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Mali

Health Systems 20/20 is working in Mali to strengthen the institutional infrastructure to expand community-based health insurance (CBHI) coverage and assess cost barriers to maternal and child health care. Initiatives in Mali include:

• The development of a national strategy to strengthen the institutional capacity to create and support well functioning mutual health organizations (MHOs).
• Collaborating with local advocacy groups to revitalize three existing inactive MHOs.
• Institutional strengthening focused on the intermediate level between the national government and MHOs — national networks, regional MHO networks, and NGOs.
• Assessing the impact of user fee elimination policies for children under age five and women seeking caesarians.

Developing a National CBHI Strategy

Health System 20/20, with Results for Development under the Ministerial Leadership Initiative, and the World Bank, have assisted the government of Mali to develop a national strategy for CBHI. A steering committee was formed and an initial national-level workshop held in November 2009 to agree on the current status and constraints of CBHI, and to present and discuss specific strategies to address constraints. A technical committee drafted the strategy and presented it for discussion and adoption at a second national workshop in February 2010. As a result of this activity, the Malian government committed $5 million to support 50 MHOs. The money, intended to subsidize premiums for MHO enrollment, marks the third time a national government in Africa has provided direct support to MHOs.

Revitalizing Current MHOs

Health Systems 20/20 is collaborating with UTM, a Malian association of MHOs that specializes in MHO development and advocacy, to develop and implement an approach to strengthen three existing MHOs in Sikasso that had become inactive. Health Systems 20/20 has developed a tool to assess the current status of an MHO which UTM has used to carry out assessments of each of the three MHOs and developed implementation plans for revitalizing them. These plans were developed in collaboration with the MHOs and are now being implemented with assistance from UTM.

Connecting MHOs through a National Network

In collaboration with local partners, Health Systems 20/20 is working in Segou Region to form the first MHO network in Mali. Segou has 22 functioning MHOs that have agreed to participate in a network. The MHOs have reached consensus on the main parameters of how the network will operate and draft by-laws have been developed. Since the network will become a purchaser of services, a feasibility study is being carried out to determine which services will be needed and how they will be financed. After the feasibility study is completed, the general assembly will be formally constituted. Health Systems 20/20 views this network as a model that can be replicated in other regions.

Elimination of Cost Barriers to Maternal and Child Health Care

Mali has a high maternal mortality ratio. At the same time, access to caesarians and other life saving obstetric care is extremely low. Health Systems 20/20 worked with the Ministry of Health to examine the effects of the free caesarian policy introduced by the government of Mali in 2005. The study examined access to caesarians, assessed equity of utilization across socioeconomic groups, and identified important remaining barriers. The team used a combination of data sources, including health facilities’ health management information system and post-policy data on beneficiaries in selected facilities, and interviews with health providers and community members. Findings from the study will be used to define future interventions or programmatic changes to reduce maternal mortality in Mali.

With the support of the Presidential Malaria Initiative (PMI) at USAID and in collaboration with the Government of Mali, Health Systems 20/20 also studied the implications (operational and financial) of removing all user fees for malaria treatment for under-five children in Mali. The study used a combination of qualitative and quantitative methods, including in-depth interviews with key national-level stakeholders, facility surveys in three regions in Mali, patient exit surveys, and focus group discussions with community members.