The abrupt shutdown of USAID and US foreign aid is having devastating effects that feel too numerous to count. In the short term, critical programs have ended nearly overnight, and we are all still wrapping our minds around the long-term effects so that we can find a way forward. We will find a way forward.
Below, we simply aim to summarize the impact on us, and that we are seeing on the ground. These firsthand observations come from our team and the partners and communities with whom we work every day.
The impact on Mali Health
We were proud to be a subcontracting partner on the USAID-funded Shifin ni Tagne project. Beginning in 2025, we were going to contribute our local, voice-based app, Kènèya Blon, to the project – helping 20,000 youth access reliable sexual and reproductive health information, connecting them to valuable resources in their language.
While we can adapt to funding losses, the suddenness of this change is what has made adjusting so difficult. There is no chance of this project proceeding without USAID funding, so we are adjusting our budgets, plans, and staffing accordingly. For the first time ever, we are having to lay of staff and reduce staff salaries in order to preserve as much of our program work as possible.
The impact on Mali
While we are figuring out how to weather the direct loss of our project funding, it is the larger context that causes us the most concern. The cessation of US funding to Mali jeopardizes vital projects for vulnerable populations. Its consequences deeply affect social sectors, including education, agriculture, health and food security.
The health system was heavily dependent on US foreign aid funding and its interruption will impact access to primary healthcare for millions of Malians. Thousands of community health workers were paid directly by foreign aid. Health programs at all levels relied on aid funding – like maternal and child health and gender-based violence prevention. Programs to combat malnutrition, to prevent, control, and treat malaria, and to prevent and treat HIV/AIDS have been profoundly affected.
In addition to health program delivery, the US was one of the largest funders of health commodities, including vaccines, contraceptives, and ready-to-use therapeutic foods.
Our partner community health centers (CSComs), the first contact communities have with the health system, are on the front lines of these abrupt and severe changes. They shared updates with our team on how they are managing, and the implications these changes are having on access to vital health services their communities, particularly for women and children. Below are some of the most alarming impacts:
Malnutrition: A disruption of contracts for ready-to-use therapeutic foods (RUTF) used to treat severe acute malnutrition (like Plumpy’Nut) means that CSComs are experiencing shortages. In response, they are rationing the doses for these extremely vulnerable young patients from their typical 3 sachets per day to 1 sachet. Despite being a peanut producer, there are no facilities in Mali that can produce RUTF, so it remains dependent on these aid contracts. We are working with partners to develop local alternatives to prevent and treat malnutition so that cases do not escalate to the stage at which RUTF is needed, but malnutrition in Mali continues to increase.
Vaccination: There has been a drastic reduction in vaccine doses being given to the CSComs, which are responsible for timely vaccination of children. Vaccination doses are being missed due to these shortages, especially BCG, but our partners report a shortage of all vaccines. Vaccine mobilization campaigns and community awareness raising activities are at a standstill because there are not sufficient doses.
Prenatal Care: Due to a shortage of supplies, women are no longer receiving standard services during their prenatal visits, including HIV testing for the prevention of mother-to-child transmission of HIV (PMTCT) because the testing reagent is not available. There is also a shortage of bed nets, which increases the already high risk of malaria for pregnant women, newborns, and children under 5 years of age.
Family Planning: Family planning supplies have almost completely run out. These products are very expensive at private pharmacies and are out of reach for most families. Lack of access to contraceptives and other supplies will lead to increases in STIs, STDs, and unwanted pregnancies.
As always, Mali Health remains committed to supporting the community health system and local actors to improve access to quality maternal and child healthcare. While we have weathered many emergencies (multiple coups d’etat, epidemics, pandemics, climate change) none have so profoundly destablized the health system as this one.
This emergency was manmade. Direct support to those on the frontlines, to those whose health systems have been dismantled, to those delivering and receiving healthcare each day – is how we will rebuild just and equitable systems and structures to ensure that pregnant women and children have the care they need and deserve, without dependence on foreign aid. Please if you can,contribute today.
Our project to assess and address vaccine confidence using a local, women-designed technology demonstrated that the use of participatory methods and tools to develop and disseminate voice-based social media messages improved both knowledge of, and confidence in, vaccination against COVID-19 in underserved peri-urban communities in Bamako, Mali.
The project used a mix of qualitative and quantitative evaluation methods, including individual interviews and focus groups discussions. The project relied and built on a participatory evaluation of social and gender norms conducted in the target community before the project began.
The key results of this project include:
100% of women who accessed voice-based health messages demonstrated improved knowledge about the benefits of vaccination against COVID-19
75% of women who used the application expressed confidence in vaccination against COVID-19
73% of women who used the application shared the information they learned with others
60% of women who used the application felt better equipped to convince others to get vaccinated against COVID-19
Part of the purpose of the project was to generate lessons for how to use social media tools and messages to address vaccine hesitancy and misinformation. Our particular focus was on hard-to-reach populations in marginalized communities, especially women. Drawing from both our work to develop Kènèya Blon, and its application to COVID-19 vaccination, we summarize our lessons learned as:
Community driven: A tool designed by women living in peri-urban communities to increase access to health information proved to be relevant and impactful, despite limited access to information technology; when trying to meet the needs of hard-to-reach or marginalized communities, they should be involved at every step, including data collection and technology design
Targeted: Technology and digital interventions must be adapted to the realities of each community or population it is trying to serve; this adaptation can include the form and function of the application or the types of content used (language, images, etc.), but also contextual factors such as social/gender norms, the kinds of misinformation circulating, etc.
Coordination: When coordinating with offline health or vaccination services, ensure the quality and availability of a respondent for interactions with users, as well as the quality and availability of the vaccination service at the health center level; when possible, train these providers in the use of digital tools/messages being used in their communities
Ongoing: Campaigns implemented once or over a limited period of time will lose impact over time; the dissemination of messages relating to COVID-19 must be ongoing and consistent until public health and vaccination targets are reached
Accessible technology: Though access to technology is increasing, it will continue to be a limiting factor for millions, especially for women who have limited skills or experience that allow them to use it effectively. This project recommends the integration of relevant, local digital tools into mobilization strategies around vaccination against Covid-19 while also continuing the search for strategies that can share voice-based messages on the types of phone and technologies that are most available to marginalized communities
Mixed methods: Promote the use of the digital tools within target communities with on-the-ground and face-to-face strategies to build trust
As the world has seen and experienced during the pandemic, vaccinating populations requires much more than a vaccine. While the availability of a vaccine is one important component, a variety of factors can influence vaccination rates and coverage. Some, like geographic, logistical, and health system factors have been a challenge to ensuring complete and timely vaccination of children for underserved communities for decades; the pandemic has exacerbated these problems. Other factors can be related to gender, social norms, or misinformation.
From October 2021 to February 2022 with funding from the Vaccine Confidence Fund, Mali Health worked with women and communities to understand the factors influencing knowledge of and confidence in COVID-19 vaccination in underserved peri-urban communities. We then developed and tested messages for Kènèya Blon, the local, voice-based smartphone application that we developed with women in Sabalibougou, a peri-urban community in Bamako.
Collecting data directly from community members was essential to understanding the factors that influenced confidence in the vaccine, and therefore how to address them. The end users were involved in every step of the original development of the Kènèya Blon platform. When assessing how to use it to address vaccine confidence as a part of this project, their participation was vital again.
We used participatory methods to understand attitudes and behaviors related to vaccination, and the norms which govern them. At the beginning of project, 95% of those surveyed did not trust COVID-19 vaccines and had no intention of getting vaccinated. According to the same survey, the primary reason given was a lack of access to trusted health sources that could provide accurate information, or correct misinformation. A lack of access to health professionals and reliable health information was a key factor in acting on misinformation and the adoption of positive behavior changes.
These findings reinforced what we learned earlier during our work as a part of the WomenConnect Challenge, Then, we learned that access to reliable health information is one of the highest priorities and biggest challenges for the women we serve. Access to information was even linked to gender equality, not only in the minds of women, but in the minds of men and community leaders. Because women living in peri-urban communities had limited opportunities to go to school where they could gain reading and writing skills, they face barriers to accessing reliable information.
The Kènèya Blon platform was designed to address this primary challenge. During the project, users had access to accurate public health information about COVID-19 and that addressed rumors and misninformation circulating in their community. They were also able to access health personnel to express their concerns related to COVID-19 vaccination and receive responses to their questions. These features were designed by women, for women – using a what we call women-centered design approaches – but its impact extends far beyond its users.
We attribute the significant short-term results of the project to this rapid access to trusted information, because it met the primary need community members expressed. To learn more about the results and lessons we documented about vaccine confidence, please continue reading our next post.
