Dr. Salif Samake is Mali's director of Health Planning and Statistics and oversees management of the ministries of Health, Social Affairs, and the Promotion of Women, Children and Family. He recently attended the International Conference on Global Health in Washington, DC, as part of the Ministerial Leadership Initiative. He spoke with AllAfrica about Mali's advances in reducing its maternal mortality rate, and efforts to extend healthcare and insurance to the nation's most vulnerable populations.
As a doctor I have many hopes and wishes for my country. In my country now there is a very big political commitment. The president himself is committed to taking care of women and children. He decided to give free healthcare to people in deprived areas as well as women and children and those suffering from HIV. Cesarean sections at public hospitals are free.
Mali is very fortunate when it comes to health-worker migration. We do not have a problem with this like some other countries. Mali has doctors. This is not the problem. We have to try to have mechanisms in place to [employ] these doctors. A challenge is also figuring out how to motivate them to travel to rural, deprived areas and maintain them there.
We have an elaborate strategy plan for human resources. A few years ago if you told some of our partners about human resources they would tell you it was a government problem, not the partner's problem. Human resources is part of the package we have to make available - even if you have bed nets and everything and not human resources to deliver that you can forget about [achieving] the Millennium Development Goals (MDGs). We work with partners on a strategy plan linked to the MDGs to scale up the delivery package. Now we're working on the demand side, on mutuals and health insurance to increase demand and get rid of the financial barriers.
There have been successes in relation to the MDGs. To achieve them we built a lot of partnerships with many stakeholders. Sometimes there is a lot of fragmentation because a lot of these partners came with their own thinking and said, 'We came to help you. This is exactly what we think. This is good for you.' We have to change that. In changing that you have to build very strong leadership ... We put this kind of process [in place] with very strong tools, having a very strong national health plan, which was elaborated with the participation of all the stakeholders. Then we can build a common platform and everybody can recognize themselves on this platform. And the government then can lead this process and bring all the partners under the same umbrella.
We didn't [yet] achieve the MDGs but if we scale up what we are doing we will be very near achieving the MDGs. The MDG we worry about is maternal mortality because there is a huge gap between the situation now and what we hope to achieve. But we have reduced maternal mortality by 20 percent in five years. The data is from five years ago, but this year we will have a new survey that will tell us what is improving.
Considering the MDGs, specifically those on child and maternal health, Mali still faces some issues. The government has done a lot - we have free healthcare for mothers and children and for those with HIV. The government invests a lot to support this and to implement health insurance and another kinds of insurance for the poorest people to help support them. There are three pillars: health insurance, insurance to help the poorest citizens and mutual insurance. And we are going for the extension of mutuals to bring all these things together.
Then the challenge is that transportation is very complicated. People live in very remote villages. The problem is from the village to the first level health center we have a lot of delay. Many mothers can die in the time it takes to get from the village to the health center. This is a big challenge. We are working with some partners to see how we can organize this [sort] of transportation. Then we can reduce maternal mortality attributed to this delay.
Mothers and children are linked; we cannot separate them. If you have a problem with a mother, you will most likely have a problem with the child. In all these African countries, you have this issue of famine. But it's a little different in my country because the government anticipates this and puts in place some food stocks. Also, the government encourages farmers to help them produce more. In fact, there is a nutrition problem. There are two things: the lack of food and the [availability] of food but no nutrition. In some areas that are the richest, there is the most malnutrition. This proves that it is not all about the availability of food.
What is missing is the education of nutrition. If you have food, a lot of people think you just prepare it and eat, but are you having a good balance? People think their food is delicious so it must be good for them, but you don't get nutrition just because your food is delicious. We have a lot of education and discussion in communities in order to help them to take care of this. Even for children, its important women know they should breast feed for two years. Sometimes, culturally, they give them some water and other things that are not very healthy.
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This is where the level of commitment from government can affect health policies. You find in other countries that at a technical level they are very committed to prepare the field, to do things. But when you bring it at a high level, they didn't have the support they need. In many countries you have commitment but sometimes you have some leadership issues and ownership issues. If you don't have leadership and ownership, the partners will take you all over the place because they have their own agenda. That is why ownership and leadership are so important. It needs to be something concrete on all the levels, even at the community level. Ownership means appropriating the role you have in this business. Today the stakeholders have a clearer role to make development effective. To have a dialogue with partners can make the government strong because goals are clearer.
