. There usually are no formal contracts – once a family decides they need use of their land, Mandy will have to give up the garden space she has not only tended, but has invested in.

But without financial institutions to help her achieve land ownership, Mandy and her fellow gardeners have little choice. To pursue their livelihoods, they use the land available to them. While they can invest to improve the plot and soil quality, there are simply some risks and obstacles they are not in a position to overcome.

Women like Mandy are one of the primary reasons that we are supporting gardening and composting cooperatives in three peri-urban communities in Bamako, including Kalabambougou. As we work alongside them to provide more support to their current activities, we are also working to help to find long-term solutions to land and water access. Learn more about the GSK project here.

 

One morning in March, at the beginning of Mali’s hot season, we went to meet Fatoumata to learn more about the activities of the women of Sanankoro, and their cooperative. Despite the blazing heat, 40° C (104° F) in the shade, Fatoumata generously welcomes us under the shade of mango trees, which offer a slight relief.

Sanankoro is a small community in Lassa, which is a quartier that sits high above Bamako on the outskirts of Commune IV. Like many peri-urban communities around Bamako, Sanankoro is remote with very limited infrastructure. The long and winding road to reach it climbs up the hills and cliffs north of the city, and along the way, the terrain changes dramatically. The earth becomes rocky; trees disappear, long ago harvested for charcoal and to clear land for cultivation. At this higher elevation, you feel surrounded by the haze and dust in the sky, and even the sun feels closer.

The women of this community are renowned for their bravery. Their primary livelihoods are related to agriculture, and they mostly raise groundnuts for cooking and groundnut leaves for animal feed, as well as keeping small market vegetable gardens and harvesting mangoes. But because they are so far away from town, they are forced to walk about 10km a day with loads of up to 50 kg on their heads to reach the markets down in the city. But the proceeds they make from selling in the markets are what help them take care of the basic needs of their households, including food, healthcare, and school fees for their children.

Fatoumata shares her experience living in Sanankoro, and how she first started organizing with women in her community:

I am Fatoumata Ballo Doumbia, I have lived here Sanankoro for 18 years now. Sanakoro is an area considered to be part of the Commune of IV of Bamako but it is neglected. There is a lack of health infrastructure, education, and even access to drinking water. We are forced to go to Lassa, at a distance of 6 km, to satisfy these needs.

One day, several years ago when I went to the health center in Lassa, I met women who told me about a social fund system that allowed them to develop and grow their income generating activities (IGAs) and meet their health needs.

When I returned home, I talked to some women in Sanankoro who bought into the idea. We then made the request to Mali Health to be accompanied in the establishment of our groups.

We set up our first savings group of 21 women. For 12 months, each time a member of the group had a need, she was able to take a loan from the either the fund for health needs or the fund for income-generating activities. Six of us were able to expand our activities by setting up a point of sale in town, and eight others were able to expand our space for market gardening.
At the end of our savings cycle, when we did the sharing of the amount saved, each of us made an overall profit of 12,500 FCFA (over $20)  from the interest on the income-generating activity loans.

With the success of this experiment, almost all women in Sanankoro and those in two nearby communities, Bankoni and Diakoni, have expressed their interest in our program and joining the next cycle.

So we went from one group of 21 women to 13 groups of 264 women! And we are currently in our 6th cycle.

After the success of their savings group activities, the women of Sanankoro, Bankoni and Diakoni asked Mali Health for help in setting up a cooperative. With the strong leadership skills and determination they demonstrated in the savings groups, we readily agreed to partner with them. The name they chose is Coopérative Bènkadi – bènkadi means coming together in Bamanakan.

Fatoumata explains how forming and operating their cooperative went for her and the other women in her community:

We decided that 30 representatives of the 13 groups would join to form a cooperative that produces soap.

In 2021, we received the training and material support necessary to develop our business. We gathered together to do the production regularly, always in the morning under the mango trees, because the soap will get too warm and will not be prepared properly in the heat of the day. We meet in Sanankoro, which is in between Bankoni and Diakoni Many of our members have a long distance to travel, and leave their homes before the sun rises to meet here at the appointed time. But we managed to produce enough to meet the soap needs of our 3 communities.

The income of each member of the cooperative has been increased on average by 35% from 0 FCFA for some to around 2,500 FCFA per week. These benefits are quite important for us for those who know the role of women in communities like ours. She is the one who completes the meal while the husband gives the cereal, she is the one who will have to meet her own health needs and those of her children, she pays for school supplies for the children as well as their clothes.

The soap that members produce is primarily for their own household use and for sale to their neighbors, because before now, soap was a relatively expensive resource that they would have to secure in Lassa, or down in Bamako. After their production activities, women divide the soap between their thirty members. Whatever they do not use themselves, they sell to their neighbors with a slight markup of 50 FCFA over cost, or about $0.10.

The impact of having soap so readily available has been remarkable and has had an immediate impact. Handwashing with soap prevents a significant portion of diarrheal diseases and acute respiratory infections – which are two of the primary causes of under-5 mortality for children in Mali, along with malaria and malnutrition. That’s why we say that soap saves lives – because in these communities, it does.

Other women in the cooperative have joined our conversation. When asked about what changes they have noticed now that they have enough soap, their enthusiasm and relief is clear. They specifically note two differences: that they are able to keep their homes much cleaner, and that there has been a noticeable reduction in illness among their children, and therefore fewer trips to the health center.

In addition, demand for their soap is extraordinarily high. The members of the cooperative use the majority of what they produce, but because of the remoteness of their communities, there is a significant potential market. As the only source of soap within 6km, they could significantly increase their production and sell in all three of their communities. They have already started to think about how to expand their production, but have faced some limitations, including finding a space to locate their expanded operations. The chef du village in Sananakoro offered them space in the community’s mosque, but it wasn’t big enough to meet their needs.

They are encountering some other challenges, too. Despite their results, the demand for their product, and the welcome changes they have noticed in their lives and the health of their families, serious challenges threaten Coopérative Bènkadi’s progress and the future of their business. Inflation has increased the cost of their inputs, including the local shea butter that is the basis of their soaps. So they have cut back on their production in the hope that the prices of their materials might return to where they were – which unfortunately is not likely.

Fatoumata explains their current challenge, but also the opportunity:

Inflation and the high cost of living have dealt a heavy blow to our business; We can no longer produce as much soap as we need for our needs. Revenues have fallen drastically.

Our members are very engaged with this activity and we have more potential to sell our products because we have already been approached by resellers with whom we can collaborate. We need a boost to increase our production in order to satisfy the needs of our 3 communities and to supply the resellers.

If Coopérative Bènkadi could expand their production beyond their own needs and begin selling more of their soap, they could invest in a proper production space, buy more raw materials in bulk at a lower cost, and perhaps even add members to their cooperative – overcoming the obstacles they face, and even growing their operations.

The members of Coopérative Bènkadi prepared a proposal for how they would invest in their cooperative to achieve their goals, and Mali Health would like to help them.  Stay tuned while we work on a strategy for supporting them and all the cooperatives with whom we partner.

>> Update: Coopérative Bènkadi will be the recipient of the very first loan from Gaoussou’s Fund, created in honor of our colleague, Gaoussou Doumbia. To learn more and support this women-led solidarity fund, please click here. <<

The following are excerpts written by Adam Aicha Hanne, an MPH – PharmD student who spent her summer practicum working with the Mali Health team in Bamako. She worked on the Gnaman ni Sôrô ni Kènèya project with the Community Capacity Building department.

The goals of the five-year Gnaman ni Sôrô ni Kènèya project are to improve community health by addressing environmental health hazards and creating opportunities for youth and women’s employment through waste collection, composting, recycling, and repurposing.

One of the goals of Gnaman ni Sôrô ni Kènèya project is to turn what is currently treated as waste into a useful commodity. Based on the Sustainable Community Project from GAYO in Ghana, we want to work with peri-urban communities to convert everyday trash into reusable products. But our very first step towards achieving our goal is to conduct research. Our research is composed of five analyses, three of which I am currently working on:

• Waste composition analysis
• Social norms analysis
• Stakeholder analysis

This week we focused on the waste composition analysis as it is the most time-consuming and physically demanding one. Along with our team of investigators, we went into our target communities – Sabalibougou, Sikoro, and Kalabambougou – to physically analyze the waste generated by the homes participating in the survey. Investigators were provided with a spreadsheet that categorized the different types of waste that are typically found in waste sacs.

Teams of investigators were responsible for adequately weighing the waste sacs, identifying and segregating the types of waste, and documenting the weight of each type. The information will be used to used to identify which waste products are recyclable and the total waste per category will be quantified. Through our analyzes, we will understand the types of waste generated by the participating communities, and how their waste can potentially benefit them.

Learning from History

However, during this research, I learned that Modibo Keïta had ruled as Mali’s leader during colonialism and post-colonialism from 1915 to 1977. But then my main question became who ruled Mali before colonialism in the 1880s? And what was the constitution or constitution-like understanding of the people of that time? I hope that my Bambara teacher who studies the history and social structures of Mali will be able to fill the gaps in the questions I have about Mali and its history. I honestly believe history is important to understand the future. My motto used to be don’t get stuck in the past but focus your energy on the future. That motto has always come in handy for me and has allowed me to advance in many ways in my life. However, as of today I now understand that it is important to look back at the past and analyze for what may have worked for people or communities and utilize those hidden gems in the future. I hope by revisiting the past I can bring to light the gems of the past to the future, and hopefully what I find can be helpful to my Malian communities.