On June 15th, MacKenzie Scott announced a gift of $15M toward Muso’s three-year, $60M strategic plan. In doing so, she affirmed what our patients have long known: no one should die waiting for health care, and it will take us all committing deeply to make this future a reality.
These funds are an investment in our goal, as we pursue a cure for delay. Over the next three years, catalyzed by this gift and a consortium of long-standing and new partners, Muso aims to double the number of patients we serve with proactive health care, publish large-scale research trial results, and support governments to build new kinds of rapid health care systems for millions of people. Read more about this announcement and our plans here.
In Q2, we solidified our Côte d’Ivoire expansion plans, supported Mali’s national COVID-19 response and health systems strengthening initiatives, and weathered a coup d’état in Mali.
As we commit to meeting more patients with the care they need, when they need it, our movement is growing too — as evidenced by the support from you, our community of action, through this period of expansion. We have the tools to cure delay, today. Half of the world is waiting for this cure. Let’s get moving.
With profound gratitude,
The Muso team
2021 Q2 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.
In May, Mali experienced its second coup d’état in less than one year, on the heels of last August’s coup. The June 5 Movement (M5), which had pushed for the resignation of Mali’s previous president, has similarly exerted pressure on the transitional government put in place last September. This pressure led the President and Prime Minister to assem- ble a new cabinet, which did not include key authors of the 2020 coup who had previously held cabinet positions. On May 24th, Vice President and 2020 coup leader Colonel Goïta seized power, arresting the transitional President and Prime Minister for what he claimed was a violation of the terms of the transition. This sparked international condemnation and efforts to mediate a peaceful return to civilian government. On June 7th, Goïta was sworn in as the new interim president. He has named a leader in the M5 movement as prime minister in efforts to repair relations between the military and civil society organizations. International actors continue to monitor the situation closely and are maintaining pressure on the new government to follow a planned 18-month transition to democratic rule, which to date President Goïta has voiced a commitment to meeting.
In the initial period after the coup, Muso temporarily activated shelter- in-place protocols for communicating with and protecting staff. As no violence or security threats related to the coup arose, we subsequently lifted these measures while continuing to monitor the situation closely.
In our rural sites in eastern Mali, a steady stream of security incidents have continued. The Bankass area, where our sites are located, saw a slight reduction in attacks in Q2, but the broader region of Mopti and its neighboring region, Ségou, have seen an increase in the number of attacks by radical groups beginning in April. These attacks have been generally directed towards security forces, though attacks have occurred against villages in areas neighboring Bankass. The main road in and out of the Bankass region remains a target for such attacks. Our team remains safe and is maintaining vigilance in accordance with our emergency response plan.
→ COVID-19 Response:
After receiving initial shipments of vaccines in March, Mali’s vaccination campaign was initially limited to its capital, Bamako, and to three target groups: the older adult population, those living with co-morbidities, and health care workers. However, vaccine hesitancy and low initial demand quickly led to opening the vaccine to the entire adult population. The geographic scope has also been expanded, with some neighboring districts outside Bamako beginning vaccinations. Despite these efforts, uptake has been low, with 138,292 first doses given and 47,899 full AstraZeneca courses completed by the end of Q2. Vaccine hesitancy and misinformation remains. Mali’s current regulations additionally prevent breastfeeding and pregnant women from vaccination. We are advocating with the government to expand their inclusion criteria.
Muso has undertaken steps to encourage all of our staff to get vaccinated. Particular attention has been given to Community Health Workers, who serve on the frontlines and are thus most at risk of contracting COVID-19 and/or transmitting infection to the patients we serve. The majority of eligible Muso CHWs have now received their first dose. We have taken initiative to increase vaccine uptake by sharing videos and testimonials and improving access to vaccines for our team. As our team becomes vaccinated, CHWs have in turn grown excited to get their patients vaccinated, especially those at highest risk. In our urban sites, CHWs are connecting patients with vaccines, and have brought mobile vaccine clinics to the homes of patients unable to travel.
Mali’s COVID-19 case rates remain low, with a total of 14,422 cumulative cases and 525 deaths to date. The national contact tracing and monitoring team designed, trained, and supported by Muso with the Malian government, continues to support rapid isolation, diagnosis, and treatment to improve outcomes for patients with COVID-19 and to stem viral spread. While the World Bank had committed to take over payment of this program, the institution froze all funds to Mali following May’s coup. Thanks to dynamic partner support, Muso continues to provide stop-gap funds for this program while playing a close technical assistance role to help find long-term, sustainable support, so that the program which Muso helped establish will continue to meet Mali’s contact tracing and monitoring needs.
In partnership with the Ministry of Health and UNICEF, Muso is working to enable every district and regional hospital in the country to provide oxygen treatment to patients. To our knowledge, no district hospitals in the country had adequate oxygen systems available at the start of the COVID-19 outbreak. Oxygen is critically important in the context of COVID-19 and for numerous other causes of morbidity and mortality. We have rolled out the new national oxygen system equipment to all 73 of Mali’s district and regional hospitals, and trainings to 64 — 88% of the way toward our goal of covering all district and regional hospitals in the country.
→ Dedicated Supervision:
The national rollout of Muso’s dedicated supervision model, which was scaled in 2020, is currently being overhauled based on learnings from the year one experience. Starting in 2019, Muso supported the government to recruit and train 150 CHW Supervisors to support 3,000 CHWs serving approximately 2M patients across the country, and with our partners at Medic, developed a version of the CHW Supervisor App for national use. In Q1 2020, these Supervisors took their posts across five regions of Mali, and were in place to support CHWs during the arrival of COVID-19 and beyond.
The Global Fund provided funding for this program through a grant to the government of Mali, which ended in December 2020. Dedicated supervision is included in the next phase of Global Fund funding as well, following a review of the program’s first year. The government, with the support of Muso, has articulated strategies for overcoming challenges and constraints encountered in the first year. Using data from the Medic plat- form, the government is able to use data to drive program performance — for example, identifying non-performing supervisors, exiting them, and recruiting and hiring new supervisors in their place. Unfortunately, dedicated supervision was paused in 2021 until this review was completed. Veteran supervisors are due to resume their post on August 1st, while new recruits are due to complete training and begin work on September 1st.
→ Second Urban Clinic:
Together with the Malian government, Muso is building and launching a new, community-led center of care in the peri-urban area we serve. Due to a surge in population and urbanization over the last decade and health infrastructure that has not kept up with this growth, Yirimadio’s single health center is over capacity. This results in long waits to see a health provider, deters patients from seeking care, exacerbates the stress placed on health care providers and the clinical care system, and risks overcrowding as our communities navigate accessing health care in the context of the COVID-19 pandemic. To support the bandwidth of providers at health centers, reduce wait times, and support the delivery of primary health care in peri-urban Mali, Muso, our local community partners, and the Malian government identified a new site and broke ground in early 2021. The government-run Bakorobabougou Health Center will serve more than 60,000 patients, and provide quality care without out-of-pocket fees. We are on track to complete construction and equipping of the health center by August, with care launching in early September.
→ Operational Plan:
Our team is gearing up to launch operations in Côte d’Ivoire, and made major strides on this front in Q2. We aim to ultimately provide direct service to approximately 310,000 patients in the country. We are pursuing this rollout as follows over the next three years:
Step 1: Launch a first test site, serving approximately 10,000 patients, and one clinic site. Make rapid iterative adjustments to test and troubleshoot operational and programmatic approaches in a new country context.
Step 2: Launch care for 150,000 patients, for a total of 160,000 patients served across 16 clinics. Collect baseline data for our research trial immediately prior to launch.
Step 3: Launch care for 150,000 additional patients, for a total of 310,000 patients, served across more than 30 clinics.
Aiming to care for approximately 310,000 patients in Côte d’Ivoire enables us to fully cover one to two districts, the basic unit of analysis for the Ministry of Health. This will allow us to reach sufficient coverage to shape national policy, and additionally allow us to optimize efficiency in terms of cost per person served.
We have identified and equipped an Abidjan office, and obtained legal registration status in the country which now allows us to open in-country bank accounts and hire staff directly. Together with our government partners, we have begun site selection as well as design for our next research study. Muso’s Abidjan-based team visited ten districts together in June, to assess in-person the local political will for partnership with Muso, key barriers delaying access, security, human resources and infrastructure, and community health system design using the CHW AIM tool.
→ COVID-19 Update:
One of the first two countries to receive vaccines through the COVAX initiative on March 1st, Côte d’Ivoire has given about 800,000 shots to date. Limited supplies, as well as vaccine skepticism, remain, but vaccine rates have picked up in recent weeks.
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 Q2, Muso received the largest single gift in our history. With Mackenzie Scott’s grant of $15M over three years ($3M in 2021, $6M in 2022, and $6M in 2023), we are on the way to making our strategic plan goals a reality. As of the end of Q2, we raised $24M toward our $60M goal; we are aiming to raise another $20M from existing partners, and anticipate $16M to raise from entirely new sources by the end of 2023.
As we prepare to launch operations in Côte d’Ivoire, we ended Q2 with $9M in unrestricted cash, or more than nine months of cash on hand. We recognized $8.7M of unrestricted revenue by the end of Q2 against a target of $10.7M for the year. Cash donations, including the large gift from Mackenzie Scott, totaled $22M.
Expenses totaled $6.2M, which is about 11% under our forecasted budget for Q2. This is due primarily to lower-than-expected contact tracing and monitoring expenses as well as a favor- able exchange rate that benefitted Muso during the quarter. Q2 expenses were $1M higher in 2021 versus 2020. This is due primarily to the construction of a second clinic in Yirimadio, increased labor costs associated with expansion and a less favorable exchange rate.
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