Community Health Worker Program in Mali Under Threat: Evidence to Drive Advocacy Efforts

The program's sustainability is threatened by the lack of domestic funding, with the central government yet to provide budgetary support. CHWs contribute extensively to the provision of care in rural Mali, with over 2,337 CHWs affiliated with 775 facilities covering 40% of the rural population in 2015. The CHW program faces several challenges, including inadequate working conditions, high turnover rates, and compartmentalization of donor and implementing partner interventions. Most CHWs lack a formal employment contract, and many are not paid on time or provided with adequate working conditions by local communities. The compartmentalization of donor and implementing partner interventions makes resource coordination and planning for the CHW program difficult for the Ministry of Health and Public Hygiene (MOHPH) to manage. A situational analysis conducted by the Health Policy Plus (HP+) project provided critical information about the CHW program. The analysis revealed that CHWs are working in over 2,026 villages across five regions plus Bamako District, and that the program relies primarily on donor resources for funding. The cost of drugs and commodities represents a significant challenge to the sustainability of the program, accounting for 63% of the resources. CHW salaries and equipment, on the other hand, represented only 20% of the resources. To address these challenges, HP+ developed a mapping tool to provide clear, concise, and accurate data on active CHWs, amounts spent by source and program area, location of health facilities and CHW-covered villages and health districts, and population density. The tool allows the MOHPH's National Directorate of Health (NDH) to enter donor data by region and year, create custom indicators, and add new donor organizations. The tool exists as a web- and computer-based repository of data with geospatial analytic capabilities, providing real-time data for decision making and advocacy. The mapping tool illustrates key functionalities that can be used to facilitate program workforce planning and funding coordination. Results across regions such as Sikasso and Koulikoro revealed that CHWs and health facilities may be inefficiently clustered and/or dispersed. Distribution of health resources is uneven, with some regions having a higher concentration of CHWs and health facilities than others. This information can be used to advocate for evidence-based domestic resource mobilization to finance the CHW program. The CHW program in Mali has the potential to play a central role in helping to achieve the health-related targets of the Sustainable Development Goals. However, the program's sustainability is threatened by the lack of domestic funding and the challenges faced by CHWs. Addressing these challenges requires effective decision making and advocacy for sustainable financing. The mapping tool developed by HP+ provides a valuable resource for the MOHPH to plan and coordinate the CHW program, and to advocate for increased domestic funding to support the program's sustainability.