ROME, Italy — Access to health care in Mali remains a pressing challenge, particularly for those living in poverty. As of 2022, the landlocked West African nation had an extreme poverty rate of 19.1%, with 90% of impoverished citizens concentrated in the country’s rural south. In an interview with The Borgen Project, Dr. Issa Sawadogo, a field coordinator at International Medical Corps, described some of the barriers hindering access to health care in Mali, as well as local and global efforts to address them.
Infrastructural Challenges
In light of ongoing political and economic instability, Mali faces significant challenges in establishing a robust national health care infrastructure. The country has a limited number of health care facilities and, according to the World Health Organization (WHO), has an average of just 0.12 medical doctors per 1,000 people. Faced with a nationwide shortage of medical personnel, equipment and resources, “much of the management of primary health care facilities is entrusted to the community, through bodies known as Community Heath Associations (CHAs),” Dr. Sawadogo explained. “Many of these facilities have been built and equipped by the communities and, therefore, some of them do not meet standards in terms of infrastructure and medical equipment.”
Alongside lacking sufficient medical equipment and facilities, there are also broader infrastructural challenges hindering access to health care in Mali. For example, “In rural areas, most of these facilities are not connected to the electricity grid. They rely on solar energy—but the installations are often of poor quality and unsustainable,” Dr. Sawadogo said.
Geographic Barriers
As this suggests, geographical location significantly impacts Malians’ ability to access reliable, quality health care. While those living in close proximity to a functioning health center have a greater chance of accessing the services that are available, many in rural regions face the challenge of traveling long distances to receive vital care. Dr. Sawadogo highlighted the challenge that distance poses, stating, “According to a survey carried out in 2022 by the Ministry of Health (MoH), 8.8% of the Malian population lives more than 15 kilometers from a functional health center. In rural areas, this proportion reaches 11.6%. In some regions—like Timbuktu—the rate is 22%. Reaching on foot or by cart (in rural areas) is difficult for sick people, particularly for pregnant women.”
Frequent flooding during Mali’s rainy season and poor road conditions exacerbate this challenge, as does the ongoing threat of armed conflict and violence, particularly in the country’s central and northern regions, Dr. Sawadogo added. Yet, while such factors have hindered “the ability of the health care facilities to provide a comprehensive package of quality health services,” Dr. Sawadogo also noted that there have been ongoing national and international efforts to improve access to health care in Mali.
Mobile Health Clinics and Telemedicine Services
For instance, in some remote areas of Northern Mali, nonprofit organizations such as International Medical Corps deploy mobile medical teams to provide services to people in hard-to-reach locations. Additionally, community-based approaches like integrated community case management (ICCM) train and equip community health workers (CHWs) to identify and treat common illnesses, bringing health care services closer to the population.
UNICEF has also played a crucial role in improving health care access in Mali. In response to ongoing conflict in the country, in 2019, UNICEF in Mali appealed for $1.47 million to bring vital health care to vulnerable communities. The organization’s efforts have included providing emergency medical equipment and supplies, administering vaccinations and supporting mobile health clinics that deliver life-saving care to remote regions impacted by violence.
Simultaneously, UNICEF in Mali is working to make health care accessible to the thousands that conflict and violence have internally displaced. For example, since February 2022, it has been providing critical support to those who fled the Ansongo district, operating mobile clinics that offer comprehensive services to families in need. In addition to basic health and nutrition services, these include immunizations, counseling on infant and maternal care and training in safe water, sanitation and hygiene practices. Ramping up its efforts to improve access to health care in Mali, in 2023, UNICEF is appealing for $114.8 million to deliver critical assistance to some 2.9 million people.
Building Equitable Infrastructure
Complementing these targeted efforts, the World Bank and other intergovernmental organizations have partnered with the Malian government to address health care disparities. For example, the World Bank’s “Jigisemejiri” (tree of hope) Emergency Safety Nets project focuses on improving the overall health of the Malian population. As of 2021, the project had distributed nutritional supplements to 105,000 individuals and provided cash transfers and free health care access to nearly 100,000.
Simultaneously, the Malian government, with the support of the U.S. Agency for International Development (USAID), is working to improve health care infrastructure, particularly in underserved areas. In addition to constructing new health centers and training additional health care professionals, its initiatives include increasing the national health budget and offering certain basic health services for free.
Looking Ahead
“Many partners, including different nonprofits and UN agencies—with financial support from various donors—are supporting the MoH to improve access to health services for the population in Mali,” Dr. Sawadogo summarized. “All these efforts make it possible to provide services to the population. But they must be maintained and strengthened to cover the maximum number of people in need.”
– Amber Kim
Photo: Flickr