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Mali

Mali is a landlocked country in West Africa. Ninety percent of Malians live in the southern third of the country, as most of its land mass is in the Sahara desert. Half of Mali’s population is under the age of 15, and two-thirds are younger than 25 years of age. The large proportion of children among Mali’s population is challenging the country’s ability to develop in the areas of food security, economic growth, and attainment of the Millennium Development Goals.

Malaria threatens the entire population and is the leading cause of morbidity and mortality. Malaria largely affects pregnant women and children under five, who suffer over two episodes per year on average. Mali’s maternal and child health indicators, while improving in recent years, still remain among the worst in the world. The high fertility rate, low contraceptive prevalence rate, and high unmet need for family planning collectively have been described as a national crisis. Malnutrition is a major contributor to maternal and child death and disability; 38 percent of children suffer from chronic undernutrition. Nearly 12 million people are at risk of one or more neglected tropical diseases. Although Mali’s HIV prevalence rate is low – an estimated 1.3 percent – compared with other sub-Saharan countries, pockets of higher prevalence exist among Mali’s most at-risk populations.

Under GHI, the U.S. has identified several priority areas for leveraging U.S. resources and partnership to enhance Mali’s health sector: strengthening ministerial leadership and strategic planning capacity; promoting a unified approach to system strengthening; supporting improved service delivery; and growing human resource capacity.

The Mali GHI Strategy aligns with the priorities of the Government of Mali’s Health Sector Development Program. By helping to build health systems, the Mali GHI Strategy will also strengthen the Ministry of Health’s leadership and strategic planning capacity.

The U.S. Global Health Initiative:

Focuses on women, girls, and gender equality
Encourages country ownership and invest in country-led plans
Builds sustainability through health systems strengthening
Strengthens and leverages key organizations and partnerships with humanitarian and faith-based groups and the private sector
Increases impact through strategic coordination and integration
Improves metrics, monitoring, and evaluation
Promotes research and innovation

The GHI Country Strategies are high level, cross cutting documents outlining select areas of focus to achieve greater value and impact by applying the GHI principles. GHI Country Strategies are implemented through existing robust technical operational plans. They do not detail all of the programming and health priorities in a country. The Strategies will evolve over time as we learn more about what works and what doesn’t in efforts to improve and save lives.

Country Leadership: National Health Plan Priorities and Challenges

The Government of Mali’s Ministry of Health defines priorities for Mali through a 10-year plan consisting of two five-year segments. The current Health Sector Development Program, PRODESS II, has been extended for two years, through the end of 2011. The plan for 2012-2016, PRODESS III, will be developed over the course of the next 12 to 15 months, to be ready for implementation at the start of 2012. U.S. programs are well coordinated with the Government of Mali and the GHI objectives are fully aligned with Government of Mali health priorities.

The majority of high impact health services implemented by the Government of Mali focus on reducing maternal and child morbidity and mortality. Within this framework, the Government of Mali supports expanded access to family planning, noting that the demand is greater than the supply and that new approaches are needed to expand services and reach those in need. The Government of Mali also places emphasis on the prevention and treatment of malaria, HIV, and other diseases, including neglected tropical diseases.

The Government of Mali recognizes the importance of surveillance as a key approach to strengthening prevention and treatment activities. Mali also prioritizes other programs, including strengthening of community-level health programs, health communication, and youth development. Youth development priorities include educating young people about reproductive health, hygiene, life-cycles, and job skills.

GHI Mali Strategy: Focus Areas

The overarching GHI country goal in Mali is to become more effective in supporting the Government of Mali in its efforts to attain Millennium Development Goals (MDGs) 4, 5, and 6. The strategy identifies three focus areas that bring additional value to existing U.S. investments in Mali:

1. Strengthening strategic planning for the development of the Health Sector Development Program and providing leadership within the partnership of donors and government

2. Expanding access to postpartum family planning

3. Delivering integrated packages of essential services at the community level to address MDGs 4 and 5, and MDG 6, for malaria only

improving Effectiveness and Efficiency through GHI Principles

The Mali GHI Strategy outlines specific steps that will be taken to advance the GHI principles. These steps include:

Strengthening alignment of U.S. investments with Malian health plans to increase the long-term sustainability of U.S. investments.
Investing in the health of women and girls to improve the health of Malian families.
Focusing on family planning with implications for Mali’s long-term health, economic development, and stability.
Brokering public-private partnerships to improve coverage and access to essential health services by exploring new collaborations with a range of community, religious, non-governmental organizations, and private organizations that provide significant contributions to Malian health.
Enhancing support to local and existing well-performing partners.
Increasing integration in planning and implementation of U.S.-supported activities to maximize the number of preventive health services offered during a single encounter.
Improving coordination with other bilateral and multilateral partners, such as working with the Country Coordinating Mechanism to the Global Fund to build better oversight of Global Fund investments.
Supporting strategically aligned systems strengthening across all health programs, including strengthening the pharmaceutical supply chain for essential drugs and contraceptives; ensuring service delivery access, quality, and use; and further developing human resource capacity and health information systems.
Strengthening monitoring and evaluation to know what works, and what doesn’t.

GHI in Action:

Integrating Essential Services for Impact

In Mali, under GHI, the U.S. Government has been able to integrate five separate annual essential services campaigns designed to provide Vitamin A supplements, de-worming, and neglected tropical disease treatments into one streamlined pilot program. In fact, the pilot boosted health coverage while cutting by half the cost of delivery.

The U.S. Government is working with the Government of Mali to scale-up this single campaign approach, with hopes of expanding it to cover 80 percent of pregnant women and children under five. The integrated campaign requires fewer financial resources while providing an additional intervention in nutrition screening. Two-thirds of health workers surveyed thought it was a more efficient use of their time, and 80 percent thought it strengthened participation by the community.