Using Health to build Power in Slums in Mali

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Using Health to build Power in Slums in Mali

Project Summary
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MHOP trains slum residents to build their own universal primary health care systems and break down the deadlock between slums and their government. Our pilot project is in Sikoroni, Mali.

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What is the primary problem your venture is trying to address and how are you addressing it (or planning to address it)?

1) SLUM DEADLOCK: Slum residents have few rights. Most are squatters who receive little help from their governments. Communities refuse to pay taxes until the government provides services, and the government refuses to provide services until the communities pay taxes. This deadlock continues indefinitely, leading to terrible infrastructure, crippling poverty, and poor health.

2) HEALTH CRISIS: People die of preventable diseases because of crowding and a lack of sanitation and healthcare.

Project Description

MHOP trains slum residents to build their own universal primary health care systems and break down the deadlock between slums and their government. Our pilot project is in Sikoroni, Mali.

Unique and different

MHOP acts as a catalyst to bring slum residents and their governments together. Our ultimate goal is to see both parties invest in slum development without outside assistance. The results of improved health are immediate and very clear. People care very strongly about health, so we use health as a tool to organize communities. When community committees (CCs) learn to design, implement, and evaluate their own projects, they invest in health and ask their governments to do the same.

MHOP has a unique system of four tools to break down the slum deadlock;

1) Health organizing
2) Accountability
3) Communication
4) Seed funding

Most other projects that work on health accidentally replace rather than foster government involvement. We catalyze government involvement and address the root causes of underinvestment in slum health.

Project plan

1) MHOP identifies or establishes community committees (CCs)
2) The CCs are trained by The Ministry of Health and the Center for Health Education
3) MHOP develops a rapport with government and local leaders, using the four tools described above.
4) The CCs meet twice a month to establish their projects.
5) Projects are funded by our three-way partnership: Community, MHOP, Government.
6) MHOP, CCs, and the government decide on a time frame for phase-out of MHOP involvement (usually 6 years plus a two-year transition period). We strive to make ourselves obsolete.

In the next six months we will be running a second 2-week training session for our community committees on coalition-building, issue-based organizing, and health record systems. We will also be working on three ongoing projects: our maternal/child health initiative, our trash initiative, and the construction of a clinic.


We partner with the Malian Ministry of Health, the Center for Health Education, a local Association for the Development of Popular Activities, World Education, the local women's association (CAFO), the Imams in our community, and many more local groups. Most of these relationships are successful because they are about mutual self-interest: we trade trainers, curriculum materials, and information. We provide office space and a community center for the women's group, in exchange for their managing our women's entrepreneurship program. As such both parties gain from the relationship.


Our vision is to achieve universal primary health care, local health leadership and empowerment, and government investment in slums around the world. In our pilot zone we aim for 100% of residents covered by a government-funded health service, and 100% of residents investing time, labor, or money in their health system.


To date, MHOP has reached over 60,000 slum residents with seven locally-led health initiatives including trash disposal, clinical care, malaria prevention, microfinance and more.

How do you engage and impact the community?

Our engagement starts with a door-knock: An MHOP Malian leader recruits a woman to be part of the Maternal and Child Health program. She sees how much of an impact basic things like malaria-prevention and early care for diarrhea can have on her family and her neighbors' families. She wants to become more involved, so MHOP trains her to be a community health worker, and she becomes responsible for the health of 600 of her neighbors. Her children live, her neighbors’ children live, and she sees herself as an agent of change. Her neighbors elect her to be on MHOP's Community Health Action Group (CHAG). On this committee she learns how to read and write, and she creates a plan to bring a clinic to her side of town, miles from paved road. After 19 months of advocacy, she and her friends succeed in getting the government to fund a clinic for 60,000 people. This is the true story of one of our leaders, Mme. Oumou Camara.

How do you measure this impact?

We measure our success at four levels:
1) INDIVIDUAL: the change in health knowledge and perception of self as a “change agent”.
2) ORGANIZING: the success of each of the initiatives taken on by our CCs.
3) UNIVERSAL HEALTH CARE: a population-level study to evaluate improvement in health outcomes.
4) POLITICAL CHANGE: political changes that result directly from our agents’ actions.


The biggest obstacle is the political will to fund health projects in Mali: while we can mobilize the population politically, whether or not the government will invest in any specific project is VERY hard to predict, and is not always within our control.

The other major obstacle is simply keeping up!: the program in Mali has grown so rapidly in the last year that it is hard for our fundraising, contact management, and staffing to keep up. That said, this is a good problem to have!

Financing source
(or how do you expect your initiative will be financed)

All of our programs are funded in a three-way partnership with the Government of Mali, Citizens of Sikoro, and MHOP. MHOP's portion of the funding comes almost entirely from small gifts of individuals around the globe: volunteers, student groups, board members, Malian musicians, 3rd grade teachers, and many more have all worked to make this project happen. However, MHOP funds mostly seed costs for programs, so the long-term funding for our programs is coming from local citizens and the government.

Aside from financial sustainability, how do you plan to grow and sustain your project?

Sikoro is a pilot project: if our model works, we will implement the idea in other slums in Bamako, adapting the exact model to each locality. We have looked at several options, and the next place we would like to work is called Djalakorodji.

We firmly believe that sharing our model is the best way to have a maximal impact: if we produce results that are publishable, we will try to get them into academic journals. I have already shared our model with leaders from around the world at the 2008 Network:TUFH conference in Bogota, Colombia.

We have also been considering how to take a successful grassroots movement and use it for political change at a national level. One strategy that we are hoping to implement is to use some of our successes, particularly the opening of the clinic, to publicly call for health financing reform in Mali. We hope eventually to create a national political coalition for primary care.

Finance details

In 2006 and 2007 MHOP raised over $35,000 and had over $147,000 in in-kind goods and services. Our 2008 year-to-date is not available at the moment, but we hope to double those numbers. But our impact is not measured in dollars: We have 3 Malian employees, 75 Malian volunteers, and over 120 US-based volunteers who make MHOP run. Furthermore, we have partnerships with 7 Mali-based NGOs, 6 student groups in the USA, and 3 institutional partners partners in the USA.

Creative funding

The most challenging and important way we acquire resources is by mobilizing them from the Malian government. This usually requires patience, gumption, an occasional demonstration, and wandering the labyrinthine halls of the Ministry of Finance trying to find our applications!

Our student groups come up with some great strategies for fundraising. Here's one of my favorites: Our Brown chapter is going to start a "Making Bank" drive: we will have local art students decorate piggy-banks in creative ways, and display 40-50 of them in a public location where people can "vote" for the best by putting quarters in them. The winner gets to keep the money in his or her pig, and the rest of the funding goes to us!

Other non finance needs

In the near future we will need pro-bono volunteers for graphic design, database entry and management, grant writing, English-French translation, publicity, electronic medical records systems, data analysis, and much more.

The Story

In 2005 in Mali, West Africa, I helped deliver a baby. He was born dead. In a hot, unventilated room, his mother, Sitan, had labored for hours, crying silently. He had died from placental malaria, and Sitan was transported to the hospital hemorrhaging, her lifeless child wrapped in the same piece of fabric she had given birth on.

I was inspired not just by the horror of this scene, but also by the sassy midwives in this maternity ward who knew exactly what to do to prevent this situation with innovative education techniques and simple medicine. These women just lacked some of the resources to get their own health projects started. One of them convinced me to come back to Mali and help her start a program. Two years later my address is “pig corner, ask for the white girl.” I have lived in Sikoroni for 19 months, and I return whenever I can.


I have received a Do Something award, the Huntington Public Service Award, and several travel and research fellowships for my work with MHOP. In addition, I was a Truman Scholarship finalist, and on the USA Today Academic Allstar 2nd Team. I received a Fulbright scholarship to work in Benin, but I turned it down so that I could work on MHOP full-time this year.

Broader context

We have student groups supporting our work at six colleges and high schools. Each school "adopts" one of our specific projects, contributing academic research, labor, and funding. Most of these groups were founded by volunteers who came with us to Mali. We are an entirely student-run project at the moment, which means that we are not only doing good work in Mali, we are training the next generation of global health leaders.


Though I am returning to school next year to study medicine, I wish to return to work on MHOP as a doctor. I hope that I will gain practical skills on how to improve health outcomes through biomedicine, but also through systems design and political mobilization. My hope is that in 8-10 years MHOP will have proven our model, and I will be able to work on sharing it widely and expanding our geographic range.

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