National Initiative in Mali Aims to Reduce Childhood Mortality

Mali suffers one of the highest global burdens of child deaths, with more than 1 in 10 children at risk of death before age 5 in 2015, according to The World Bank. Many such deaths occur because fast-acting but preventable diseases aren't stopped quickly enough.

But a unique model of healthcare pioneered in one Malian region offers a new way to tackle the crisis by flipping how care reaches patients. Instead of waiting for patients to arrive at clinics, care workers track down those in need of attention.

"If we can reach children early with care, in the first hours of their illness, millions of lives could be saved," said Ari Johnson, MD, assistant professor of medicine at UC San Francisco and co-founder and CEO of global health nonprofit Project Muso.

At the recent Clinton Global Initiative (CGI) meeting in New York, Malian Minister of Health and Hygiene Ousmane Koné announced the launch of a nation-wide effort, called Proactive Community Case Management, to scale up access to health workers using the proactive approach developed by Johnson and colleagues at Muso, Harvard University and UCSF.

In a pilot project, Johnson and his colleagues attempted to reduce childhood deaths in one region, Yirimadjo, by turning health care delivery around. Rather than waiting for patients to reach clinics, community health workers traveled door-to-door for hours each day, seeking out sick children and directing them to early and free treatment. The strategy reduced child mortality in the region 10-fold, the group reported in a 2013 study.

Now, Project Muso, UCSF and Harvard researchers will build a research platform to guide Mali's national effort toward expanding this proactive model of patient care. The team will work through 9 operational research sites that will assess important questions on maximizing the impact of community health care workers' efforts.

"We have seen that the death of a child can become a rare event, even in communities in the midst of this crisis," said Koné. "This approach is an opportunity to construct a national and global model."