Collecting data and waste for Gnaman ni Sôrô ni Kènèya

Collecting data and waste for Gnaman ni Sôrô ni Kènèya

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

Adam Aicha Hanne

Last week I had an in-depth. fruitful conversation with my aunt and cousin about pre/post-colonial Mali. So, basically, our conversation was about Mali in the 1880s & 1960s. We spoke about how Mali was succeeding with the ruling of President Modibo Keïta. My aunty expressed that around the time of Modibo Keïta, Mali was functioning sustainably and the streets of Bamako were so clean. She emphasized how the community was centered around the culture, and how traditional ways were respected and followed as laws. For instance, people were frowned upon if they littered or did not contribute to community efforts to keep the country up to par. Mali was united regardless of tribalism or religious beliefs. After our conversation, she told me to take a look at Mali’s original constitution. Therefore, I focused on finding Mali’s first constitution right after gaining its independence from the French government.

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.

Improving community awareness and confidence in COVID-19 vaccines with local women-designed technology

Improving community awareness and confidence in COVID-19 vaccines with local women-designed technology

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.

Meet Oumou Doumbia, first president of the cooperative union

Meet Oumou Doumbia, first president of the cooperative union

Madame Oumou Mariko Doumbia was elected by her peers to be the first leader of the cooperative union in September. She lives in Sabalibougou, a peri-urban community in Commune V of Bamako, where Mali Health has worked for several years.

She 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 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 2016 when Madame Doumbia learned about Mali Health organizing savings groups in Sabalibougou to help women access healthcare. She invited our animateurs 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 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 the new cooperative union, a women-led grassroots organization created to support the cooperatives, developed by women in savings groups like hers. Focusing on peri-urban communities, the union currently has five member cooperatives from three different communities around Bamako. They named their union Keneya Yiriwa Ton, which translates to Promotion of Health.

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 union, 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 union. 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. »

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

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

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.