One of Mali Health’s goals is to mobilize citizens at the community level to plan and execute projects that improve health outcomes in Sikoro. Since 2011, Mali Health has trained a local women’s group to plan, organize, and execute local development projects. The women of this Action Training Group chose to undertake a well improvement project. Sourakabougou, a sub-section of Sikoro, is infamous for its lack of access to clean water, as the high altitude, rocky soil, and poor road conditions makes digging wells extremely difficult. This makes the task of getting water for the family to drink, bathe, and cook with an everyday hassle for women and girls, as the closest source of water is over three and a half miles away over rocky and treacherous terrain.
Mali Health’s Action Training group made it a priority to improve their neighborhood’s access to water. Over 15 years ago, another NGO had begun digging 5 wells in Sourakabougou, but failed to complete even one. The wells had lain unused – and without water – for 15 years, while local women struggled to gather water for their daily needs. Before the work even began, the Action Training group developed an action plan, a technical plan to excavate the remaining depth to reach water, and a budget, and then began soliciting the funds and donations from the surrounding community. Community members also offered in-kind services such as labor, food for the laborers, and materials, making this project truly community-based. In February and March the Action Training group successfully completed digging their first well and they plan to finish the remaining four. Now that the work is finished, the well improvement project will increase access to water for 103 households, or about 700 men, women, and children.
Mali Health may have given this Action Training the tools and knowledge they needed to succeed, but it was the motivation and determination of these women that has made their lives just a little bit easier.
Written by Matt Schinske
Mali has a decentralized health system, which means that the responsibility of health care facilities to the community resides with locally elected associations and an engaged population holding those associations accountable. These local health associations are known as ASACOs.
Radio Sigida Joli (RSJ) and Mali Health sponsored an awareness campaign for the local citizens of Sikoro (the community we work in, just outside of Bamako). The goal of this campaign was to stress the importance of community participation in the management of ASACOs through home visits and selling ASACO membership cards. These cards are vital to the community because they allow the cardholder to vote in ASACO elections. This means that they have a voice as to how their local health association is run and by whom. Another benefit to purchasing an ASACO membership card is that it offers discounts at local health clinics for doctor consultations.
This campaign was planned, developed, and implemented by one of RSJ’s listening groups, with technical and financial assistance provided by the RSJ team. The membership cards were sold over the weekend of the 23rd and 24th of February with the help of 20 volunteers from the listening group. The goal was to visit 250 families and share information about the roles of the ASACO, stress why community engagement with local health institutions is vital, and to sell as many membership cards as possible.
Overall this locally run health campaign was a great success with 260 families reached and 50 ASACO membership cards sold! The price of membership card is about $2, which is not cheap when you consider that the majority of residents are living on less than $1 a day. It is also exciting to see a local clinic enthusiastic about selling these cards. Although it is every citizens’ right to purchase one, the majority of clinics are reluctant to sell them, and offer any number of excuses as to why they are not available. It sometimes feels like we are fighting an uphill battle trying to increase community engagement and ownership of local health institutions while those same institutions sometimes push back to maintain control, power, and an apathetic constituency. Mali health and our partners are focused on the climb and we continue to fight for a more conscientious, engaged, and healthy Sikoro.
Project Design Formation
Written by Dramane Diarra and Matt Schinske
Mali Health held a free training workshop for young community leaders over the course of three weekends (January 26-27, January 30, and February 2-3) that focused on project planning, implementation, and monitoring and evaluation techniques, organized by our Action Training program. Action Training is one of the most challenging aspects of our work, but is also the most rewarding when we see it take hold. This platform is what differentiates us from other NGOs because it allows the community to stand up and take on the challenge of development independently. You can see it when you are on the ground that this is how these young community leaders want it to be, they just need the right tools.
The goal for this workshop was to continue building capacity within the local community but with a focus on how to plan and design effective community health projects and execute them efficiently. The training also covered ways with which to monitor and evaluate their projects so they can see what is working well and what areas can be improved, a vital skill to have if residents of Sikoro are going to be responsible for the betterment of their community.
The training took place over five days. There were a total of 34 participants; all young people between the ages of 19 and 32. The days were filled with interactive discussions and participatory exercises that developed the attendees’ knowledge and skills about project design and its importance. This workshop was the first time any of the participants experienced this type of training and the feedback we got tells us we are on the right track.
Some reactions from the participants follow:
Ibrahim: “This training is very timely. At school, one of our teachers had offered to facilitate such training [for a fee paid] by interested students, but I have not been able to participate because I did not have the means. Thank you for giving me this opportunity.”
Sanata: “I learned a lot and it was really interesting. Not only did it teach me about project design, I also learned about strengthening my character to the benefit of my community. “
Samerou is a member of Dugu Yelen (local youth group): “I was very happy to receive this training. I will return the lessons learned here to other Dugu Yelen members, and I promise you that very soon you will see results from what we learned here. Development is the responsibility of the young, not just to earn degrees in school, but to become leaders in our communities. “
Our goal is to continue strengthening programs like these (Action Training) because they affect the most change in a lasting and sustainable way because it is grassroots and the desire is already there, we just need to show them the way. It is exciting to think about the possibilities that can arise when you give young leaders the tools they need to self direct and the assurance that they know someone is there supporting them and cheering them on towards success.
Last, this comes at a particularly opportune time for members of Dugu Yelen, who have recently partnered with California-based World We Want Foundation, who promotes and supports young global citizens making positive social change in their communities around the world. Dugu Yelen and World We Want will be implementing school hygiene programs over the next several months, and for Mali Health – it’s an even larger victory in that our model is working. We guided, trained, and laid the foundation upon which the local community is continuing to build.
“Development is the responsibility of the young.”
Written by Diack Traore
The 21st of January marked an important day in the process of constructing the maternity ward in Sikoro-Sourakabougou. That day, the population of the neighborhood came out in numbers to reaffirm their support for the project and their partnership with Mali Health (or, as they know us, Association Sigida Keneyali). It was the first large community meeting to solicit voluntary community contributions to fund the construction.
I opened my speech stating why the community contribution was so important – for the community to show their degree of engagement for the activity, and to show others their own commitment to this maternity, that they are ready to make their own sacrifices too. Our director, Kris, followed, stating that « we are working not just for you, but with you » and, as he said, nobody can do everything, but everyone can do something. »
Mamdou Niaré, the village chief, took the floor to thank those responsible from our association and to anyone who believed in and agreed to help in the the construction of the maternity ward.
The meeting rose in power when the Niaré right away put his hand is his pocket to give 5000 CFA as a contribution [equivalent to $10, or three days worth of local wages]. Then is was the turn of many others to make contributions.
Neighborhood women were quick to respond. Well represented, at least 5 different women’s associations were present, many vocalizig their support and contributing what they can. The most striking response of the day was that of Fanta Damba, a griotte from the neighborhood [in West African societies, griots and griottes serve as the oral repositories of local history and tradition]. She credited all those who continue to work to alleviate suffering of the populations in Sikoro-Sourakabougou and volunteered to collect contributions from all the women who work in the market. She concluded by saying that women are the most affected by the maternity and won’t rest until its construction is realized.
A total of 40,000 CFA was collected in the first meeting.
It ended with the establishiment of a collection commission who will follow the work already begun by the village chief. Those responsible to collect will go door to door to collect the voluntary contribution throughout the neighborhood.
Written by Kris Ansin, Executive Director
Over the last several months, Mali, once considered a haven of democracy in an otherwise-volatile region has become a state stricken by national, regional, and geopolitical crises. In the last ten months, the country endured a military coup d’état, regional food insecurity, a feeble transitional government, a separatist uprising, and the occupation of the country’s northern half by religious extremists. Over 350,000 Malians have been forced to flee. The close of the calendar year saw Prime Minister Cheik Modibo Diarra arrested and forced to resign, shedding new light on the challenges of civilian rule and the role the military in Mali’s political landscape. While popular assertions that the country was on its way to becoming the “Next Somalia” or “Africanistan” are largely sensationalist, it has become evident that acute issues have arisen in a country plagued by chronic conditions of poverty and ill health. All of these factors serve to create a precarious environment, leaving Mali’s population – most notably its women and children – particularly vulnerable. Many actors engaged in transformational work – be it in the health, economic development, or agriculture fields – have been forced to closed their doors or indefinitely suspend operations.
As is often the case, it is the poor that suffer most. Jobs are lost, access to basic services cut off, livelihoods endangered. As resources become scarcer within Mali’s borders, many citizens find themselves without the capacities or networks to find refuge elsewhere. In Bamako – some 400 miles from the line in the sand between government controlled and occupied territory displaced populations from the north continue to flee south at a faster pace in recent days from renewed fighting.
As the unpredictable winds of political fragility, food insecurity, and extremist agendas continue to blow it is crucial that NGO and civil society actors remain committed to carrying out our intended operations throughout these times of heightened need. The UN reports nearly 200,000 have been displaced within the country, with Bamako serving as the most frequented destination for IDPs. The Mali Health Organizing Project – with our committed mission of reducing maternal and child mortality via a three-pronged approach of community empowerment, direct services, and system strengthening – is just one such of these agents who are now finding our role increasingly necessary during this period of uncertainty. Recognizing the position we’re in to offer additional support to the displaced and the shifting situation writ large, we do what we can, maintaining close communications with local governing bodies and providing support services and capacity building to a large population in Bamako. We recently hosted a radio show, for instance, on the experience and health challenges of the displaced, joined by the mayor of Gao, once a commercial center for trans-Saharan trade and now one of three main cities in the north occupied by extremists. These partnerships, once considered ancillary, are now becoming a necessity to providing critical services for those who need them most.
I’m encouraged that the Mali Health Organizing Project has persevered throughout this time of instability and is in fact, growing in spite of it. After a month-long delay, we’re expanding operations to include free care for 1200 more children and holistic support for their families through an innovative health service delivery system that encourages engagement in community development activities. We’ve also begun to provide technical training to new community groups and have plans to construct a maternity ward in 2013. Yet despite our own progress, we realize that the limit of our own capacities mirrors a larger problem. To some degree, there is overlap between the reasons for our existence and the causes that have precipitated the fallout: factors like poverty, weak governance, growing populations, and scant resources.
From the ground it is evident that civil society has an important role to play within the current context. When disaster strikes anywhere, one looks to those closest to them for support – family, friends, and neighbors. Throughout this tumultuous period, social systems within Mali remain incredibly strong, a land where nearly everyone is considered – and treated as – an ancestral cousin, even in the face of war. Civil society – the aggregate of actors beyond the state working to advance common interests and human rights, health, and dignities – and the fraternal support that emanates from within the country, coupled with the generosity of outside states, organizations, and individuals, have the capacity to ease suffering, save lives, and even hold sway over the geopolitical quagmire. When the situation turns dangerous and the temptation to cut-and-run, even though rooted in a basic instinct of self-preservation, becomes a more “responsible” option, we must ask ourselves; if not us, than who? We do not have the luxury to operate exclusively during times of stability, for those other moments are when we are needed most and it is these moments that define us.
It’s clear that avarice and ego can exploit a power vacuum. With or without traditional systems of state structure, there remains a responsibility to act, and with it, an opportunity to carve out a stronghold, however small, in that vacuum.
Written by Adama Kouyate, Health Radio Coordinator
We alone lack the means to provide medical treatment to all the displaced in our target community facing health and financial challenges. With these shows Mali Health intends to mobilize community members and international organizations to take action and find solutions to support the displaced. We have strong confidence in the power of radio as a community mobilization tool and hope this will be the beginning of a process to support victims of the country’s instability.
Following the country’s military coup in March of this year, the escalation of extremism and infighting among armed groups in Northern Mali have caused serious political and security crises while displacing more than 350,000 thousand people. According to the Office of International Migration (OIM), the March military coup against the incumbent President has not only resulted in the occupation of the contested area by various terrorist-linked groups but has also generated a complex humanitarian crisis of widespread dimensions that continues to significantly impact Mali, one of the poorest countries in the world, also heavily impacted by the Sahel food crisis. Although a provisional government was established for the transitional period before elections in 2013, the capacity of the government to assist conflict-affected displaced populations remains limited due to complex political meanderings and weakened infrastructure.
As the fighting and insecurity have worn on, so too have the experience of the displaced. Strict doctrinal laws, beatings, amputations, murder and the shattering of holy shrines have forced residents to flee.
The Mali Health Radio Program recently leveraged its popular show to bring voice to these in-country refugees (officially, Internally Displaced Persons, or IDPs) on the challenges they continue to face. With these shows, we aimed to create more awareness about their precarious living conditions at the local and international levels and to collect qualitative data about their experience.
Several leaders have participated in these recent shows, including Madame Mariam Maiga, the deputy mayor of Gao,Northern Mali’s largest city, currently under extremist control; district census officials; and leaders from the international organization ACTED (Agency for Technical Cooperation and Development), working in tandem with the Word Food Program to assist IDPs; and several other people representing the community of IDPs living in Bamako.
Findings shared on the show indicate that Bamako’s IDPs are dispersed heavily throughout the six communes of the city. The following are some highlights of the findings:
- The Office of International Migration in Mali estimated 204,000 individuals to be forcefully displaced in the country.
- Nearly 50,000 are currently housing displaced persons in Bamako
- 69% of IDPs are living with host families, while 10% live in public spaces such as mosques, churches, schools and rented houses.
- As a result of this displacement and instability, 660,000 children are predicted to suffer from acute malnutrition 2013.
Early successes of the programs were evident in the mobilization of several local and international organizations to collect food items, used clothes, and to fund the support of IDPs throughout the country. Madame Mariam Maiga, Deputy at the mayor office of Gao reported that “Just a few days after the radio shows with the Mali Health Radio team, we have been contacted by several persons or groups of persons willing to help. They have heard our call and started to help us via donations including foodstuffs and even shelters. On behalf of all Mali IDPs, I want to thank the Mali Heath Organizing Project team for their genius initiatives and for their everyday lifesaving work”.
Written by: Djibril F. Traoré, Community Health Worker Supervisor
It is with both joy and sadness that I present this document to you on the situation of Action for Health’s target families and their thoughts on the program.
Sad, on one hand, with regards to the situation these disadvantaged families are in.
Happy, on the other, with regards to the generous donors supporting our cause and Mali Health for its management and good governance.
As a former Community Health Worker and the current Community Health Worker Supervisor, I am in a very good position to speak to you about families in our program and the problems they are confronted with. I work directly with them and the Community Health Workers.
It’s not easy to speak on behalf of these clients to explain their problems, and given their situation, it’s easy for others to want to judge their behavior. But, let’s try to imagine ourselves in their shoes in an effort to understand their hardships and what we would do in the same situation.
The families with which we work are vulnerable and in very difficult situations. In addition to being mostly illiterate and having limited access to clean water, these families have very limited access to health education. That is why Mali Health decided to support these families and remain by their side in difficult situations.
Mali Health aims to reduce the mortality and morbidity of children under the age of 5, directly linked to four diseases (malaria, diarrhea, malnutrition, and dehydration). Mali Health also provides prenatal consultations to women and helps the community participate in its own development.
I wish to share a few stories with you from my time spent supervising families participating in Mali Health’s Action for Health program.
One of these families consists of parents and their three children, the youngest of whom recently turned two. The father works as a laborer and doesn’t earn much money and the mother, Oumou, is a housewife. The youngest child was feverish, with diarrhea and vomiting. Oumou called a Community Health Worker to report this. The worker went to the home as quickly as possible, and then accompanied the child to Mali Health’s clinic. There, the child was able to take advantage of free health care and medicine. The family did not know what to do, because they didn’t have the means to pay for medication, but because of Mali Health, the child received free medicine. The family was very appreciative of the services provided by Action for Health.
Another family consisted of a mother and child. The child had been very badly burned and the mother didn’t know how to treat his wounds. Thanks to God and Mali Health, the child was treated as an Action for Health program participant and the mother was happy with the job well done by the clinic.
In addition to providing health care, Mali Health also focuses its efforts on health education. Its Community Health Workers regularly provide families with chlorine tablets, thus spreading awareness on how to help prevent diarrhea. The organization also works to educate participating families on the topic of malnutrition, conducting culinary demonstrations on Laro – a nutrient-rich food – and encouraging the consumption of other nutrient-rich foods. Furthermore, Mali Health provides cereal to malnourished children and families with nothing to eat, in an effort to ensure the well-being of children and prevent further malnutrition.
The program is well received in the community and sought out by families to learn about:
- Free health care
- Education provided by Community Health Workers
- Home visits by Community Health Workers
- Malnutrition prevention
- Prenatal and postnatal consultations
- Essential family practices
On behalf of the families benefiting from Action for Health’s services, I extend a heart-felt thanks to Mali Health and the generous donors and hope that these worthwhile activities continue.
Thank you for your understanding,
Djibril F. Traoré Community Health Worker Supervisor
Written from Bamako on September 10, 2012
Written by Diane Pueschel, Development and Communications Intern
Walking into the current delivery room of Mali Heath’s community clinic in Sikoro – one of Bamako’s poorest and fastest growing neighborhoods – it isn’t hard to grasp the overwhelming need for a stand-alone maternity ward and laboratory. Today, available resources provide only two beds and little space for delivery and recovery. Situated in one corner of the health clinic, they offer mothers and newborns minimal separation from ordinary sick patients during childbirth, recovery, or immunizations.
Limited resources at the clinic lead Sikoro’s residents to opt to deliver in the privacy of their own home. Typically this is done without the assistance of a skilled attendant, increasing the risk of maternal and infant mortality. Without proper access in the community, instances of women delivering in taxis or shared cabs are also common.
All this will change next year, thanks to a new partnership with Seattle-based One Day’s Wages to build a maternity ward and basic laboratory in the community. Based upon the premise that we can all afford to contribute one day’s worth of our salary (about 0.4%) to better the lives of others, the organization has committed to funding 50% of the project – over $17,000. By working within our communities, the difference will be raised through an online campaign.
“We are proud to come alongside Mali Health again,” says One Day’s Wages Operations Director Philip Keeton, after having supported Mali Health’s efforts in primary care delivery last year “to support their efforts empowering the people of Mali and strengthening their health care system.” The maternity ward and laboratory will serve as the final piece of a three-part project set in motion in 2009 to outfit Sikoro with a functional health center. Mali Health began construction on the main clinic in 2009 and in 2011, erected a wall around the property to provide patients with added privacy. The facility will stand independent of the main clinic and expand the capacity of the entire facility to care for Sikoro’s women and children, adding dedicated delivery and recovery wards, a family planning center, and a prenatal care consultation room.
Our community members look forward to the addition, citing many positive changes it will bring. Long-time Sikoro resident Ramata Kone spoke candidly of anticipated benefits: “If we have a maternity ward, we will save money because it is close by. We won’t have to pay for a taxi and can use the money for medications and to take care of our children.” With more than half of the population in Mali living on less than one US dollar per day, reducing these barriers to access is vital.
The maternity ward and laboratory won’t simply increase capacity at the clinic to serve more patients, but will deepen the sense of community in Sikoro. Already, local women are collaborating with the clinic’s management committee to organize their own fundraising to support the project.
To help us build a better future for Mali’s mothers and children or learn more about the work of One Day’s Wages, please click here.
On a warm Thursday morning 15 men and women gathered in the shade of the mango tree in Mali Health’s courtyard to learn about a simple and effective way to prevent malaria – neem cream. Neem cream is a mosquito repellent made from the leaves of the neem tree, shea butter and soap – the ingredients are widely available and inexpensive, and the cream prevents mosquito bites which can transmit malaria. The neem tree is widespread, and plays a key role in Malian traditional medicine – in fact, the neem contains natural insecticides. The other primary ingredient, shea butter, is produced locally in Mali, and traditionally used as a lotion for children. Since bug sprays are not widely available in Mali (not to mention that they contain noxious chemicals), neem cream is a great alternative for Sikoro residents.
Claudine Adou-lath, Aissitan Dembele and Haoua Traore of Peace Corps Mali led the training, generously sharing their expertise with representatives from Mali Health’s Radio Listener Groups, partner associations such as the Sourakabougu Action Group, and our community health workers. Each group will offer a further training to their colleagues, allowing the technique to disseminated across the neighborhood. One group, Muso Kalan So, was even inspired to start produce the neem cream commercially! Aissatou Toure, Muso Kalan So’s president said, “This is a great product for us to use to protect our children from malaria. Our women’s association wants to start producing commercial batches and selling this at our market and at local stores!”
You can give it a try at home, for an environmentally sound alternative to bug spray.
3 large handfuls of neem leaves
1 kilo of pure shea butter
1 bar of soap
1 litre of water
Boil the neem leaves in the water until the water turns green. Strain out the leaves. Grate the soap into fine pieces and add to the hot liquid, stirring until dissolved. Add in the shea butter a little at a time, and stir until incorporated. Let cool, and store in an airtight container.
As I settled into my economy class middle seat, a well dressed 20-something Burkinabe slid in the seat next to mine. An air of excitement to him, we quickly struck up a conversation. He, Dabré, is a junior officer in Burkina’s Ministry of Agriculture. The purpose of this flight – to begin a Master’s program in Brussels, studying “La Préservation de Cultures Tropicaux”, or, I gathered, how a poor country in the developing world can be best prepared for global warming. As we talked, then sat in silence, then chatted, then paused, it became clear that the interior of this flying bird was fascinating to Dabré. “Your first time on a plane?” “Oui.” I showed him how to fasten the seatbelt.
Hands placed firmly on his knees, suit and tie pressed, head on a swivel, Dabré absorbed it all. As the plane taxied, the grip on his knees visibly tightened. A minute later, we were airborne, circling Burkina’s capital city from above. As the plane dipped a wing, the whole city came into view, and too a wide grin from my new friend. “Ouagadougou,” (the capital) he said, taking in this sensation and vantage point of all he lives and of so much he knows, above and away from his world through a flying looking glass.
“Ouagadougou.” It gave me pause, and his genuineness has remained with me as I continue my travel back to the US to carry on Mali Health’s work from Boston over the next few months. I have the privilege, honor and challenge of seeing our work at Mali Health from the ground and from the air. And as Dabré now knows, seeing it from a different angle can mean seeing it for the first time.
Having spent the last two months on the ground helped me to understand where we are as a program, what’s working, and where our opportunities lie to further our mission in improving maternal and child health in Mali, starting with next month’s significant expansion of our Action for Health program.
My time in Sikoro confirmed that every member of our team is living our mission. From our accountant, to our doctor, to our radio announcers to our Malian Board of Advisors – each has a sense of purpose, and carry out with import and diligence their work. We can improve. We can be better. And we owe it to those we serve – and those that serve us – to identify and act upon those areas. But after these few months, I’m simply really proud of our staff and team. As supporters of the organization, you should be too. They’re working hard, making a real impact, and by living the mission, they are spreading something contagious to all of our constituents– hope.
High above West Africa, Dabré saw his community in a different way for the first time. Stepping back and out of our ground operations, so did I.← Older posts