Maternal care at the doorstep: Salimata’s story

In 2012, Salimata Konaré returned to her hometown, Yirimadio, a peri-urban area on the edge of Bamako, the capital of Mali. A recent coup d’état of the government had left parts of central and northern Mali destabilized, and had prompted her to leave the Mopti region with her children. Salimata’s husband remained in Mopti, earning money for the family through his job as a driver. They had been married since she was 14 years old. 

The Yirimadio that Salimata returned to was different than the one she had known growing up. The region’s population was rapidly expanding, as it still is today. A new program by Muso had begun providing health care. Muso’s Proactive Care programming was different. Formerly, patients in Yirimadio would have to pay for every health service and medication they received, with few exceptions for specific treatments. With Muso’s model, patients received treatment without user fees, creating access to health care services by eliminating the cost barriers that deterred many from ever seeking care for themselves and their children.  

When Salimata returned to Yirimadio, Djelika, a fellow local, came to visit her. Salimata was acquainted with Djelika as her neighbor before she left for Mopti, but since they had last seen each other, Djelika had become a Community Health Worker with Muso. In her role as a CHW, Djelika visits Salimata and her children several times a month, checking on her and her nine children’s health and providing care when needed. Salimata and Djelika’s relationship, the relationship between the CHW and the patient, is the crux of Muso’s Proactive Care model. Driven by trust, shared goals, and compassion, they work together to make sure Salimata and her family stay healthy.

One critical piece of care Djelika brings to the doorstep is a package of reproductive health services, including both family planning and maternal care services. Salimata was able to receive Depo-Provera shots in her home, and when the medication did not agree with her, Djelika helped her to get an arm implant contraceptive at the community health center. Salimata, now age 39, is expecting her tenth child this year. Her last birth was just under two years ago, to twins. When Salimata delivered her twins, Djelika stayed the night with her in the hospital. This time, Djelika has been instrumental in helping Salimata receive the prenatal care she needs and prepare for the birth. Because of the number of pregnancies Salimata has already had, she faces higher risks associated with this birth. For that reason, Muso has already arranged for Salimata to give birth at the referral hospital. After Salimata delivers her child, Djelika will facilitate postpartum counseling with Salimata, including an opportunity to discuss family planning options together. In fact, these conversations have already begun, and through exchanges with Djelika, Salimata’s husband has come to support her use of family planning and has given his blessing for her to resume using contraception after this birth. Salimata, like all Muso patients, will pay no user fees throughout her course of care.

Salimata did not always have access to this package of reproductive health care, as most Malian women still do not. Through Muso’s Proactive Reproductive Health package, she now has the freedom to decide what is best for herself and family, and to stay healthy while doing it. For her part, Djelika says that she is most proud of her work in prenatal and maternal care. She knows this is a critical element of ensuring maternal and child health in her community — and she’s already seen how CHWs can contribute to this vision. Since 2016, Djelika and her fellow CHWs across Muso sites have detected 10,000 pregnancies and have helped 22,583 women access family planning resources. 

To ensure women across Mali receive this level of care, the Malian Ministry of Health plans to remove point of care fees for pregnant women as part of the recently announced national health care reform. As Muso works with the Malian government and other partners internationally to redesign health care delivery systems at a national scale, we design with patients — with Salimata — in mind. There are women like Salimata all over the world, who want to ensure their and their children’s health, but may be restricted by intersecting barriers such as cost and a lack of support. Proactive Care reimagines what is possible for women and families like Salimata’s: professionally trained and supervised CHWs seek patients out proactively, and ensure women and families receive rapid access to the care they need, without fees and without hesitation, because health can’t wait.