Improving Community Health in Sikasso and Koulikoro regions (2011-2015)

Final results achieved as of May 2015 include: (i) 274 community health workers (CHW) (105 men and 169 women) were trained on Integrated Community Case Management (iCCM) (an approach to prevent and treat childhood illness beyond health facilities so that more children can access life-saving treatments), pharmaceutical management, and maternal, newborn and child health services; (ii) 20 workshops allowing CHW to share experiences and best practices were held; (iii) 126 stakeholders participated in meetings with the World Health Organization, UNICEF, the United Nations Population Fund, the Aga Khan Foundation, Plan Canada, and Save the Children to explain and engage relevant decision-makers on implementing a gender sensitive ICCM approach to addressing diarrhea, malaria, and pneumonia; (iv) 21 health messages relating to maternal, newborn and child health, cultural barriers, environmental health and gender were designed and recorded; and (v) the Red Cross Mali improved its ability to coordinate and collaborate with the Ministry of Health in the delivery of maternal, newborn and child health services in a gender-sensitive manner.

These are contributing to improving people’s access to quality health care services

ICCM, part of the Malian government 2007-2012 National Child Survival Strategy, was formally adopted in late 2010, with the roll out of the new CHW workforce progressively taking place throughout 2010 and 2011. Implemented by the Mali Red Cross, with technical and financial support from the Canadian Red Cross, the project commenced in December 2011 with the objective to reach 56,036 households for a total of 934,128 people, 172,814 of which are children under 5 and 205,508 are women of reproductive age through 224 CHWs and 1,120 volunteers. At the end of the implementation period in May 2015, 100% of the project activities were fully completed and the project achieved the majority of the expected results.

Prior to the project, in the geographical areas of the project, less than 15% of children under 5 were assessed for treatment or referral, whereas by the end of the project the numbers successfully increased to 51% by the last year of the project. The project strengthened MoH by building M&E capacity, and supporting strategies to improve the MoH national supply chain systems.

Within the scope of the project, 85,055 children were assessed, treated or referred for Malaria, Pneumonia, Diarrhea or Malnutrition and among them, 97% were treated in the community by the Community Health Workers (CHWs) and only 3% of the assessed children required referrals to the MoH health facility. This endline result showed both a significant decline in the number of cases requiring referral compared to 36% at baseline and significantly exceeded the target of having only 26% referral. This change can be attributed to the Behavioural Change Communication (BCC) activities which have resulted in parents implementing more preventative practices and seeking care for their child earlier. This highlights a significant achievement with respect to the project’s intermediate outcome 1: Improved quality, including gender sensitivity, of MoH MNCH services at the regional, district and community levels.

The project also has experienced positive results toward the achievement of the intermediate outcome 2: Increased use of MNCH services and preventative practices at the community level by women, male and female children under-five, by reducing financial barriers to MOH services at the community level through advocacy work done lower ICCM & MNCH consultation fees and standardize them across sites. This led to the increased use of ICCM and MNCH services at the community level by women and children under 5. The presence of CHWs providing ICCM and the local Red Cross volunteers providing CBHFA led to antenatal care usage by early identification and follow-up of pregnant women, as well as postnatal care usage and the immunization of both the mother and child. Thus, between the project inception and closure in May 2015, the number of pregnant women who have received four antenatal visits increased from 33.72% to 55.99% in Koulikoro region (exceeding the target of 45%) and from 36.48% to 50.22% in Sikasso region (exceeding the target of 46%) while the percentage of mothers who have had postnatal care within two days after birth increased from 34.97% to 45.54% in Koulikoro (exceeding the target of 30% which had been set lower than baseline due to concerns with the baseline result) and from 25.98% to 38.15% in Sikasso (coming within 2% of the target of 40%). Furthermore, the number of children under 5 years who were immunized by DPT (3 doses of Penta) increased from 64.94% to 81.63% in Koulikoro region (exceeding the target of 79%) and from 48.02% to 59.32% in Sikasso region (coming 3% shy of the taregt of 62%).

In addition the Red Cross volunteers contributed to achieving significant results with respect to household visits. The number of visits increased yearly and by the end the project, the volunteers visited 82.84% of the households in Koulikoro region and 84.58% in Sikasso region benefited monthly from at least one Red Cross volunteer’s visit. The number of beneficiaries reached through Behavioural Change Communication (BCC) activities doubled between the first and the second year of the project and surpassed half a million at the end of the project.

The progress towards achieving intermediate outcome 3: The role of the Mali Red Cross in supporting the MoH in the delivery of gender sensitive MNCH services at the community level was also significant, as evidenced by the composition of the steering committee (50% women), increased in participation of female volunteers and CHWs in project activities. 336 female volunteers among a total of 1120 CRM volunteers provided frontline support to the communities, to CHWs and to the community-directed activities of the MoH health facilities. 95% of the female volunteers were still active in the communities at the end of the project and demonstrates the project’s efforts to facilitate and support the participation of women throughout the program. Additionally 49% of the Village Health Committees (VHCs) had women making up at least 40% of their membership or were led by women. The mid-point evaluation shows that these VHCs were are more organised with regular successful activities such as Hygiene Day, mobilisation to support the Red Cross volunteers, the CHW or the MoH activities (vaccination, deworming, distribution of vitamin A, etc.).

The gender balance amongst the CHW/RC volunteer teams had a positive effect on engaging both male and female community members in the project activities. This is reflected through work of the 169 female CHWs (61% of the 274 CHWs) where use of the use of family planning increased (example in Sikasso from 8.46% to 18.45%) due to the availability of CHWs to discuss these issues with women in the community. At the same time, the male CHWs have been instrumental in bringing in the men to these discussions. The BCC activities conducted by the CHWs and the Red Cross volunteers were systematically gender sensitive as they took into consideration gender dynamics in a community while at the same time encouraged behaviour change that would result in better health indicators for the community. For example, traditionally if a child falls ill while a father is at home and the mother is away from home, due to seeing children’s health as a mother’s responsibility, men typically wait for the wife to return home for her to seek care for the child. This delay in care seeking can have serious implications. Hence the CHWs and volunteers worked to change these practices by encouraging men to take the child to the CHW for consultation immediately, without waiting for the wife to return home.