Mali

Latest Operational Update: December 2007

Field Staff: 54

Reason for Intervention:

Endemic/Epidemic disease

Malaria is endemic in Mali, where it is the main cause of mortality for children under five. Access to healthcare is limited in this country, where 72 per cent of the population still live below the poverty line. The costrecovery system of care is a serious impediment and attendance at health centers is extremely low. MSF is working to offer quality care for malaria, especially to the most vulnerable and those excluded from the healthcare system during the rainy season.

Back in 2005, a medical investigation conducted by MSF in southern Mali produced alarming results. Significant mortality rates were found, together with poor access to care and high levels of resistance to the chloroquine- based treatments. In collaboration with national health authorities, MSF launched a project in Kangaba to help people with malaria by offering quality diagnostics and care using Artemisinin-based combination therapy (ACT), reducing the cost of treatment and addressing the geographical barrier to care.

These mobile ‘malaria teams’ mean children in isolated villages can now receive free treatment during the rainy season.

MSF offers free treatment to all children under five, and free consultations and treatment for febrile diseases to pregnant women in seven health centers in Kangaba. A flat rate policy of only 200 FCFA (50 cents) is also implemented instead of the cost-recovery system to enable the rest of the population to access treatment for malaria and other febrile diseases.

Since the implementation of this combined system, the number of consultations has increased four-fold. In 2007, each health center was seeing about 34 patients a day, compared to an average of eight in 2005. Pregnant women and children under five are the main beneficiaries.

Distance between villages and health centers has been identified as a main obstacle to access to care, particularly during the rainy season when roads are impassable. MSF has trained community groups and equipped them with rapid screening tests and ACT, enabling them to treat simple cases of malaria in children under the age of 10. These mobile ‘malaria teams’ mean children in isolated villages can now receive free treatment during the rainy season.

The number of children with access to quality healthcare at sites more than five kilometers from a health center was five times higher in 2007 than in 2006 during high transmission periods. Malaria rates fell from eight per cent in 2006 to 1.7 per cent in 2007 following the implementation of this new model of care.

MSF has worked in Mali since 1992.