Between Poverty and Fragility: Affordable and Accessible Health Centers in Mali

It was only during her seventh pregnancy that Ms. Salama Traoré was able to receive adequate health care: she was treated at a community health center in Bamako and expressed a sense of relief tinged with heavy memories. The ordeals endured by her couple, sometimes tragic, are not forgotten. “My first six children were born at home because my husband and I couldn't afford the cost of pre- and post-natal care,” she said, referring to the loss of two of her children due to inadequate care. Ms. Traoré is now a beneficiary of the Accelerating Progress Toward Health Coverage Project (PACSU), which provides access to quality health care to the poorest in Mali.

Until recently, accessing health care was a daunting battle for vulnerable populations constrained by purchasing power and availability of care. “Previously, it was not uncommon for patients to travel between 3 and 5 kilometers to reach a community health center, often without being sure that they would be treated because of the high costs,” recalls Mr. Zanga Dao, Secretary General of the Kati City Hall.

Indeed, figures from the comprehensive survey on household living conditions (EICVM 2018 – 2019) reveal that 51% of Malians forego health care for financial reasons. This dropout rate is even higher for the poorest quintile (60%) classified by income of consumption levels and in certain regions such as Kayes, Koulikoro and Taoudenit. Even in Bamako, the capital, the financial barrier remains significant (40 percent). The low level of utilization of health services, even where geographic accessibility is better than average, suggests that financial barriers and quality of services are key factors.

More affordable and available care for vulnerable groups

PACSU, funded by the World Bank, the Global Financing Facility (GFF), and the Netherlands, aims to improve access to and quality of health services. The project contributed to increased utilization of services, quality of care, patient satisfaction, recruitment of staff, equipment, and expansion of infrastructure.

The Results-Based Financing (RBF) approach gives health facilities autonomous management of resources based on performance and allows for meeting specific needs such as equipment, human resources, and drugs. This method has proven to be effective, even in insecure areas, ensuring continuity of services with trained personnel.

Mr. Zanga Dao attests to the satisfaction of the beneficiaries: “It is a complete relief because in the center, the quality and affordability of care are now a reality.” The range of care offered meets the essential needs of the communities, including prenatal consultations, childbirth, malnutrition, and malaria treatment, among others.

“A consultation costs 1,000 CFA francs and the ticket is valid for one week; the follow-up of prenatal consultations during pregnancy costs 2,500 CFA francs,” states Mrs. Achta Dembele, a midwife. The Malian medical sector acknowledges the significant impact of the project. “Never before has our health system been so strengthened,” says Dr. Doctor Doctor of the Kati Health District.  Ismael Simaga points out that the project promotes quality, with constant availability of medicines in 90% of structures in Kati.

Increased utilization rates of improved health services

Statistics attest to the effectiveness of PACSU: the quality of services has increased from 37% to 81%, and availability of essential drugs has reached 87%. This was achieved through the recruitment of 337 local health professionals and the training of 80 senior officials from the ministries of health and finance to international RBF standards. In terms of infrastructure, 697 new buildings were built and 265 renovated or rehabilitated. In terms of equipment, 104 centers have been equipped with laboratories. In total, 2,251 out of 2,310 public and private health facilities have integrated RBF.

The project's success is reflected in a patient satisfaction rate of 88%. Sidi Modibo Thera, a community auditor, believes that PACSU addresses a major challenge in medical practices in Mali: “That of transforming the caregiver-patient relationship into a provider-client dynamic.” The culture of performance and results is increasingly reflected in the attitude of users and health personnel in the centers involved in the project.