North Mali: The Challenge of Access to Health Services

In northern Mali, access to basic healthcare – particularly for women and children – remains a major concern. The security crisis, which started in 2012, has had negative impacts on an already weak health system in the north of the country. The first phase of the North Mali Health Facility (2014-2017) brought some health indicators in the Timbuktu and Gao regions in line with national averages. However, there are still many unmet needs and the health system remains very weak. AFD has set out to address these challenges by financing a second phase of the project, in the context of the Tiwara initiative.

Effective first phase

The first phase of the North Mali Health Facility, financed by AFD with EUR 8m, contributed to rapidly upgrading healthcare provision in the Gao and Timbuktu regions. 94% of the 100 centers supported were consequently able to provide basic healthcare services at project completion, against 50% in 2013. This first facility has also allowed some 2,000 medical evacuations and a mobile clinic to be set up in the Gao region.

To scale up their actions, AFD and its partners (Handicap International – Humanity and Inclusion and Doctors of the World Belgium) signed financing agreements for the second phase of the facility on 22 May 2018. With EUR 10m provided by AFD, the North Mali Health Facility 2 runs for three years (2018-2020). Its operating method, with direct financing to NGOs and working closely with the Ministry of Health and Public Hygiene, will meet urgent needs, while taking a more long-term approach. This rapid intervention method in the most vulnerable areas is in line with the commitments made by France in the context of the Sahel Alliance. 

This second facility continues the initial objectives, i.e. reducin maternal and child mortality and strengthen health facilities in the Gao and Timbuktu regions. The increased resources will allow phase 2 to reach a total of 103 community health centers and 7 referral health centers, which will benefit 300,000 women of child-bearing age and 150,000 children under 5 years of age. Some 2,000 cases of malnutrition will be treated in the Gao region, while 10,000 children will be immunized and 6,000 childbirths will be assisted in the Timbuktu region.

Healthcare and its financing

The North Mali Health Facility 2 strengthens the achievements of the first phase by continuing to support healthcare provision (refurbishments, equipment, health facilities, provision of medicines, access to the most remote areas…). It also focuses on screening and treating malnutrition.

The second phase of the project also focuses on developing the health financing system and on the transition already underway from completely free healthcare towards free care targeting children under the age of 5 and pregnant women. This second facility is consequently at the heart of the challenge of “humanitarian-development transition”. It is being coordinated with the humanitarian financing of ECHO and with the actions conducted on financial access to healthcare and the economic balance of health centers in North Mali. In this respect, the facility plans to conduct action-research activities on the impacts of this transition, assist health centers with their financial management and support the identification of the most vulnerable populations and healthcare for them.