Sixteen years ago, a group of Malians and Americans moved in with the communities of Yirimadio, on the edge of Mali’s capital, Bamako. There, we accompanied our neighbors as they struggled and failed to access health care in time, mourned at the funerals of our neighbors when they died waiting for care that came too late or not at all, and together made a commitment: that no one should die waiting for care. Together with you, our community of action, we built what to our knowledge is the world’s fastest health system.
With the arrival of 2021, the Muso team is taking a major step toward making proactive, community-led care available to all who need it. We are launching a partnership with the government of Côte d’Ivoire. Together we will pursue ambitious goals for universal early access, maternal health, and child survival. The global COVID-19 pandemic has thrown into sharp relief the danger of delayed access to testing, diagnosis, supplies, and treatment. It is clearer than ever that outbreaks feed on delay. To stop COVID-19 and other dangerous illnesses, health systems need to move faster to protect populations and health workers, identify new cases, isolate contacts, and care for patients. In Côte d’Ivoire, we will deliver proactive care to the patients who need it most, conduct joint research, and support the Ivorian government to build systems that cure delay across their national health care system.
As we embark on this new partnership, our team is firing on all cylinders to deliver essential care, conduct research to change the global health evidence base, and partner with governments to reinforce their national health systems. In Q1, Muso CHWs operating in the context of COVID-19 conducted 45% more home visits compared to Q1 of the previous year. With our government partners, we reinforced Mali's contact tracing and monitoring system and its oxygen program, and partnered on national vaccine and personal protective equipment rollout in both countries, as detailed below.
With gratitude for your partnership,
The Muso team
2021 Q1 IMPACT REPORT
SERVICE TO DATE ⤵︎
Community Health Workers
Q1 2021 PROACTIVE CARE IN MALI ⤵︎
CHW home visits for active case finding, diagnosis, treatment, and follow-up.
Comprehensive and free clinic-based care.
SPEED OF CARE
Muso CHWs aim to reach and treat every patient within hours of their first symptoms. % : of children under age 5 treated by CHWs within 24 hours in Q1.
*Muso's rural sites consist of passive and proactive workflow arms due to the ProCCM Trial, a Randomized Controlled Trial embedded in our rural care delivery sites. The results of this trial, available in late 2021, will inform the ultimate workflow Bankass sites adopt. We anticipate some indicators listed here are lower than they might be otherwise, as our rural sites are comprised of half passive CHWs, who are not conducting proactive case detection.
NB: In order to align with national reporting standards across all health care sites in Mali, Muso’s month runs from the 26th to the 25th.
QUARTER 1 PROGRESS
→ National technical assistance partnership.
→ Future operational sites in the process of being selected.
→ National technical assistance partnership.
→ 8 operational sites in rural Mali serving 145,000 people.
→ 1 operational site (+1 under construction) in peri-urban Mali serving 210,000 people.
Bankass region, ©2021 CNES
Q1 SUCCESSES & CHALLENGES
＋ Launching long-term, national-scale partnership in Côte d’Ivoire.
＋ Oxygen equipment and training program rolling out across Mali.
－ COVID-19 cases rising across our partner countries.
－ High rates of vaccine skepticism and global inequalities in distribution have hampered vaccine rollout and uptake.
Mali received its first allocation of 396,000 doses of the COVID-19 Oxford-AstraZeneca vaccine on March 5, provided by COVAX. This initiative is co-led by GAVI, the WHO, and the Coalition for Epidemic Preparedness Innovations, and it aims to provide free vaccines to middle- and low-income countries. After initially planning to focus vaccination efforts on health workers, elderly populations, and patients with comorbidities, low uptake of Mali’s initial rollout caused the government to make the vaccine available to all adults.
From September to December 2020, Mali’s government launched a CHW Sentinel program conceived of and administered by Muso staff seconded to support Mali’s health care reform. Through this program, CHWs proactively detected cases of COVID-19, as well as tuberculosis, malaria, and pneumonia (as CHWs already do in Muso sites) across Bamako. They conducted over 500,000 home visits, finding 30,000 cases of illness during their period of operation, including 197 positive COVID-19 cases. This program was wound down at the end of the year, with the learnings informing Mali’s larger CHW scale-up efforts underway.
Mali experienced a spike in COVID-19 cases during the global surge in late December and early January. New cases dropped steadily for much of the rest of Q1, though at the end of the quarter, rising case numbers suggested the start of a third wave. We supported contact tracers and monitors deployed across 21 districts in the eight regions of the country with active cases. Handover of financial support for this national program from Muso to the World Bank is underway, with costs planned to be covered by the World Bank starting in April. Muso will continue to provide technical assistance to support the national contact tracing and monitoring program that we helped establish to meet Mali’s rapid COVID-19 response needs.
In partnership with UNICEF and the Ministry of Health, Muso developed a national initiative to distribute multi-patient oxygen concentrator machines and training to enable every district and regional hospital in the country to provide oxygen treatment to patients. In Q1, 67% of district and regional hospitals had received both training and equipment, with outstanding hospitals predominantly located in the northern regions of the country. Muso is working closely with partners to ensure that these hospitals all receive the equipment and training necessary for true national coverage.
Through the COVID-19 Action Fund for Africa, in 2020 we secured shipments to supply over six million pieces of PPE to our partner countries. In Mali, distribution of these materials is ongoing, with allocations rolling out to the south and central regions of the country. We continue to work with Mali’s government and other NGO partners to complete the distribution of PPE for the northern regions.
Following last August’s coup d’état, Mali’s civilian transitional government will remain in power until national elections scheduled for March 2022. International actors continue to closely follow Mali’s transition, and the African Union has created a special supervisory body called the Transition Monitoring and Support Group. As Mali’s new Minister of Health replaced her cabinet shortly into her tenure, we have devoted significant time to relationship-building with the Minister’s new cabinet. Muso continues to work predominantly with long-term civil servants in our government partnerships, who remained in their roles through the coup.
In Q1, Mali saw a reduction in incidents within Mali’s central regions, including Bankass, the location of our rural sites. This may be attributed in part to the intercommunal peace and reconciliation initiatives in these areas. However, the situation remains fragile, with some segments of the population not supportive of the government's involvement in the implementation of the peace initiatives.
There were multiple attacks in our rural sites in Q1, including the burning of a village and attacks on the main road between Bankass and the regional capital, targeting civilians as well as humanitarian actors and security forces. We continue to monitor the evolution of the situation and support our team to take all necessary precautions in accordance with our emergency response plan.
On March 1, Côte d’Ivoire and Ghana became the first nations to begin vaccinating their populations through the COVAX initiative. Côte d’Ivoire received an initial allocation of 500,000 doses of the Oxford-AstraZeneca vaccine. As in Mali, Côte d’Ivoire saw a spike in COVID-19 cases around the new year. Cases rose again in March, with new coronavirus variants bringing concern for the possibility of a third wave.
Muso’s new Country Director for Côte d’Ivoire arrived in-country in early February along with our COO, joining teammates who had embedded within the Ministry of Health during our initial technical assistance partnership in the country. We have secured an office space and are working on registering Muso as a legal entity within Côte d’Ivoire. Other preparatory steps such as fundraising, developing a research study design, and planning for future recruitment are underway.
Together with VillageReach, we worked with the COVID-19 Action Fund for Africa to secure PPE based on needs projections we conducted with our government partners. The distribution of these materials has now reached target districts in Côte d’Ivoire.
Muso’s research pursues four key goals:
Learning: We pursue research that will answer our central question: how do we cure delay in health care? Our research teaches us how to better serve patients with rapid access to care.
Accountability: Through our research, we hold ourselves accountable to our community partners and patients. Our research enables us to test our assumptions, and determine the extent to which we have fulfilled our commitments.
National Health System Transformation: We conduct research jointly with government partners, so that they can use findings to inform national policy and practice.
Changing Global Policy and Practice: Our research is designed to drive global change in what global health funders finance, what technical bodies like the World Health Organization and UNICEF recommend, and how implementers practice.
As we ready to launch operations in Côte d’Ivoire, our Research team is determining the optimal research study design to achieve these goals. In Q1, we gathered input from the Ivorian government on their priorities and needs, and are considering various research plans to meet them. We hope to determine our new study design by the end of Q2.
In Mali, data analysis in the ProCCM Trial continues. In Q1, we published two studies using baseline data from our rural sites, the first assessing barriers and influences that help determine women’s use of modern contraceptives and the second examining household factors associated with under-five mortality.
For the past thirteen years, Dr. Amadou Beydi Cissé has served Muso in multiple capacities, leading at the forefront of many of our greatest challenges and opportunities for growth. When Muso launched services in the Bankass region in 2016, Dr. Cissé was appointed Rural Site Coordinator, overseeing care delivery across the eight sites that would function as Muso’s boldest operational research project to date: the ProCCM Trial. Dr. Cissé’s leadership has been pivotal in ensuring care providers and researchers are able to continue their work safely, as COVID-19 and violence and insecurity have threatened patients’ lives and access to care within the Bankass region.
Dr. Cissé was recently promoted to Muso’s first Country Director for Côte d’Ivoire. In this role, he will guide the team forging Muso’s first expansion outside of Mali, supporting the Ivorian government to build systems that cure delay across their national health care system, and paving the way toward UHC.
We want to show that these strategies have been successful in Mali and can also be replicated in other contexts, countries, and at the global level. This is what we are going to implement in Côte d'Ivoire.
STATEMENT OF ACTIVITY* ⤵︎
STATEMENT OF FINANCIAL POSITION* ⤵︎
In 2020, Muso’s community of action rallied to support our team’s COVID-19 response efforts and expansion plans, leading to 50% higher funds raised than anticipated. This robust position allowed us to begin 2021 with more than eight months of cash on hand. This investment was put to use immediately in Q1, with our team launching efforts to expand to a new partner country, Côte d'Ivoire. In Mali, a second clinic in Yirimadio broke ground during the quarter. In Q1, our budget grew by $1.1M compared to the same quarter in 2020, due primarily to construction costs, a less favorable exchange rate, and increased staffing expenses as we expand our organizational capacity and ready to double our footprint.
As we open offices and begin site selection in Côte d'Ivoire, our goals require ambitious revenue growth. While funds raised to date allow us to begin preparations for Ivorian operational research sites, we aim to raise an additional $2M this year beyond our board-approved budget to launch care delivery before the end of the year, and more than $22.6M between 2021-2023 to reach our goal of serving 300,000 patients across Côte d'Ivoire.
TOTAL BUDGET OVER 3 YEARS
Funds to Raise from New Sources
Projections < 70% probability
Received or Committed
Projections ⋝ 70% probability
Additional $2M to launch Côte d'Ivoire operations in 2021
YEAR BY YEAR
Received or Committed
Projections ⋝ 70% probability
Projections < 70% probability