Mali community case management

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
  • 2014: 2,437 CHWs present (49.9% coverage) in 5/8 of country
  • 3,092 new volunteers trained on early referral of severe cases.
  • 2,600 new CHWs need to be recruited

 

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 know as an Agent de Santé Communautaire (ASCs).
  • CHWs use pre-referral interventions (rectal artesunate 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 costs 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