In 2017, Muso, in partnership with the Malian Ministry of Health and a consortium of researchers, envisioned the ProCCM (Proactive Community Case Management) Trial as a vital response to gaps in research on community and primary health systems. . This trial explored the adaptability of Muso's Rapid Care model in a remote rural area and ventured into uncharted territories by assessing the resiliency of this model in the midst of an escalating conflict zone.
On November 28th, Principal Investigator Dr. Kassoum Kayentao from the University of Bamako and Muso Senior Scientist presented the findings in Lusaka, Zambia at the International Conference for Public Health In Africa (CPHIA).
Here is what the study found: When Bankass became an active conflict zone in 2018, Muso and its partners braced for child mortality to rise significantly, aligning with global data in conflict zones. And yet, the results were astoundingly positive. Child mortality rates plummeted by over half, decreasing from 148/1000 to 55/1000 - marking the largest, fastest drop in under-five mortality ever documented in a conflict zone.
A house in Libé Peulh village burnt during armed attacks in the Bankass Cercle area in February 2021. Photo: MINUSMA/Marco Dormino.
“When the conflict arrived a year after we launched the trial, the consequences were devastating. Villages were burned, populations displaced and there were explosives on the roads,” says Dr. Kayentao. There was a pivotal element, however, which allowed the study team to continue the trial, and ultimately maintain care delivery in communities. “We recruited and trained Community Health Workers from within,” he explains. “We also provided training to surveyors on how to effectively communicate with community members without creating any form of tension. This was crucial to building trust.”
Dr. Kayentao emphasizes that the significant drop in child mortality and improvements in prenatal care access - particularly in the midst of conflict - “is very relevant for governments and Ministries of Health across the African continent, as they work towards achieving the sustainable development goals.” He notes that [Muso’s Rapid Care] model - composed of proCHWs, upgraded primary care centers, and fee removal - is a realistic one for governments to scale. Dr. Kayentao finds that this holds particularly true for Muso’s government partners in Mali, considering the trial was co-designed with the Ministry of Health (MoH) and Muso’s history of testing the model in Mali since 2007, meaning there is a significant amount of evidence to build on.
Administrative headquarters in Bamako, Mali. Photo: Mande Infos.
Indeed, Muso has collaborated with the Malian MoH for over a decade now as an operational research and implementing partner, building the evidence base required to create national health policy change. Drawing on the results seen in our Rapid Care sites, our government partners committed to growing the existing national workforce of 3,000 proCHWs by an additional 5,000 ultimately reaching a total of 6 million people in the next three years. And there is more.
“Based on the [child mortality results] in trial sites, the biggest takeaway from this study is that, despite difficult living conditions, professional Community Health Workers (proCHWs) - when equipped with the right tools - can achieve incredible results,” says Dr. Mohamed Berthé, Coordinator of Maliʼs Health System Strengthening Implementation Unit (UMRSS) at the Ministry of Health. “Removing the financial barrier also played a critical role. We were pleasantly surprised - we knew it was possible but not to this extent,” he adds.
“We appreciate Muso’s collaborative and supportive approach. They do not come to impose ideas or particular methods, but rather bring innovative ideas and technical assistance to support us with the implementation of strategic choices,” says Dr. Berthé. “Today, the security context makes it difficult to secure the necessary resources from the national budget to cure health-related issues, but our partnership with Muso supports us in securing other sources of funding at the international level and achieving universal health care for all.”
Dr. Berthé shares that starting in January 2024, 65 additional health centers will benefit from care without fees for pregnant women and children under five, with the support of The Global Fund and Gavi.
The trial findings come at a moment when the world faces more active conflicts than any moment since World War II. 40% of child deaths - more than two million each year - occur in conflict zones and fragile contexts. These results offer a roadmap for addressing some of the most pressing challenges for communities in conflict settings.
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The Trial main effects findings on child mortality are currently undergoing peer review in preparation for upcoming publication. The Trial's findings on maternal health have been recently published in the British Medical Journal of Global Health, which can be found here.