Malian individuals, households, and communities – especially women and young people – are a rich source of dynamism and resilience that can be leveraged to reinforce existing community health infrastructures while also introducing innovation. However, the potential of community members to design, manage, and finance their own health has yet to be realized.
Maternal mortality indicators from Mali’s 2018 Enquête Démographique et de Santé and Troisième Rapport de Suivi de la Mise en OEuvre des Objectifs du Millénaire pour le Développement au Mali illustrate remaining health gaps. For example, Mali’s maternal mortality rate (MMR) had been reduced to 325 deaths per 100,000 live births, which is 1.4 times below the average of 510 deaths for 100,000 live births registered for sub-Saharan Africa. While this is a significant personal achievement for Mali (a 37% decrease in MMR since 2001), the mortality level remains 2.5 times higher than the Government of Mali’s target of 146 deaths per 100,000 live births. Additionally, the country’s MMR is still significantly above the global rate of 230 per 100,000 live births.
The underlying factors contributing to Mali’s high maternal and child death and disability rates include:
- Cultural and social barriers and norms that limit the ability of clients and care-givers – primarily women – to make health care-seeking decisions and practice healthy behaviors;
- Health system challenges, such as: poor access to quality maternal, newborn, and child health family planning/reproductive health, malaria; and nutrition; supply shortages; a lack of well-trained and motivated facility and community health workers; weak public sector governance; a lack of quality data and limited capacity to use data for effective programmatic management; poor coordination of health investments; and weak community ownership in planning, financing, and managing health programs; and
- Political, economic, and security challenges.
Overview and Objectives
USAID Keneya Nieta (also known as the USAID Household and Community Health Activity) aims to build a resilient community health system by strengthening human and social capacity and empowering communities to use local resources to manage their own health and hold health systems accountable.
The name Keneya Nieta is Bambara for “health for well-being”.
Keneya Nieta has four strategic objectives:
- Adopting and sustaining health behaviors;
- Improving individual household and community financial management, planning, and savings for health;
- Increasing community engagement, ownership, and oversight of local health services; and
- Ensuring that communities independently plan and implement key health promotion and outreach activities.
Keneya Nieta is achieving these objectives by using a multifaceted approach integrated with evidence-based social and behavior change communications and participatory community-based methods. The activity addresses cultural and social barriers and norms to facilitate individual and household adoption of healthy behaviors and uptake of quality health services in the Mopti, Segou, and Sikasso regions. This will ultimately extend the reach of community health workers and result in the sustainable reduction of maternal, newborn, and child mortality.