Child Survival and Development

Issues

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Impact

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Health

© UNICEF/MLIA2010/Asselin
A woman with malaria, 8 months pregnant, is monitored carefully at the Regional Health Reference Centre in Kita.

Strategic level

The Government, through the Ministry of Health and with support from development partners including the Mali-UNICEF country programme, has initiated innovative actions at institutional and operational levels to strengthen the health system and improve the quality of services in health facilities and in the community.

Significant progress has been made in the last ten years, with strong political commitment and appropriate actions to improve the health status of mothers and children. The MOH has mobilized all partners involved in the implementation of PRODESS under the Growth and Poverty Reduction Strategy Framework (GPRSF) to increase, as much as possible, the proportion of investments in health from government resources. Thus, several actions in the form of initiatives, projects or programmes have been undertaken: the 2010 Vision, initiative of the First Ladies of West and Central Africa, and adaptation of the roadmap for accelerated reduction of maternal and neonatal mortality. The adoption of the National Child Survival Strategy (NESS), which is being implemented through national programmes and operational plans, strengthens the continuum of "mother-newborn-child" care: SONU; NMCP; EPI; CPNR / PMTCT SENN / SMK, etc.

To ensure operationalization of programmes based on the experiences of other African countries (Ethiopia, Senegal, Madagascar, etc.) and Asia countries (China, Nepal) with community workers (in the treatment of malaria, diarrhoea and ARIs), Mali has conducted operational research on:

  • infant TPI along with routine immunization;
  • the impact of the use of zinc + ORS in the treatment of diarrhoea;
  • management of acute respiratory infections at home with antibiotics (cotrimoxazole);
  • community management of asphyxia neonatorum;
  • monitoring of children infected with HIV.

The results of these studies could be used in developing a national policy and guidelines to improve the PMA in terms of structures and community-based management of childhood diseases by workers with the MoH indicated for that level.

Operational level

For better organization of services and achievement of programme objectives, UNICEF collaborates with partners in the detection and treatment of childbirth complication diseases in health facilities at community level and the implementation of actions to promote health. The focus is placed mainly on the following areas:

  • the management of cases and referral/counter referral in health facilities through improved technical facilities, continuous training of service providers, provision of health services with equipment adapted to the level, monitoring and supervision of service providers, monitoring of interventions in health centres and in the community, and evaluation of programmes;
  • community management of childhood diseases (malaria, diarrhoea, acute respiratory infections and malnutrition) by establishing a system of community-based health system through the recruitment of community health workers paid by the communities; 
  • promotion of health through implementation of key family practices known as "Facts for Life" followed by community workers, in particular exclusive breastfeeding for first six months of life, sleeping under insecticide-treated mosquito nets, washing hands with soap at critical times, and the treatment of diarrhoea with oral rehydration solution (ORS) and zinc.

Community health volunteers are residents selected by communities to carry out activities towards behavioural change. They make home visits and organize educational talks on Key Family Practices (KFP) concerning child survival and support households in the management of early childhood diseases (diarrhoea, malaria, ARI, and malnutrition).

Each community worker covers an average of 35 households, corresponding to about 250 inhabitants. They are trained and monitored by health personnel and members of the Community Health Association. They are equipped with bicycles and materials for recording data on households. They are recruited on a voluntary basis, and therefore are not wage-earning employees. The issue of motivating them remains an abiding concern for the MOH and partners. Local authorities are expected to take the initiative to decide on any appropriate forms of motivation that can be borne by the communities.

 

 
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