Contribution of Community Health Workers to Strengthening the Health System in Mali: Impact and Challenges, 2010-2024

Abstract

Faced with a critical shortage of qualified personnel (6 health workers per 10,000 inhabitants compared to the 23 per 10,000 recommended by the World Health Organization) and limited access to healthcare, Mali institutionalized community-based essential health care in 2009. This study assessed the contribution and impact of community health workers on maternal and child health from 2010 to 2024. A cross-sectional study was conducted from September 2022 to August 2025. It covered the first five regions ( Kayes, Koulikoro, Sikasso, Ségou, and Mopti) to implement community-based essential health care in Mali. Retrospective modeling was performed using the Lives Saved Tool integrated into the Spectrum software, along with qualitative interviews with 385 stakeholders and beneficiaries. High acceptance of community-based essential health care (97.9%) was observed among users. Between 2010 and 2024, infant and child mortality fell by an average of 42.02 per 1,000 live births nationally, with Kayes recording the largest decrease (45.53 points). Maternal mortality also declined (from 121.88 to 101.28 per 100,000 live births). However, the reduction remained marginal for neonatal mortality (2.52 per 1,000 live births), particularly in Koulikoro (0.33 per 1,000 live births). Regarding gender, 75.2% of respondents believe that female community health workers (CHWs) benefit from greater social acceptance. The Community Health Strategy (CHS) in Mali has proven its effectiveness through a major reduction in infant and child mortality, driven by strong social acceptance and access to care.