Mali's Model Clinic

Mali's Model Clinic

Bamako, MaliCambridge, United States
Year Founded:
2007
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
$250,000 - $500,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Mali Health is improving maternal and child health in Mali, West Africa, through innovative programs, community development, and sustainable approaches to health services in resource-poor settings. We create platforms for residents to transform their own health outcomes and work alongside communities in developing and achieving impact in global health.

About Project

Problem: What problem is this project trying to address?

In Mali, one in five children die before the age of 5, 90% due to 5 treatable, preventable conditions. For the poor, even low barriers to care become insurmountable as patients delay treatment, allowing illnesses to worsen and costs, morbidity, and mortality rates to rise. Simultaneously, Mali’s decentralized, fee-for-service health system remain incapable of appropriately meeting local needs, disproportionately so among poor communities where clinics lack the resources to function properly. This results in the continually exacerbated tragedy, then, of poor health outcomes, reduced livelihood capacity, and a skeletal health system without the means to achieve its purpose.

Solution: What is the proposed solution? Please be specific!

We will adapt 5 strategies of performance to address child mortality at the primary health level. 1. Reduce blockages in treatment, such as care-seeking, costs, and treatment adherence. 2. Help clinics manage systems such as labor use, wait times, inventory, and supply allocation. 3. Rigorous quality improvement, root-cause analysis, and feedback on outcomes. 4. Standardization and technology improvements to diagnose, treat, and refer patients. 5. Pricing strategy and financial mechanisms to reduce barriers to care-seeking and through cross subsidization. We will operate in a peri-urban slum on the outskirts of Bamako, serving 50,000 of the city’s poorest and geographically isolated.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Aligned with our organizational mission to improve maternal and child health sustainably, the goal of our pilot program is to increase under-5 survival in a peri-urban community in Mali through improvements in clinical operation efficiencies, the reduction of barriers to care, more efficient treatment delivery, and a greater emphasis on quality improvement with continued evaluation by: 1. Instituting a “Goal for Zero” child mortality target objective and culture at identified clinic(s) 2. Improving patient/mother access to prompt and appropriate care and service delivery satisfaction 3. Strengthen a peri-urban health system’s efficiency, capacity and sustainability

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

Through direct health services, supporting nearly 2,000 children under 5 and their families, we have maintained mortality rates under 1%, compared to a nationwide average of almost 20%. Enrolled children are 3 times more likely to visit a doctor when sick, and enrolled women are 30% more likely to seek prenatal care and 18% more likely to give birth in a clinic. Community-wide (including the entire population served by the clinic we constructed in 2009), women are 50% more likely to give birth with a skilled attendant and children are 59% more likely to receive vaccines. With a focus on health system improvements, in addition to infrastructure projects, Mali Health has reduced the average costs of care through technical trainings and the development of approved prescription packages for common infirmities. We worked with a local clinic to develop its own strategic plan for measured improvement. Our health worker system has proven an exceptionally cost-effective model that has exhibited the capacity scale. Last, we have witnessed the development of an engaged citizenry, working to improve the health, sanitation and knowledge retained and diffused among and across this peri-urban community.
Sustainability

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

Sept – Nov 2013: • Develop initial methodologies and protocols • Develop mobile health application and backend dashboard for data collection and analysis • Observe processes, consider workflow to improve efficiencies and eliminate wasted efforts Nov 2013 – June 2015 • Implement algorithmic protocols • Analyze and adapt cost models • Launch clinic-based community health worker system • Hold quality improvement meetings, feedback sessions, and reporting on agreed-upon deliverables, adapting and adopting rapidly • Develop best practices and program improvements • Engage with Ministry of Health and NGOs to expand services • June 2013: Hand over successful operations to clinic to continue employing most efficient and effective practices

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Traditional healers and clinics can be considered competitors to Mali Health, as they offer inexpensive services that draw patients away from the formal system. Private clinics exist, with quality and satisfaction rates similar to public institutions. The national healthcare system can be inconsistent and unreliable, promising plans to rollout a subsidization program for the poor, or distributing products inconsistently to local clinics. These actors could draw support and investment away from Mali Health’s efforts, though in anticipation, we hope to engage others as partners over competitors and prepare contingencies should policies or deliverables change.
Team

Founding Story

When our founder was working overnight shifts in Bamako’s main hospital and a women gave birth to a stillborn child, she realized that in a country ranked 2nd highest in infant mortality, simple and inexpensive interventions during pregnancy could have saved that that life and countless others.
Organization Name

Mali Health Organizing Project

About You
About You
First Name

Kris

Last Name

Ansin

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Innovation
Explain what the "innovation" is about, e.g., is it the idea and/or the model you use to accomplish the idea, or your understanding of the target population, etc.?

An unavoidable tension exist between two global problems – how to provide quality care to the poor, and how to fund it. Access to basic services remains elusive to the poor as financial, geographic and knowledge barriers often keep the indignant from seeking – and receiving – proper and affordable basic care, while simultaneously, health systems in the global south are outstretched, underfinanced, poorly equipped and inadequately staffed, an environment where a community’s health care “provider” simply can’t provide.

Drawing upon successful advances in accessible and quality services delivery from around the world, Mali Health will develop a model of primary care delivery in poor resource slum environments, addressing these two dilemmas seemingly in endless conflict. Through the integration of community health workers, use of treatment algorithms and mobile tools, streamlined processes for health delivery, adaptive financing, and the development of systemic quality improvement mechanisms, our model clinic will revolve around user-orientation and outcomes, increasing usage and demand while improving efficiencies and cost structures in Mali’s decentralized health system.

Describe how your innovation model is distinct from any other organization in your field?

While similar models have been used to increase access to low-cost, high quality services in targeted arenas like cataract surgery, and cardiac care, Mali Health’s model is the first used to provide primary care in the developing world. The model also focuses specifically on the emergent challenge of providing access to care for peri-urban communities, the fastest growing populace in the world, not by replacing or competing with present services, but by improving existing institutions by strengthening the ability and efficiency of a model primary clinic to provide quality and affordable care.

What type of operating environment and internal organizational factors make your innovation successful?

With a weak and highly decentralized health system, the environment in Mali is particularly amenable to such an intervention that improves efficiencies and strengthens primary care clinics at the community level. Mali’s context is one where far too many of the poor and vulnerable succumb to preventable conditions that will be addressed this model. More, working in the greater community for over five years with a visible record of success, Mali Health has established the trust and expertise needed to identify and successfully undertake such an endeavor.

How do you make sure you constantly innovate in light of (potential) external challenges, or your growth plan?

Already operating in Mali’s challenging and shifting context, Mali Health has been successfully expanded and improvement operational activities over the last several years. More, continual innovation and improvement rest at the core of this model through disruptive change and mechanisms for continual feedback and development. Through ambitious goal setting, data transparency, opportunities for beneficiary and expert feedback and support, and the inclusion of relevant actors to shares results and lessons, Mali Health’s model is framed around a dynamism that not only allows for innovation, but necessitates it.

Organization Country

, MA, Cambridge, Suffolk County

Business Model
The systemic challenge you are trying to overcome (select one)

Bring accessible healthcare to communities in emerging markets

Health area (target market) where the need is [select only one]

Primary healthcare services

Categories along the health continuum you are covering [select all that apply]

Prevention, Detection, Intervention, Follow-up.

Stage that best applies to your solution [select only one]

Piloting (a pilot that has just begun operating)

Core strategies of your business model [select all that apply]

Approaches to behavioral change at the individual level, Patient-centered design, Redesign of the public healthcare system for more efficiency (in terms of processes, structure etc.), New approaches to distribution of health products and services, New financing strategies for health.

If other, specify here:
Most relevant tools you are using to implement the strategies outlined above [select only two]

Education/training, Community financing.

If other, specify here:
What is your value proposition?

With an emphasis on user-orientation, efficiency, and outcomes, we will increase access to basic care and preventative services through a model clinic that will utilize a number of methods to improve operations, increase volume, and manage costs. In addition, Mali Health will support the development of mobile health data collection and analysis tools, implement evidence-based algorithmic medicine, and implement a system of continual feedback, improvement, and learning.

Who is your customer(s)?

The project will serve a peri-urban slum on the outskirts of Bamako, Mali’s capital and fastest growing city in Africa. The community is poor, most surviving on $1 - $2 per day. On average, women bear 5 - 6 children, 20% as teenagers. Saving money is rare, and the utilization of alternative forms of health care (market medicine, traditional healers) or deferment of treatment is common. Our customers include the clinic staff, women and mothers caring for children under 5 in this community, and, peripherally – given local decision making about care seeking and finances – male heads of households.

What approaches to you use to reach your customers?

A cadre of 20 frontline community health workers regularly visit families, provide in-home health education, identify sick children, ensure access to the health system, serve as a patient advocate, and provide follow-up care throughout the community. In 2009 we constructed a clinic, now fully integrated into the national healthcare system, to better meet community needs. Customers are also identified often through word of mouth, given the organization’s longstanding development within the greater community.

What are your primary activities?

Activities will take place in the clinic and the community. In the latter, we will implement an expanded in-home health worker program that delivers more services and products to patients, and activities like market days and health fairs. In the clinic, we will implement quality improvement systems and metrics, launch a clinic to health worker tele-communication program and implement new systems like patient exit surveys, feedback sessions, results reviews, and new incentive compensation schemes to reward achievements and improvements. Additionally, we will invest in mobile data collection and analysis tools and the implementation of algorithmic medicine for common childhood infirmities.

What other challenges - individual, organizational, or environmental – are you currently facing or might hinder future success of your business, and how do you plan to overcome those?

Local politics, not uncommon in Mali’s healthcare systems managed by local committees, must be navigated. Mali Health employs a local MD with a track record of negotiation and experience, having run a rural Malian hospital himself, to mitigate these challenges. More, Mali itself presents a challenge, given the evolving nature of geopolitical challenges, particularly in the country’s northern half. Our approach in employing local capacity, operating in resource poor communities, and working with local government officials has and will continue to help the organization succeed despite the context.

Briefly describe your growth strategy going forward

As service delivery improves, we expect patient demand and clinic margins to increase. We will engage with the Ministry of Health and other NGO actors to expand services and best practices to additional facilities as the model clinic agrees to absorb programming costs and continue most effective practices.

What dimensions for growth are you currently targeting for your innovation [select all that apply]

New customer group(s), New market(s)/country(ies).

What makes your business "ready" for growth?

We have the relationships and experience to pursue a sophisticated model of delivery and see opportunity in increasing our focus on health system improvements, for this community and the field of global health. More, the need for solutions exists in a growing slum where 1 in 5 children die unnecessarily.

What are your key growth objectives?

1. To institute a “Goal for Zero” child mortality target objective and culture at identified clinic(s)
2. To improve patient/mother access to prompt and appropriate care and service delivery satisfaction
3. To strengthen a peri-urban health system’s efficiency, capacity and sustainability

Organization's Country of Operation

, CD, Bamako

Social Impact
What methods for quantification of social impact are you applying (if at all)?

We employ several methods to measure our impact. Each program collects monthly metrics online, including health worker effectiveness, morbidity rates, and clinical usage, available for the board, donors and others. We hold an annual process evaluation, and are currently working with Brown University and Innovations for Poverty Action to conduct a randomized control evaluation on the effectiveness of health workers and the elimination of user fees on health outcomes and behaviors. In our proposed project, we will collect and monitor several indicators related to the patient experience, clinical transparency and quality improvement, including wait times, satisfaction, errors, and usage rates.

Could your solution work in other geographies or regions? If so, where?

The peri-urban environment is the fastest growing in the world, and it is our intent to create solutions that are replicable and adaptable to other parts of West Africa and the world, where health systems lack the current capacity to adequately meet the basic needs of growing populations. Mali’s decentralized health system is a particularly appropriate environment, but the improvements and extensions to a primary healthcare system are likely to function in several other poor-resource settings.

What is your projected impact over the next 1-3 years?

Increase child survival
• Decrease under-5 mortality
• Reduce error rates
• Reduce prevalence of most common under-5 infirmities
• Increase accessibility of medical staff to community
Improve maternal and child access to prompt and appropriate care
• Increase service satisfaction
• Increase patient management of condition
• Reduce readmission cases
• Reduce wait time
• Reduce delay in care-seeking
• Train staff in treatment algorithm diagnostics
• Develop quality improvement training
• Create financial management tools for clinic
Strengthen a peri-urban health system’s efficiency, capacity and sustainability
• Increase health center revenue
• Increase health center usage
• Increase utilization of evidence-based care
• Ensure clinic sites producing computer-generated

Sustainability
Elaborate on your current financing strategy

Mali Health is financed by individual donations (65%) and grants (35%). Our budget has grown annually since conception, managed by a lean US-based operation that consists of the Executive Director (splitting his time between the US and Mali) a part-time Operations Manager, interns, and volunteers. Mali Health implements two major campaigns annually, in the second and fourth quarters, and remain diligent in donor communications and transparency. Institutional donors have grown as a percentage of the budget in recent years, while the number of major gifts and grassroots funding has also growing. We have recently begun to expand our development support to include the diaspora community, French resource, and corporate partnerships. While maintaining low rates of attrition, Mali Health solicits new support through events, school groups, grantor relationships and, increasingly, partnerships in Mali.

Share of revenue generation in total income of organization (in percent)

0%

Direct sales to patients or other beneficiaries (in percent)

0%

Of the possible sources of these sales listed below, check all that apply to your current strategy

Licensing fees, e.g., for technology/franchise model (in percent)

0%

Of the possible sources of these licensing opportunities listed below, check all that apply to your current strategy

Service contract with organizations, e.g., government, NGOs (in percent)

0%

Of the possible sources of the service contracts listed below, check all that apply to your current strategy

Explain your revenue generation strategy in more detail

While Mali Health’s current financing strategy does not focus on revenue generation, an effective model of providing high quality cost with improved efficiency has the potential to sustain itself through revenue generation. As increased efficiency, and the resulting increase in demand, serves to lower costs, the accessibility of basic health services will increase, along with possible revenue for clinics and programs implementing the model.

Share of philanthropy in total income of organization (in percent)

100%

Philanthrophy strategies you are using

Diversified strategy.

Explain your philanthropic approach in more detail

Mali Health uses philanthropic funding to launch and maintain project operations with the intent to create sustainable and replicable interventions that can be adopted by clinics and national health systems. In this way, increased access and quality of health care remains high, without the project’s continued dependence on Mali Health or philanthropic funding. While channeling as many resources as possible into programs, we have also placed additional importance on quality communications, reporting, and branding towards our donors, maintaining the same level of professionalism and performance we expect on the ground in Mali.

Expand on your selections; explain how you will sustain funding over the next 1-3 years.

Over the next 3 years, we intend to diversify our funding streams to include revenue-generating activities through programs and service provision, including those described above, to support the growth and sustainability of the model. Additionally, it is our expectation that portions and best practices of the model will be adopted and absorbed into clinical expenses over time. Mali Health will continue its principles of transparency and results-sharing, intended to both support the effectiveness of our program but additional to attract new and existing partners. For continued expansion and expenses, we expect to solicit larger institutional partners, including multi-year government and grant funding to support the expansion of our services in the region. We also intend to continue receiving a portion of unrestricted funding from private donors as well, and expect the balance of several different sources of revenue will help the organization grow methodically over the next several years.

Years in Operation

Operating 1-5 years

Has the organization received awards or honors? Please tell us about them

Mali Health has received several recognitions in addition to funding awards and institutional funding:
Received Do Something Award in 2007
Founder Caitlin Cohen received a FOX Teen Choice Award and a 2008 Br!ck award finalist for her work