Lowering under-five mortality through proactive care in Mali

Muso

At a glance

Traditional care systems are not meeting the needs of most patients living in poverty, with millions of preventable deaths annually. Early access to proven healthcare tools can avert nearly all under-five child deaths. Muso has documented rapid health improvements in communities it serves with its proactive care model, including sustaining a rate of child mortality lower than any country in sub-Saharan Africa for five years running. Muso seeks to replicate and scale these results across Mali and beyond, saving millions of lives every year.

The partners

Muso was founded in 2005 by a small group of Malians and Americans who came together to address the injustices of health and poverty they witnessed. Since Muso began they have built expertise and strong relationships with partners at all levels of government and civil society. Muso has served as an operational research partner to the Malian Ministry of Health for over a decade. In February 2019, Mali's president committed to rolling out key elements Muso has co-designed and tested with the government, as part of an historic health system reform effort.

The problem

Globally, half the world’s population lacks access to essential healthcare.1  Those who are poor often receive care too late or not at all. Worldwide, in 2020, 5.2 million children died before their fifth birthday.2  With a population of over 18 million, Mali is at the epicenter of the child mortality crisis. The country's under-five mortality rate of 114 per 1,000 live birth is 13 times that of the United States and one of the world's highest.3  Currently, 59 percent of Malian women do not access basic prenatal care during pregnancy.4 And pregnancy complications killed one in 27 women in 2017.5 In Mali, like in much of the world, the top killers of children are malaria, diarrhea, pneumonia and neonatal causes. Minutes and hours matter in treating these diseases – for Malian patients, access to care is low, and late.

The solution

Muso’s proactive community case management (ProCCM) model brings together three core components to shrink the time from symptom onset to treatment:

  • Community health workers (CHWs) proactively search for patients, through door-to-door home visits, to connect them with care early.
  • CHWs provide an integrated package of life-saving doorstep care in the home, including family planning, pregnancy testing, newborn screening and treatment for children with malaria, diarrhea, pneumonia and malnutrition, supported by monthly on-site mentoring and training from a dedicated supervisor.
  • CHWs identify patients needing more complex care, and accompany them to expanded, rapid-access government-run health centers, where Muso builds infrastructure, trains and supports staff, and provides technical advising to ensure fee-free, quality universal care delivery.

The evidence

A 2013 study found that in the peri-urban area of Muso’s intervention with the Malian government, the under-five mortality rate was 155 per 1,000 at baseline and 17 per 1,000 at year three, a 10-fold difference. A 2018 study showed that these same sites sustained an under-five mortality rate at or below 28 per 1,000 since 2011, ultimately reaching a rate of seven per 1,000 – the same child mortality rate as the United States, and lower than any country in sub-Saharan Africa.6

The Impact

This philanthropic investment will support Muso to:

  • Provide intensive technical assistance to help facilitate the implementation of a national health system reform in Mali, reaching approximately 2.1 million people with 3,000 community health workers (CHWs) and 150 CHW supervisors during the grant period; and
  • Conduct research to guide this historic reform toward greater impact.

Muso works towards SDGs:

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1 WHO (2017). Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses. Retrieved from: https://www.who.int/news/item/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses. Last consulted: October 19, 2020.

2 WHO (2020). Children: improving survival and well-being. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality. Last consulted: October 19, 2020.

3 Johnson, A. D., Thiero, O., Whidden, C., Poudiougou, B., Diakité, D., Traoré, F., Samaké, S., Koné, D., Cissé, I., & Kayentao, K. (2018). Proactive community case management and child survival in periurban Mali. BMJ global health, 3(2), e000634. https://doi.org/10.1136/bmjgh-2017-000634

4 Muso (2020). Reproductive Health: Catalyzing Women's Progress in Reproductive Health. Retrieved from: https://www.musohealth.org/maternal-reproductive-health/. Last consulted: October 2019, 2020. 

5 WHO (2020). Maternal mortality in 2000-2017: Internationally comparable MMR estimates by the Maternal Mortality Estimation Inter-Agency Group (MMEIG) WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Retrieved from: https://www.who.int/gho/maternal_health/countries/mli.pdf?ua=1. Last consulted: October 19, 2020. 

6 Muso (2020).  Results: Redefining healthcare means redefining how we measure success. Retrieved from: https://www.musohealth.org/the-results/. Last consulted: October 20, 2020.