According to the Minister of Health and Social Affairs of Mali, “the Global Action Plan for Healthy Lives and Well-being for All has been a transformative framework for Mali to start a dialogue with all partners on how to quicken the pace of action, reach communities and achieve greater health impact”.
The Global Action Plan for Healthy Lives and Well-being for All has been a transformative framework for Mali to start a dialogue with all partners on how to quicken the pace of action, reach communities and achieve greater health impact.
Mali faces significant health challenges, including persistently high maternal and child mortality rates, the highest adolescent fertility rate in the world, low basic child immunization coverage, malnutrition, a relatively high burden of infectious diseases – particularly tuberculosis, malaria and diarrhoeal disease – and an increasing burden of noncommunicable diseases. The country also has one of the lowest densities of health workers in the world, low national expenditure on health and suboptimal laboratory capacity and supply chain systems. Key obstacles to achieving UHC in Mali include a fragmented national health insurance scheme with very limited coverage, high out- of-pocket health expenditure and geographical barriers to accessing services. The country’s UHC index is 38 out of 100.
To accelerate progress towards UHC, Mali is embarking on major health reforms, a pillar of which is strengthening the PHC system. Although the current system is fragile, it is decentralized to village level through a network of community health workers in community health centres. Mali also plans to strengthen its universal health insurance scheme to provide an expanded package of services for all citizens, creating “last mile” delivery systems for health commodities and upgrading secondary and tertiary health facilities. The health reform framework of the Government, known as the Mali Action Plan (MAP), expresses Mali’s vision “to become the first country to nationalize and implement the Global Action Plan for Healthy Lives and Wellbeing for All”. To coordinate financing for the MAP and to strengthen national capacity to implement it, the Government has established a management unit in the Ministry of Health and Social Affairs and is exploring opportunities to establish a MAP “basket fund”.
The Minister of Health and Social Affairs recognized early that enhanced collaboration among the GAP agencies came at an opportune time for Mali, and he requested in July 2019 that the signatory agencies and other development partners align their support and collaborative actions with the MAP; most GAP agencies have signed a commitment to do so. In August 2019, Gavi and the Global Fund agreed to align a total of € 22 million in financing for health systems strengthening over the next year to support Mali’s PHC system, using the MAP management unit to channel and manage the funds. Subsequent discussions culminated in a formal presentation of the MAP to technical and financial partners in January 2020, when the Government requested that the agencies specifically support the MAP’s PHC priorities and activities. The GAP agencies were also requested to increase commitments to fill financing and capacity gaps, including by seconding technical expertise to the management unit, to participate actively in the MAP’s national coordination platforms and to support domestic and international launches of the MAP.
With support from the GAP PHC accelerator working group, country-facing staff of the GAP agencies have defined the support they can provide together in response to Mali’s requests. The Government is mapping resources for the National Health Strategic Plan and the related investment case with support from GFF and the World Bank to identify the available resources and funding required for the MAP. GFF and the World Bank, with support from the Government of The Netherlands, launched the Projet d’Accélération des progrès vers la Couverture Sanitaire Universelle (PACSU) to accelerate progress towards UHC with an investment of US$ 80 million to strengthen Mali’s health care system and contribute to the MAP objectives. Other possible activities of GAP agencies include joint support for the MAP’s community health roadmap, including accreditation and training of community health workers and digitalization of the community health system linked to DHIS-2; strengthening maternal, new- born and child health service delivery and diagnostic and laboratory services; support for services in fragile areas of the country and in the context of COVID-19; strengthening governance, financial management and “last-mile” procurement of medicines; and exploring opportunities to implement performance- based funding at the primary care level.
GAP implementation in Mali has benefited from strong leadership from the Government, a clear national plan and vision to guide alignment of and action by the signatory agencies and other development partners, and intensive discussions among the agencies’ country- facing staff and with the Government to ensure that stronger collaboration helps to accelerate the country’s progress towards UHC.