Mali community case management

Community case management in Mali

In 2010, Mali approved an integrated community case management (iCCM) package offered by community health workers (Agents de Santé Communautaires [ASCs]) to provide health services at the village and household levels. The ASCs also provide primary care to newborns and some family planning services for eligible families.

Based on national iCCM directives, the iCCM package and ASC model have been introduced in villages located 5 km or more from a health facility and cover 2-3 villages in a radius of 3 km with a catchment area of approximately 1,500 people.

This iCCM approach and ASC efforts are supported by an additional cadre of community health volunteers, the relais de santé communitaire, whose role is to carry out social and behavior change activities (SBC) and health education to promote key health messages to complement iCCM activities.

Community health centres (CHC):

Run by community health workers (CHWs) and community health volunteers.

  • Managed by Community Health Associations (ASACO) who carry out treatment, awareness-raising and preventive activities.
  • Clinical Integrated Management of Childhood Illnesses (IMCI) replaced by home-based treatment (HBT) for malaria treatment in Mali
    • HBT: community health volunteers and relatives within the household treat malaria

Community Health Workers / Agent de Santé Communautaire (ASCs)

  • Receive refresher training every 3 months and supportive supervision on a regular basis
  • Paid a salary of ~$100 per month (supported by various donors)
  • Continued funding a concern

ASC Coverage:

  • 1 CHW needed per 1,500 inhabitants in a 3km radius and in a zone located over 5km from a health center
  • 1 volunteer needed per 50 households
  • As of 2019, a total of 2,982 ASCs had been trained and were fully functional.
  • According to the new Ministry of Health reform document, the estimated numbers of ASCs needed to achieve full coverage of iCCM activities in Mali are:
    • 27,576 in 2022
    • 31,775 in 2025
    • 35,210 in 2030.

Severe malaria case management

  • Severe cases identified in the community are referred to the Centre de Santé Communautaire or community health centre (CSCOM), where they can receive appropriate treatment by a community health worker (an Agent de Santé Communautaire; ASC or community health workers).
  • CHWs use pre-referral interventions (artesunate rectal capsules) and refer the patients to the CHCs

Plans:

  • The Government of Mali (GoM) is also revising its community strategy (called ‘SEC’ locally), to reduce donor dependency and to incorporate cost recovery into the program with a goal of sustainability over the long term.

Challenges:

  • Regular payment of incentives to CHWs
  • CHW integrating themselves into communities
  • Drug stock outs
  • Coverage in certain zones on account of insecurity
  • IEC/BCC and interpersonal communication capacities
  • Retaining CHWs at their site
  • CHW supervision