Many countries have succeeded in reducing their child mortality rates over the past two decades. The number of children in developing countries who died before they reached the age of five dropped from 100 to 72 deaths per 1,000 live births between 1990 and 2008. Still, every year almost nine million children die before they reach their fifth birthday. Many of these children, 43 percent, died from pneumonia, diarrhea, malaria or AIDS, and more than a third of all child deaths were related to under-nutrition.
Policymakers and development organizations across the developing world have been striving to reduce the number of children that die before their fifth birthday by two-thirds by 2015, in accordance with the UN Millennium Development Goals. Not everyone agrees on the most effective, and most cost-effective ways to reach this goal, however, and much debate has surrounded the delivery and funding of primary healthcare for children. This study contributes much-needed evidence on what drives parents’ decisions about their children’s health care and the barriers they face in obtaining timely care for their children.
Context of the Evaluation:Mali has shown considerable progress in addressing child mortality since 1990, essentially halving the proportion of children who die before the age of five. Despite this progress, health indicators in Mali remain poor, and infant mortality rates are still among the highest in the world, with 128 out of 1,000 children dying before age five.
The Mali Health Organizing Project (Mali Health), the implementing partner in this study, aims to improve health care quality and access for people living in impoverished areas of Bamako. Founded in 2007, Mali Health works to deliver cost-effective results through community-driven, culturally appropriate, and sustainable approaches. This study will help the organization assess how to provide quality health services at an affordable cost to poor populations.
Details of the intervention:To evaluate the impact of providing health care workers and free health care to families in Mali on use of preventive care, use of formal medical care vs. traditional healers, and the amount of time families wait before seeking care when their child is acutely ill, researchers are carrying out a randomized evaluation among low-income households in Sikoroni, near urban Bamako. Researchers randomly assigned 1,050 similar households into one of four groups and Mali Health implemented the programs.
Healthcare worker only: Each family is assigned a locally recruited health worker, trained by Mali Health and employed full time. In biweekly visits, the health worker assesses the child's health according to a WHO-based protocol and advises the family if they should visit the clinic. The health workers also provide general information about good health practices and encourage preventive measures. These efforts focus on 13 Essential Family Practices as defined by the Malian government and include hand washing, bednet usage and water purification.
Free healthcare only: Healthcare at the two local clinics is free for the enrolled children if their illness is due to malnutrition, malaria, vaccine preventable diseases, diarrhea, or acute respiratory infection, and can be treated at the community clinic. The average cost per clinic visit that Mali Health currently reimburses is about CFA6000, or roughly US$12
Free healthcare and healthcare workers
No intervention- comparison group
Researchers collected detailed data on each child’s socio-economic background and used weekly visits over 7 to 10 weeks in two survey rounds in order to construct a complete health history detailing on a daily basis all symptoms that a child exhibited, and all healthcare sought by the family. Researchers are using data to pinpoint specific characteristics, identified during the initial survey period, that prevent families from seeking care, such as financial constraints, inability to borrow or save, insufficient information about health and healthcare, and/or different spending priorities.
Results and Policy Lessons:
Results forthcoming.
