How One Community in Mali Reduced their Infant Mortality Rate

Battling infant mortality is one of the most important health concerns facing many countries, including the United States. Those on the front lines of this battle are heralding the good news from the results of a 7-year study in the West African country of Mali, a nation that has the ninth highest child mortality rate in the world. To combat the high child mortality rate, the Malian government instituted a localized program in 2008, based in the neighborhood of Yirimadio, which is located on the periphery of the capital city of Bamako. The program has effectively reduced the infant mortality rate from 154 to 7 per 1000 live births. The study also showed a reduction of under-five mortality in Yirimadio over the course of the intervention, maintaining a mortality rate of 28 per 1,000 children under-five while the national average in Mali was 148 per 1,000 in 2008 and 114 per 1,000 in 2015, according to the findings published in the BMJ.

Not only was infant and under five mortality reduced, the study revealed that these problems can be tackled relatively inexpensively through community-based initiatives that literally save thousands of lives.

Reduction of the child mortality rate also impacts family planning. Studies suggest that when child mortality rates are high, female fertility are also affected. Women tend to have more children and larger families if the fear exists that children will not survive infancy or beyond the age of five. Lower mortality rates means smaller families. Currently, Mali has the third highest fertility rate in the world with 6.01 births per woman.

These results are encouraging and experts attribute the success of the program to several variables, but the method of intervention emerged as one of the most important. In Yirimadio, community health workers canvassed neighborhoods looking for at-risk children as part of a preventative program, rather than waiting for cases to materialize. These health workers searched for signs of the diseases that are the leading cause of death among children in the region — diarrhea, malaria, infant sepsis, and pneumonia — all of which have “evidence-based and cost-effective prevention and treatment methods.”

However, each of those diseases develop rapidly into more serious health conditions, which is why the second goal of the intervention program was to increase access to the healthcare system. Treatment was thus offered at home and at no cost. Considerable time was also spent improving the infrastructure for administration of care and staff capacity building, according to the Financial Times.

The intervention was launched in 2008 by the non governmental organization MUSO and the Malian Ministry of Health. Termed ProCCM (proactive community care management), it is designed to surmount barriers to effective health care and provide timely access to preventative and curative care. The critical components of the program range from home care to cost elimination were in place by September 2008. One of the most substantial challenges was the continued influx of migrants and increase in the population, which was estimated at 56,371 in 2011 and grew to 77,132 in 2013.

In order to address how population changes could impact the delivery of services, adjustments were made. The number of community health workers was adjusted to accommodate population growth and maintain a health worker ratio 1 per 1000 residents. To keep pace, the numbers of workers increased from 20 in 2008 to 150 in 2015. Additionally, group supervision visits occurred weekly by representatives of the study from 2008 to 2013, and, by July 2013, the program had developed a dedicated group of community health workers who then conducted the weekly supervisory visits. Additionally, the demand for additional care led to increased construction and the expansion of a public health centers between 2009 and 2015.

This study is part of a larger strategy to improve health outcomes for populations in sub-Saharan Africa. The United Nations led this initiative as part of its Sustainable Development Goals, agreed upon by member states in 2015. Each country is expected to achieve universal health coverage and an under five mortality rate of 25 per 1000 live births by 2030. To achieve these goals, the community health worker model is being deployed in 28 African countries. It is clear the strategy is working where it is employed effectively. Mali has maintained and sustained an under-five mortality rate that is among the lowest in sub-Saharan Africa. Challenges still exist for the region, in part due to the rapid urbanization. But, the health system has attempted to grapple with the population growth by recruiting additional health workers, expanding the health system, and the annual adjustment of medication and supply needs. The success of this program has led Mali’s leader President Ibrahim Boubacar Keïta to announce the program’s extension to the rest of the country. He has announced a 2022 target date for full coverage country wide, which is expected to cost $120 million. The announcement was also praised by the Malian health minister Samba Ousmane Sow, who noted that the expansion of the program was a positive step forward in changing and updating an antiquated healthcare system first instituted by the French more than 50 years ago, according to NPR.

The proactive community care management strategy is working. Despite the challenges of urbanization and rapid population increase, it holds one of the best keys to reducing the overall infant and under-five mortality rates in sub-Saharan Africa.

About the Author

Stephen G. Hall is a sections editor for The North Star. He is a historian specializing in 19th and 20th century African American and American intellectual, social and cultural history and the African Diaspora. Hall is the author of A Faithful Account of the Race: African American Historical Writing in Nineteenth-Century America and is working on a new book exploring the scholarly production of Black historians on the African Diaspora from 1885 to 1960.