Health workers fear deaths will continue

Every morning at the health centre in Koro, a sandy village 800km west of the Malian capital, Bamako, a motorbike briefly breaks the silence.

“We are going to Segue Bengou as part of an advanced strategy,” says Yana Yanali proudly, balancing packets of mosquito nets on the back of the motorbike before she climbs onto the seat. “We go out each morning from here because there are 41 villages in the zone that we must cover.”

Then, with nursing assistant Yousouf Dama driving, the two set off. Yanali’s white doctor’s coat trailed in the orange dust as they streaked down the road.

The “advanced strategy” was founded by Mali’s government and major aid donors to help stop the country’s perilous humanitarian decline. Mali today is one of the deadliest places to live in the world.

The United Nations population agency (UNFPA) says that one Malian woman dies in childbirth every three hours. One in five children under five years old will die, mostly from diarrhoea, malaria, or a malnutrition-related illness - all entirely preventable with minimal investment.

These statistics get worse in rural areas where few people have access to even basic health knowledge and facilities, and often lack the money for healthcare even if it is available.

In 1990, trying to stop Mali’s slide, the government decentralised access to healthcare. Community health centres, financed entirely by the communities themselves, were created.

But the scheme was found 10 years later to have failed because people were not visiting the health centres. “We realised that this had not even reduced infant mortality by 1 percent,” said Fayiri Togola, a technical adviser to UNICEF.

Illustrating the problem, in the Mopti region where Segue Bengou is located, some 1.8 million people live throughout 80,000 square km area with just 123 health centres among them.

Mali’s government spends just 4.8 percent of GDP on healthcare, or US$39 per person, per year, according to the World Health Organisation (WHO).

Under the new scheme, the government has put together teams of health workers, such as Dama and Yanali, who are to visit villages that lie more than 15km from a health centre at least once every week.

The approach was put into action in 2002 by the Malian government in conjunction with UNICEF with the goal of reducing deaths among women and infants.

“In this context, we thought that to reduce mortality... it was important not just to concentrate activities uniquely on health centres, but also to get a bit closer to the populations,” said UNICEF’s Togola.

Vaccinations for children, consultations for pregnant women, and education campaigns about the need to wash, drink clean water, and to recognise illness in their children are all part of the programme. Mosquito nets have also been distributed to prevent the spread of malaria, which is endemic in Mali.

Officials say it is too soon to tell whether being proactive about treatment and prevention will yield better results than the passive model. The government will run another survey later this year to assess the current levels of maternal and infant deaths.

But UNICEF’s Togola is not optimistic that the survey will register anything more than a tiny improvement, given the scale of the problem and the lack of overall investment in Mali’s healthcare and education system.

“I think that we have still got a lot of challenges to overcome, especially changing behaviours among the target population so that the households can take care of themselves,” he said.

West Africa has the worst maternal and infant mortality figures in the world, with levels in many parts of the region rising, not falling, despite the influx of hundreds of thousands of dollars of Western aid and development assistance.

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