Dramatic reduction in child mortality in a town close to the Malian capital shows effectiveness of a community-based system based on health workers going from house to house checking on warning signs of illness
DAKAR (Thomson Reuters Foundation) – Child mortality has been reduced tenfold in three years in Yirimadjo, a town with about 56,000 residents close to the Malian capital Bamako, according to a Harvard University researchers’ study of a pilot healthcare system focused on community health workers.
The report, published in the medical journal Plos One, says the under-five mortality rate dropped from 155/1000 in 2008 to 17/1000 in 2011, the steepest and fastest decline in child mortality ever documented.
Worldwide, 6.6 million children under the age of five died in 2012, most of them from diseases with known means of prevention and treatment. There is still a gap between well-validated methods for improving child survival and equitable, timely access to those methods, the report said.
Mali has the world's eighth highest child mortality rate and, like the vast majority of sub-Saharan countries, is struggling to meet targets for Millennium Development Goal 4 – reducing child mortality by two-thirds by 2015. In Mali’s case this is partly because its people have little access to healthcare.
The new approach, designed by Muso, uses community health workers to search for patients on a door-to-door basis, looking especially for children with fever (a sign of infection), and to guide them to early and free treatment and care.
At the same time the educational charity Tostan helps people to understand their rights and responsibilities in terms of health, development and child protection through its model, three-year community empowerment programme.
This combined approach is having a massive impact on child mortality rates compared with the standard health care system in Mali, Dr. Hamed Diallo, who heads the health centre in Yirimadgo, told Thomson Reuters Foundation by telephone.
“The crucial difference is that children are treated early and that the financial and geographical barriers to treatment have been lifted,” said Diallo, noting that most children in developing countries die from preventable or curable diseases.
“The community is at the heart of the intervention. Health workers are recruited locally, the community is involved in decision-making as well as the management of health workers, and the whole community is involved in supporting the sick,” he said.
Ari Johnston, co-founder of Muso and co-author of the research, said the new model might be particularly useful in conflict and post-conflict settings, where patients face even greater barriers to early access to care.
Mali was plunged into violence last year when a joint Tuareg-Islamist rebellion in the isolated north spread southwards and toppled the government in Bamako, displacing some 500,000 people.
French intervention in March this year restored order in the south and brought a democratically elected government, releasing some $4.2 billion worth of international aid for rebuilding the West African nation.
According to the World Health Organization, in 2011 Mali’s total health expenditure was $45 per capita. The new programme would add 18 percent to that sum, but Johnson says it is a worthwhile investment.
“$8 per capita is a very small investment for the impact it could produce. Even health spending of $53 ($45+$8) per capital would put per capita spending in Mali well below countries such as Rwanda [$63] and Senegal [$67],” he said.
The project still has some challenges to overcome. At present, the community health workers have far too many patients to screen and community leaders cannot yet accurately diagnose a child’s illness, Diallo said. The main reason for these shortcomings was a shortage of financial support for the project.
Johnson said that on a broader scale, the billions of dollars invested in medicines by global philanthropic organisations and governments could go to waste and expire in storehouses if the current bottleneck in healthcare delivery was not resolved.
“Global health institutions are investing billions in antimalarials, antibiotics and other life-saving commodities. But these investments will be wasted unless there are rapid, equitable, effective delivery systems,” he said.
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