After years of calls from civil society, the Mali government has just announced concrete steps to provide free healthcare for pregnant women and children under five as part of the country’s effort to strengthen its public healthcare system. On the 25th February 2019, the Head of State of Mali, Ibrahim Boubacar Keita, made a huge and unexpected political announcement in front of hundreds of high-level stakeholders*. During a consultation on the new health system reform, the President of Mali announced his approval of:

  • Free of chargehealth care for all children under 5, pregnant women (including deliveries) and adults above 70 years old;
  • Free of charge antenatal care and post-natal care
  • Free of charge first aid for all emergencies cases
  • Integration of community health workers into the national payment system under management of community health centres
  • An increase of the national budget allocated to the health in order to cover the above and to reach the ‘Abuja declaration’ target (15% of national budget).
 
Why is this change significant?

Mali is one of the worst countries in the world to be a child. Financial barriers are one of the main causes of maternal and under five mortality. Most Malians have had to pay at least 45% of their health costs themselves, which results in fewer people accessing or using health services. This new health policy which removes user fees has the potential to improve the current coverage of health services and reach an estimated further 300,000 children, mothers and newborns!

 

How did Save the Children contribute to this achievement?

Our work towards universal health coverage (UHC) in Mali began in 2012, as part of our EVERYONE global campaign. Since then, Save the Children in Mali, together with our CSO partners and other development actors, have been advocating for the government to remove user fees for children under five and pregnant women. This was in order to reduce Mali’s high rate of maternal and child mortality – which is among the highest in the world.

We used all opportunities- including annual health forums since 2014, the presidential elections in 2018 and the World Health Assembly in 2018, to draw the attention of high-level decision makers to our call for free health care.

  • In 2014, we supported the Ministry of Solidarity to set up a National Reflection Committee to review and push for Universal Health Coverage
  • We supported the Ministry of Health to review the previous National Human Resources for Health Strategic Plan and elaborate a new one- which includes use of community health workers as key actors of reducing under five deaths on the ground
  • We supported the creation of a Civil Society platform for UHC promotion to complement local work with global level advocacy
  • We supported several advocacy meetings organized by our CSO partners or peer organizations to advocate for the integration of community health workers into the national health system
  • In April 2017, we met the current Minister of Health to reinforce our asks
  • In April 2018, we met the Minister of Solidarity and the Secretary General of the Ministry of Health to discuss Mali’s participation at the World Health Assembly in May 2018.
  • In May 2018, a medical doctor from one of our community health programmes in Mali spoke at a public event at the World Health Assembly in Geneva, where he made the case for the country’s reforms on universal health coverage. After this intervention, we had multiple bilateral meetings with the Mali delegation at the Assembly in Geneva.

All this work, supported by a GSK-funded project, has contributed to create a positive political climate for the President of Mali to make this historic decision for children’s health.

What next?

Obviously, this is a great step towards reducing the number of deaths of children under five, and deaths of women. It also helps make progress to meet the Sustainable Development Goal to ensure everyone can lead healthy lives and that we can promote well-being for all. But we must see it as just a step. It is progress towards filling the gap of human resources for health in the country. But we do need to continue to put pressure on the government of Mali in order to make this dream a reality in the coming years. Specifically, we do need to accelerate the integration of community health workers into the health system and resolve their salaries/incentives to ensure that they are supported to save lives, particularly in hard-to-reach areas.

*Stakeholders included representatives from the World Health Organization, UNFP, World Bank, UNAIDS, John Hopkins University, University of Maryland, Clinton Foundation, GAVI, Regional Directors of OAAS, UNFPA, WHO and all local representatives of USAID, UNFPA, WHO, Netherlands, Canadian embassy and more.