It always seems impossible until it’s done. —Nelson Mandela.
Yesterday, Mali’s President made a historic announcement: Mali’s national health care system will undergo a complete re-boot. The government committed to greater investment in primary health care, in the community and in the clinic. The government will provide free care for children, pregnant women, and elders, as well as contraceptives without cost, nationwide. Paid, professionalized Community Health Workers will be the vanguard of this plan, offering health care free of charge for patients of all ages across the country. The core Proactive Care strategies that Muso has tested with the government will become the foundation of health care for Mali’s 18 million citizens, over the next four years.
Muso began this journey more than a decade ago, at the funerals of children who died because their parents didn’t have enough cash in their pockets. We began by sitting with toddlers, siblings who had just lost their mother because she couldn’t make it to a primary care clinic in time. We began with a common commitment: that no one should die waiting for care.
This moment is a long time coming. For more than a decade, it seemed impossible, to nearly everyone. More than 30 years ago, the Bamako Initiative launched in Mali during the World Health Organization Regional Assembly. Signed by health ministers from across the continent, the Bamako Initiative popularized user fees, asking patients to pay for their own health care costs out of pocket. Following the Bamako Initiative, countries across Africa adopted user fees.
The results for patients have been devastating. Research has since demonstrated that when patients are asked to pay out of pocket to receive care, access to health care plummets, particularly among the poor. Patients may delay seeking out care, which results in catastrophic health care expenditures required to treat more advanced illness, and increases risk of death. Catastrophic health care costs drive more than 100 million people newly into poverty each year, according to the World Health Organization.
In this context, Mali’s decision to remove user fees for pregnant women, children, and the elderly may signal the death knell for this harmful practice, with countries increasingly transitioning to paying for their citizens’ health care through prepayment in the form of taxes and insurance premiums.
The communities Muso serves have achieved and sustained a rate of child death lower than any country in Sub-Saharan Africa for five years running, after deploying proactive Community Health Workers, removing out of pocket fees, and strengthening primary care clinics. Mali’s Ministry of Health now aims to bring these strategies, and this transformation in child survival, to the nation.
Thank you for standing with our patients, for affirming that the right to health care can’t be measured by the depth of their pockets or by where they live. We’ve made it to this moment because you committed, because you did not give up. We’re grateful to Minister Samba Sow and his team for their partnership, for boldly rethinking Mali’s health care system from the ground up based on rigorous research. And most importantly, we’re grateful to our patients for teaching us, for drawing for us the blueprints for the primary care systems of the future.
To deliver on the promise of today’s announcement, we have a long road ahead. We’re fired up to share that road with you.
The Muso Team