In Mali, deaths among under fives have reduced from 214 for every 1,000 live births in 2000 to 176 in 2011 (according to data from the World Health Organisation). New research suggests the figure could be as low as 130 deaths per 1,000 in 2012. These reductions have been made possible through an improvement in antenatal and children’s health services and higher levels of immunisation. But there are tragically still far too many deaths among young children, many from preventable and treatable illnesses such as diarrhoea, pneumonia and malaria.
Now the results from a trial health programme suggest many more children could be saved. In Yirimajdjo, southeast of the capital Bamako, a new healthcare model has been treating patients for three years and seen deaths among under-fives decrease tenfold during that period, from 155 per 1,000 children to just 17 per 1,000 (though other factors such as demographic changes and immigration may have played a part).
Speed is the key
The trial health programme running in Yirimajdjo is based on the principle that when children are diagnosed and treated as soon as the first symptoms appear, recovery rates are extremely high. This is because many child illnesses are extremely time-sensitive and youngsters can deteriorate rapidly once they become ill.
So instead of waiting for families to bring their children to local health centres, by which time youngsters are often dangerously ill, community health workers in Yirimadjo visit homes and see out sick patients. The approach is known as “proactive doorstep care”.
When children or pregnant women are identified as needing treatment from early symptoms, the health teams provide care in the homes or refer people to local health centres. The programme also includes the removal of user fees which would discourage poor families from receiving medical assistance. This approach raised the number of patient visits tenfold between 2008 and 2011 and undoubtedly saved many lives.
Speaking to the news agency IRIN, the executive director of one of the non-governmental organisations which helped to operate the trial health services said the programme worked by being “reactive”. The visits of community health workers also helped local people to understand the “root causes” of disease and give them “the information ... to make decisions”. With the stunning results and the involvement and commitment of the community, the director concludes “that’s how change becomes sustainable”.