Towards Universal Health Coverage in Mali: The Pivotal Role and Limitations of Community Health Workers in the Fight Against Malnutrition 2010-2024

Abstract

Context: Faced with barriers to accessing healthcare, Mali undertook a reform of its community health system in 2010. This study evaluated the contribution of Community Health Workers (CHWs) in the fight against malnutrition in five regions (Kayes, Koulikoro, Sikasso, Ségou, Mopti) in Mali.
Methodology: A cross-sectional analytical study was conducted. It combined a retrospective review (2010-2024) of DHIS2 data and a perception survey (2024-2025) of stakeholders and beneficiaries. Quantitative data from questionnaires were entered and analyzed using SPSS software (version 25.0) . Retrospective modeling was performed using the Lives Saved Tool integrated into Spectrum software, and qualitative interviews were conducted with 385 stakeholders and beneficiaries.
Results: Our study found that the profile of community health workers (CHWs) reveals a high proportion of women (68.24%) and a high level of professional experience (57.85% aged 28 to 38). Clinically, CHWs managed a cumulative total of 142,327 cases of moderate acute malnutrition (MAM) and 520,439 cases of severe acute malnutrition (SAM). While user satisfaction is high (97.92%), accessibility is hampered by a critical lack of transportation (4.6%) and frequent stockouts of essential supplies (62.86% availability). Average coverage of target populations remains limited to 14.42% for MAM and 27.89% for SAM.
Conclusion: The Essential Community Care strategy in Mali has proven its ability to manage simple cases of malnutrition, treating over half a million cases in ten years. Despite the expertise and social commitment of community health workers, coverage remains limited by critical mobility (4.6%) and logistical disruptions. Sustaining these gains requires increased professionalization and a more secure supply chain.