Mali: Improving access to health care

Over the years, MSF has provided medical and nutritional support as well as assistance to implement new health policies and rehabilitate health facilities. The primary focus of MSF's medical programs here is firmly placed on access to care since exclusion is a huge problem. Primary health care and nursing education Since 1996, MSF has provided support to one hospital and three health centers in the Ansongo district, covering Bara, Tinhama and Talataye health areas. The district is located in a desert region and the health situation is poor, especially among women and children. Vaccination coverage is low and there is a chronic shortage of medical personnel. MSF gives support through staff training (including surgical training), the provision of essential medicines and materials, vaccination and outreach activities and a referral system. MSF also trains traditional birth attendants and helps supervise the overall management of the health centers. People living in this region face several forms of exclusion from health care due to huge distances between their homes and health facilities, harsh climate conditions, financial constraints, cultural differences and poor communication. Given the importance of conducting outreach activities for this population, MSF has developed specific strategies, such as decentralization, which are now being implemented in different health areas. In Gao, MSF provides assistance to the nursing school ‘Sahel Formation' through technical support directed at teachers and overall school management. In addition to strengthening the school's teaching capacity, MSF has helped construct parts of the school's infrastructure. The school prepares health staff for Mali's three northern regions: Gao, Tombouctou and Kidal. Eye care in Mopti and Segou The region of Mopti, located about 600 kilometers northeast of Bamako, has a particularly high prevalence of eye illnesses. Since 2000, MSF has been conducting mobile, basic, surgical activities in the region as part of the minimum package of health center activities. In 2003, the mobile team carried out 650 surgical interventions for cataracts (400 in mobile surgery and 250 at the hospital) while 1,200 people with trichiasis received an operation to correct the problem. In 2001, MSF organized a mass distribution of the medicine azithromycin to treat trachoma. The generic form of the drug has been registered and used in Mali. It is now available at an accessible price for the population. In 2003 as many as 265,510 people received this treatment. The distribution of azithromycin has been accompanied by epidemiological surveillance before and during distribution (at three, six and nine months). In addition to these activities, MSF has developed a global action plan to fight trachoma that was implemented in 2003. An improved sanitary situation should help decrease the number of trachoma carriers and therefore the disease's transmission too. Operational health district of Selingué Binko, Kangaré, Siékorolé and Tagan comprise the health district of Selingué, a provincial city. MSF helped local communities build and organize health centers which became operational in 1999. In 2002, MSF continued to provide technical support in the medical, administrative and financial management of Selingue health structures and upgraded the quality of care provided. A socio-economical survey was carried out amongst the population to determine the reasons why some members of the local population did not frequent the health structures. As a result, during 2003, MSF started a program to stimulate community involvement and use of the local health facilities. The program used an anthropological survey to find out more about community involvement issues and people's use of health facilities. A medical program was then started to improve care and increase knowledge on local diseases and health problems. Advocating for better malaria treatment In Bougouni (Koumantou) MSF's malaria program staff concluded a survey on chloroquine and fansidar resistance and found high levels of resistance, far above the acceptable standards set out by the World Health Organization. MSF plans to use the collected medical data in its lobbying efforts to convince the government to change its national malaria protocol to artemisinin-containing combination therapy (ACT). Fighting cholera Cholera is another concern in Mali. MSF's emergency response during cholera outbreaks is ongoing. In 2003, MSF organized an emergency medical team in Mopti which included rapid intervention units (three potential mobile teams). The team addressed epidemics for meningitis and cholera in Mali, and neighboring Burkina Faso. Due to the sudden response required, stock management and the provision of other logistical equipment remains an important issue. Looking ahead During 2004, MSF plans to start a pilot program in Tombouctou to help the nomadic population improve their access to health care and increase the quality of the services. In addition, MSF hopes to involve more and more of civil society through its programs so that the people can act as a counter power to the health authorities and gain more control over the delivery and quality of medical care in the country. 1 Trichiasis is a condition in which the eyelashes grow inward and damage the eye. 2 Trachoma is a viral disease which damages the eyelid and can lead to blindness.