In March, Muso officially launched operations in Diapé, our test site serving approximately 7,000 patients in the district of Adzopé, Côte d’Ivoire. In the first two weeks, we saw a more than 10x increase in patient visits. Four months after launch, we are quickly learning about how to best approach the implementation of ProCCM in the Ivorian context, with some challenges and positive outcomes along the way.
New Infrastructure and Care without Fees
“I was skeptical when I first heard we did not have to pay fees for care,” shares Achi Bertin, a middle-aged man living in the community. “I was pleasantly surprised when my wife was able to obtain medication without paying any fees after suffering from a severe stomach ache. Before, when you didn’t pay upfront, the medical staff would not even touch you. But since Muso’s arrival [in Diapé], this is no longer the case. Claudia (a Muso CHW) has been great. She has demonstrated her availability at all times and is very caring.”
The newly rehabilitated Diapé Health Center is open every day from 8 AM to 5:30 PM, and after 5:30 PM only emergencies are treated. While the center provides a wide array of services, the infrastructure sometimes can be limited for more complex cases. For instance, blood work cannot be completed at the facility as there is no lab and equipment for such an exam. This is why Muso partnered with the Adzopé Hospital in June, so patients experiencing more severe symptoms and diseases that cannot be examined or treated in the Diapé Health Center can seek fee-free treatment at the district-level hospital. Additionally, the surge of patients since the launch of operations in March has created strain on the two sole nurses working in the facility. Following advocacy efforts from Muso’s team in Adzopé with local authorities, a recruitment process has been launched for a third nurse to join the staff.
Lessons Learned and Next Steps
Diapé, as our test site, is enabling us to test our assumptions and learn quickly about how to best approach the implementation of ProCCM in the Ivorian context. We have already noted important differences between the Malian and Ivorian context, which will impact the ways in which we provide medical supplies and rapid care. At the national level, we have observed much more strict central government control over supply chain for medications in Côte d'Ivoire than in Mali, which means that if a medicine stocks out in the national system, we are unable to procure in parallel as a short-term solution, which has been necessary at points throughout our 14 years providing care in Mali. The Muso team is currently pursuing an array of short- and long-term solutions in this regard.
Additionally, many of our patients farm tree crops such as palm, rubber and cocoa, which make up major components of the Ivorian economy. These crops are distant from their homes, and farmers have adapted to periodically spending the night under their trees in family camps, whereas in Mali, farmers return home each night to their village. As a central component of the Muso model is to reach patients with rapid care where they are, our team is in the process of mapping the locations of these camps to determine the optimal way to reach patients sleeping away from home. Despite these challenges, we are seeing a similarly dramatic, order-of-magnitude change in access in our first Ivorian site, as previously mentioned. This is indicative that the Model can adapt and serve in a transformative way in this new context. The Muso team will continue to analyze and update our assumptions as we go.
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