*Y.C.* Community-Based Malaria Program

*Y.C.* Community-Based Malaria Program

Mali
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.

Project Muso Ladamunen (the Project for the Empowered Woman) is a high-growth nonprofit organization that aims to reverse cycles of poverty and disease in Yirimadjo, Mali. By integrating medical services with women's education, microfinance, and community mobilization, our programs improve community health through multiple channels--the best way to create sustained change. We are the only service in Mali that provides comprehensive free healthcare for malaria and other illnesses to the destitute poor, and with a rapidly expanding funding stream, we are preparing for an ambitious and direly-needed regional scale-up by 2012.

Our newest program is the Community-Based Malaria Program, launched in September 2008.
The program’s major objective is to: Create a model community-based delivery system for malaria prevention and treatment while simultaneously strengthening the capacity, quality, and accessibility of the healthcare system as a whole. Our specific aim is to meet and exceed goals set by the Malian government’s National Malaria Control Program –
• 50% reduction in child mortality
• 85% of pregnant women and children younger than five sleeping under treated bednets
• 85% of children younger than five getting malaria treatment within 24 hours of symptom onset
• 85% of pregnant women receiving malaria prophylaxis

About Project

Problem: What problem is this project trying to address?

Despite effective tools for prevention and treatment, USAID estimates that up to 85% of pregnant women in this country will contract the disease. One in 15 women dies due to complications from pregnancy—malaria is one of the most common causes. Mali is poised to transform its malaria crisis. The Malian Ministry of Health has developed an ambitious plan for reducing malaria mortality, providing free bednets, preventive prophylaxis for pregnant women, and medications to treat children younger than five. While the government’s mobilization has been a critical step in eradicating disease here, so far, their efforts have not been sufficient. Our annual randomized Malaria Prevention and Treatment Survey of 400 households in Yirimadjo found no change in malaria treatment for under fives between June 2007 and 2008: this means that even though new government resources are available, patients are not accessing them. To overcome geographic, social, financial, and informational barriers to care, Mali desperately needs programs that can coordinate and deliver the medical resources the government is beginning to provide.
About You
Organization:
Project Muso Ladamunen
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Section 1: About You
First Name

Jessica

Last Name

Beckerman

Organization

Project Muso Ladamunen

Country
Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?

Yes

Section 2: About Your Organization
Organization Name

Project Muso Ladamunen

Organization Phone

(617) 872-7079

Organization Address

1380 Monroe Street, NW, Box 309, Washington, DC 20010

Organization Country

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Your idea
Country your work focuses on

, CD

Innovation
What makes your idea unique?

Efforts that focus solely on short-term distribution of bednets and medications are unlikely to stop deaths from malaria. To achieve and sustain Mali’s ambitious goals for malaria reduction, particularly for pregnant women and children, it will be necessary to build both a community-based distribution network and a strong and accessible primary health care delivery system for populations that have up until now lacked access to care.

Project Muso's Community Based Malaria Program is an innovative pilot project that solves this problem, through its tripartite approach to rolling back malaria: We have (1) trained local women to form a network of mobile Community Health Workers who are treating malaria in the home during its earliest stages before it becomes deadly; (2) removed financial barriers to care through a new Solidarity Fund that provides free care to the most impoverished families; and (3) built health-system capacity by training personnel, constructing new clinical facilities, and improving infrastructure. This is a model that can both achieve ambitious coverage goals in the short term and build the capacity of strong and accessible government health care delivery systems in the long term.

The Community-Based Malaria Program is also unique in that it relies on intersectoral collaboration with Project Muso’s community organizing, microfinance, and participatory education programs. By linking community-based medical services with these programs, we create a virtuous cycle of increased economic security and improved health. Doing so allows the community to gradually transition towards the financial security necessary to fully finance its own healthcare.

Do you have a patent for this idea?

Impact
What impact have you had?

Project Muso’s community health workers are providing bednets, counseling to pregnant women, malaria diagnosis and treatment for children, direct observation of malaria prophylaxis for pregnant women, accompaniment, or referrals to an average of 1,683 patients per month. Since our launch in September 2008, our program has provided comprehensive free healthcare during over 15,679 patient visits in the first 17 months. Of these, 479 were pregnant women who received free prenatal consultations through Project Muso’s Solidarity Fund, which has removed direct and indirect financial care barriers for women who would not otherwise have access to care. Now, these women receive ultrasounds, prenatal vitamins, and information on how to stay healthy while they are pregnant. Furthermore, by ensuring free care for all illnesses ensures that seeking treatment is not perceived by patients and their families as a financial risk; only this can build enough regular reliance in the health system to achieve rapid health services utilization and diagnosis and treatment of malaria cases within 24 hours.

During the first two years of our malaria prevention program, the percentage of pregnant women sleeping under impregnated bednets the previous night rose from 27.5% in 2007 to 56% in 2009. The percent of children under five with a fever in the past two weeks receiving effective antimalarial therapy within 24 hours of symptom onset was 14% in June 2008. Ten months into our program, by June 2009, 35% of children under 5 with a fever in the past two weeks were treated for malaria within 24 hours of onset; an additional 12% of these children were tested for malaria within 24 hours, bringing the total percentage of children tested OR treated within 24 hours to 47%.

Actions

Community Health Workers (CHWs) are the bedrock of our program. Our CHWs are local mothers, many of whom had never picked up a pen before joining Project Muso. Now, after rigorous training, they are diagnosing and treating malaria in the field and rushing referrals of more complex cases to the local clinic. By making house calls and building trusting relationships with community members they have a unique capacity to identify pregnant women and children who are not sleeping under insecticide-treated nets and provide information to mothers on how to correctly use mosquito nets. They also identify pregnancies early, referring pregnant women to the health center for prenatal consultations, providing counseling and follow-up to promote healthy pregnancy, and ensuring intermittent preventative malaria prophylaxis adherence.

Project Muso also builds health systems capacity by providing clinical staff with additional trainings focused on improving high-impact skills related to maternal-child health. Last year, we constructed and equipped a new clinical care building at the Yirimadjo Community Health Center, and renovated the old clinical facility into an expanded maternity ward.

Results

Through the Community-Based Malaria Program, Project Muso has systematically removed barriers to care through Community Health Worker outreach, free care for those who cannot afford to pay, and an enhanced clinical care building to accommodate more patients. In the 12 months before Project Muso’s Community-Based Malaria Program launched in September 2008, there were 11,056 patient visits at the Yirimadjo health clinic. During the first 12 months of the program, the number of curative care patient visits to the clinic increased 93%, nearly doubling access to care in the area. Of the 21,288 patients that visited between September 2008 and August 2009, 9,562 received free healthcare through Project Muso’s Solidarity Fund.

As an operational research pilot, the Community-Based Malaria Program is designed to directly inform national efforts in malaria control and health system capacity building. Even in the first year of its implementation, the program has begun to serve this role.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

- overcome national drug and medical supply shortages
- collaborate with Ministry of Health structures in Mali to scale up program to additional communities via national level funding sources
- secure additional investors and funding partners for current site serving 20,000 people, and for scale up, in partnership with government structures

What would prevent your project from being a success?

The project would fail without (1) government support and collaboration, (2) the participation of men and (3) adequate funding. This is why we have made extensive efforts to involve the participation of men along with women in the earliest stages of program design, as well as participation and partnership with government structures. We are searching for partners to help us fill our funding gap.

How many people will your project serve annually?

More than 10,000

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your project seek to have an impact on public policy?

Yes

Sustainability
What stage is your project in?

Operating for 1‐5 years

Is your initiative connected to an established organization?

Yes

If yes, provide organization name.

Project Muso Ladamunen

How long has this organization been operating?

1‐5 years

Does your organization have a Board of Directors or an Advisory Board?

Yes

Does your organization have a non-monetary partnerships with NGOs?

Yes

Does your organization have a non-monetary partnerships with businesses?

Does your organization have a non-monetary partnerships with government?

Yes

Please tell us more about how these partnerships are critical to the success of your innovation.

Project Muso believes that lasting change will occur when community members fuel improvements in care, and are supported by partnerships with existing health systems and structures. For this reason, Project Muso has partnered with Mali’s Ministry of Health, the DNLP, the Commune VI Health Reference Center (CSREF), the Yirimadjo CSCOM, and the Yirimadjo Community Action Committee in launching the Community Based Malaria Program. These collaborations allow us to build the capacity of public-sector systems—without wasting money on overlapping services. Project Muso and its Community-Based Malaria Program also benefit from the support and expertise of Partners in Health and Tostan.

Just as important are partnerships with local community leaders. Religious leaders, who are in close contact with many of the poorest and most marginalized community members, play a crucial role in connecting those people to our program—to CHWs and to free care. They are also essential for communicating to the population the importance of seeking prompt treatment for malaria and timely prenatal care for pregnant women.

What are the three most important actions needed to grow your initiative or organization?

Secure long-term funding partners and investors
Strengthen relationships with Malian Ministry of Health
Hire additional leadership staff

The Story
What was the defining moment that you led to this innovation?

By the time that we launched the Community-Based Malaria Program in 2008, Project Muso had been working in the community of Yirimadjo for three years, and had seen great success. Our first initiative trained a Community Action Committee, an advocacy group that has spearheaded initiatives to improve community infrastructure. We then launched our Women’s Education Program, which taught essential health skills to 247 women who previously had little or no access to formal education. Upon completion of the course, these women were able to start or expand their own small businesses through our Springboard Microfinance Program. These loans allowed women to develop small enterprises, and to exercise personal agency. However, the women also expressed that if they and their families were not healthy, the skills they had and the money they earned were not enough. Several mothers in our education and microfinance program died due to lack of health care. Other mothers dropped out of the education program because they or their children were sick and without access to care. Others used their loan capital to pay for health care for themselves or their children.

We were also aware that the problem wasn’t that the community didn’t want to access health care, it was that there were barriers to care preventing them from seeking care at the local clinic. In a community with major food security issues that lacks paved roads, electricity, and a sanitation system, many people simply can’t afford care. Community members face the direct costs of health care services, as all care in Mali is fee for service, plus indirect costs such as transportation and lost work time. Furthermore, many of Mali’s medical facilities are overcrowded or inadequately equipped which undercuts community members’ confidence in the health care system.

Project Muso witnessed each of these barriers to care in Yirimadjo, and heard its participants and other community members say that their most pressing need was access to health care. In a country where 22,000 people die from malaria each year and 1 in 15 women die from pregnancy complications, we could not continue our other programs and ignore the fact that our participants and their friends and family members were dying each day from preventable causes.

Tell us about the social innovator behind this idea.

In 2005, a team of Malian and American medical professionals, educators, and social entrepreneurs founded Project Muso Ladamunen. Project Muso aims to solve health crises at their roots, by addressing and transforming the violent conditions of poverty and gender inequality that cause disease. To do this, Project Muso integrates health care delivery with microfinance, community organizing, and participatory education programs. This integrated model aims to stop the deadly, mutually reinforcing cycle of poverty and disease, and replace it with a healing cycle of women’s empowerment, community mobilization, microenterprise, and health care access.

How did you first hear about Changemakers?

Through another organization or company

If through another, please provide the name of the organization or company