Mali just took a huge step towards universal healthcare

People stand in line as they wait to cast their vote for the presidential election at a polling station in Bamako, Mali July 29, 2018. REUTERS/Luc Gnago - RC19B68776C0

More than one in 10 children in Mali currently die before their fifth birthday. Image: REUTERS/Luc Gnago

Douglas Broom
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When the World Health Organization reports that half the global population does not have access to essential healthcare, it's easy to be pessimistic about the chances of giving all of Africa’s children a healthy start in life.

But as we approach World Health Day on April 7, health experts are optimistic that an initiative announced in Mali to provide basic healthcare to all under fives and pregnant women may help provide a solution to an intractable problem.

Image: Statista

Mali’s initiative, which is expected to cost $120 million, has the backing of the country’s major partners and is due to be rolled out in 2022. It aims to increase the number of healthcare professionals as well as providing free contraceptives and boosting healthcare for the elderly. Key to its success has been signing up new funding partners.

Currently, more than one in 10 of Mali’s children die before their fifth birthday. Latest estimates from the UN Child Mortality Agency (IGME) put the rate at 106 per 1,000 births. Although sub-Saharan Africa still has the world's worst infant mortality, death rates among under fives have halved since 2000.

If the Malian initiative succeeds it is likely to be adopted by other countries in pursuit of the UN’s Millennium Development Goals covering child mortality, health in pregnancy and fighting diseases like malaria and HIV.

Schemes to introduce free healthcare for Africa’s youngest children are not new. In 2010 the African Union and UN called for the introduction of healthcare free at the point of use for pregnant women and children under five. South Africa promptly set the pace by abolishing many healthcare charges.

Other countries followed and a 2016 study of Sierra Leone’s Free Healthcare Initiative found that, in its first four years, the initiative gave the people it treated a total of an extra 595,000 years of life at an annual cost of $6.2 per head of population.

Some countries were less successful. Analysis of projects in Africa in the development journal Afrique Contemporaine found other schemes were undermined by multiple factors from rushed implementation and poor organization to inadequate funding and a shortage of doctors, nurses and drugs.

The first comprehensive approach to providing healthcare in Africa was set out in the Bamako Initiative, agreed by African health ministers in 1987. Sponsored by the UN and WHO, it sought to provide a framework based on a mix of state and NGO funding with user fees.

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Since then, opinion has turned against charging fees to patients. A study by a team led by Dr Valéry Ridde of the University of Montreal Hospital Research Centre argued that, however low, fees discouraged people from seeking help. The study also said that, if properly planned, free healthcare was affordable and very effective.

Evidence that this approach works came last year when a team behind a seven-year project to bring free healthcare to under fives and their mothers in a suburb of the Malian capital Bamako reported that they had cut the local infant mortality rate from 154 deaths per 1,000 births to just seven.

The World Economic Forum is playing its part in tackling the global challenge to deliver affordable, quality healthcare. Its Value in Healthcare project reported last year offering guidance for policymakers on how to transform healthcare systems worldwide.

The challenge to deliver healthcare to the expected 9.8 billion world citizens by 2050 is being addressed by the Forum’s Global Future Council of Health and Healthcare, co-led by former New Zealand Prime Minister Helen Clark and Francesca Colombo, Head of Health at the Organization for Economic Co-operation and Development (OECD).

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