For the past decade, Muso has worked in Mali to redesign health care around the idea of time: Those who are poor often receive care too late or not at all. The later a child gets treatment for diseases like malaria, diarrhea, or pneumonia, the more likely the child will die.
Time is of the essence. Nevertheless, the global standard of care is passive. Doctors and Community Health Workers wait for patients to come to them, and the failures of passive health systems drive millions of child deaths every year. With some of the world’s highest maternal and child mortality rates, Mali is at the epicenter of this global crisis.
Muso’s model is designed to be straightforward and cost-effective, so that governments can feasibly implement and finance its strategies at national scale. For this reason, we have partnered with the Malian government since our founding.
To prepare for government implementation at scale, we focus on redesigning and strengthening the existing Malian health system. Our sites (nine in 2017) are based around government primary care centers. In these sites, we tap into existing Ministry of Health distribution channels, train and support government clinical staff, and evaluate the impact of these innovations with policy makers from the Ministry of Health. Muso’s team includes dedicated staff focused on working with leaders across the various branches of government. We involve our government colleagues as key partners in our work and research, providing the evidence base and supporting government leadership to make use of the results of our joint research to improve and transform the national health system.
Muso’s work in Mali occupies an unusual space in the global health community, as a small but rapidly growing NGO positioned at the juncture of research, healthcare delivery, and policy change. Most NGOs are not set up to conduct or participate in large-scale randomized trials with academic rigor, while most academic research lacks a path to direct national implementation and policy change. Operating between these two worlds presents an opportunity for Muso, the Malian government, and the global community.
A 2013 study co-authored by the Malian Ministry of Health found a 10x increase in access to care and a 10x difference in child mortality in the area of Muso’s intervention. Results like these prompted the then-Minister of Health Ousmane Koné to state: “I want to see this in every part of the country.” If these results could be replicated and brought to scale, the lives of millions of children could be saved annually.
In September 2015, the Malian Ministry of Health and Muso made a commitment at the Clinton Global Initiative to test the Muso model at scale in Mali, and assess the intervention as a national and global model for universal health care and child survival. Muso and the MoH selected nine operational sites in the district of Bankass in rural Mali to launch the health systems study. Over the next three years, we will test a core component of our model: active case detection by CHWs, CHW supervision, user fee removal and universal health coverage.
Muso is currently conducting five embedded research studies. With the Malian government as partners, our joint operational research is poised to affect health policy for Mali’s 18 million citizens, while also allowing us to vet Muso’s model to be robust enough to take on the most difficult settings, anywhere.
As Mali’s government and 30 other countries in sub-Saharan Africa undertake historic transformations of their health systems, Muso intends to serve as an evidence broker for the global effort to reach universal health coverage and to end the child mortality crisis. Our partnership with the Malian Ministry of Health, and the joint research into proactive health systems could help deliver on the potential of these investments to help save millions of lives worldwide.