Ms. Salama Traoré, during her seventh pregnancy, finally received adequate health care at a community health center in Bamako. She expressed relief, recalling past hardships. "My first six children were born at home because my husband and I couldn't afford the cost of pre- and post-natal care," she said, noting the loss of two children due to inadequate care. Ms. Traoré now benefits from the Accelerating Progress Toward Health Coverage Project (PACSU), which provides quality health care to Mali's poorest.
Accessing health care has been challenging for vulnerable populations due to financial constraints and availability issues. "Previously, it was not uncommon for patients to travel between 3 and 5 kilometers to reach a community health center, often without being sure that they would be treated because of the high costs," recalled Mr. Zanga Dao, Secretary General of Kati City Hall.
Data from the comprehensive survey on household living conditions (EICVM 2018 – 2019) shows that 51% of Malians forego health care for financial reasons. This rate is higher among the poorest quintile (60%) and in regions such as Kayes, Koulikoro, and Taoudenit. Even in Bamako, the financial barrier remains significant (40%). The low utilization of health services suggests that financial barriers and service quality are critical factors.
PACSU, funded by the World Bank, the Global Financing Facility (GFF), and the Netherlands, aims to improve access to and quality of health services. The project has increased service utilization, improved care quality, patient satisfaction, staff recruitment, equipment acquisition, and infrastructure expansion.
The Results-Based Financing (RBF) approach allows autonomous management of resources based on performance in health facilities. This method addresses specific needs like equipment, human resources, and drugs effectively—even in insecure areas—ensuring continuity with trained personnel.
Mr. Zanga Dao noted beneficiary satisfaction: "It is a complete relief because in the center, the quality and affordability of care are now a reality." The range of services includes prenatal consultations, childbirth assistance, malnutrition treatment, and malaria treatment.
"A consultation costs 1,000 CFA francs and the ticket is valid for one week; follow-up prenatal consultations during pregnancy cost 2,500 CFA francs," stated Mrs. Achta Dembele, a midwife. Dr. Ismael Simaga highlighted PACSU's impact: “Never before has our health system been so strengthened,” pointing out constant medicine availability in 90% of structures in Kati.
Statistics show PACSU's effectiveness: service quality increased from 37% to 81%, essential drug availability reached 87%, with recruitment of 337 local health professionals and training of 80 senior officials to international RBF standards. Infrastructure improvements include building 697 new structures and renovating or rehabilitating 265 buildings; equipping 104 centers with laboratories; integrating RBF into 2,251 out of 2,310 public and private facilities.
Patient satisfaction stands at 88%. Sidi Modibo Thera noted PACSU's role in transforming medical practices: “That of transforming the caregiver-patient relationship into a provider-client dynamic.” Performance culture is increasingly evident among users and personnel involved in PACSU.
Beneficiaries at Kati Koko II Community Health Center shared their experiences during a joint Government-World Bank mission visit.
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