nderstanding Mali’s unique community health system
Like many West African countries, Mali’s health system is tiered and decentralized. But at the community level, Mali’s health system is unique.
Primary care in Mali is delivered at community health centers – Centres de Sante Communautaire, or CSComs. The Ministry of Health provides limited support to CSComs, such as some commodities (like prescription drugs) and some salary support. But, the financing and governance of CSComs – their overall management – is not overseen by the government – it is done by the community.
Increasing community participation and ownership
Community members become members of, and elect leaders of, a membership association, known as the ASACO, to manage the health center. ASACO leaders receive no formal training or support, but they run the health center, and are responsible everything from payroll to keeping the pharmacy stocked.
While the intent behind this decentralized structure is to increase community participation and ownership, in practice, communities are left without the resources they need to manage their health centers effectively. Despite the lack of resources, we see not only incredible potential for a democratic community-led health system, we also see the opportunity to innovate.
Recovering costs in local health systems
The second strategy behind a decentralized health system was to create local systems for cost recovery. CSComs receive some start-up capital but limited state support for operating expenses, which often leads to an inability to pay staff salaries and frequent stock shortages of basic medications.
Limited resources leads to limited quality, which drives down demand for services makes cost recovery more challenging. We believe that cost recovery and healthcare that is affordable and accessible to all are not mutually exclusive.
Mali, like the rest of the world, is urbanizing.
Growth in the bustling capital city, Bamako, has been rapid, unregulated and uneven. Newcomers often make their homes in informal, quickly-settled neighborhoods that usually lack basic services like improved water and electricity, or sanitation and health services.
Mali Health works in 8 peri-urban communities across Bamako. It is easy to make the assumption that more resources exist in urban communities, but in the peri-urban communities where we work, resources are extremely limited.
Residents of peri-urban communities often live below the international poverty line, and struggle to access education or economic opportunities that could help them overcome poverty. At the same time, these are dynamic and busy neighborhoods and residents are eager to come together to improve their communities.
As Bamako continues to grow rapidly, investment in health infrastructure and services today will determine health outcomes and urban living conditions in the future.
Read more about the effect of urban inequality on maternal and child
health in Save the Children’s 2015 State of the World’s Mothers report.
WHERE WE WORK 