Skip to main content

Main menu

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • Special Collections
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Tips for Writing About Programs in GHSP
      • Local Voices Webinar
      • Connecting Creators and Users of Knowledge
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers

User menu

  • My Alerts

Search

  • Advanced search
Global Health: Science and Practice
  • My Alerts

Global Health: Science and Practice

Dedicated to what works in global health programs

Advanced Search

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • Special Collections
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Tips for Writing About Programs in GHSP
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Alerts
  • Find GHSP on LinkedIn
  • Visit GHSP on Facebook
  • RSS
ORIGINAL ARTICLE
Open Access

Community Health Worker Program Sustainability in Africa: Evidence From Costing, Financing, and Geospatial Analyses in Mali

Patrick Pascal Saint-Firmin, Birama Diakite, Kevin Ward, Mitto Benard, Sara Stratton, Christine Ortiz, Arin Dutta and Seydou Traore
Global Health: Science and Practice March 2021, 9(Supplement 1):S79-S97; https://doi.org/10.9745/GHSP-D-20-00404
Patrick Pascal Saint-Firmin
aPalladium Group, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: pascal.saint-firmin@thepalladiumgroup.com
Birama Diakite
bPalladium Group, Bamako, Mali.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kevin Ward
aPalladium Group, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mitto Benard
cIndependent consultant, Nairobi, Kenya.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sara Stratton
aPalladium Group, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Christine Ortiz
dIndependent consultant, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Arin Dutta
aPalladium Group, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Seydou Traore
bPalladium Group, Bamako, Mali.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
PreviousNext
  • Article
  • Figures & Tables
  • Supplements
  • Info & Metrics
  • Comments
  • PDF
Loading

Figures & Tables

Figures

  • Tables
  • Additional Files
  • Figure1
    • Download figure
    • Open in new tab
    • Download powerpoint

    Community health workers in Mali. © 2018 Souleymane Bathieno/Health Policy Plus

  • Figure2
    • Download figure
    • Open in new tab
    • Download powerpoint

    Community health worker in Mali conducts growth monitoring of child. © 2018 Souleymane Bathieno/Health Policy Plus

  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Funding Needed Versus Expenditure by Community Health Worker Program Input in 2015, Mali

    Abbreviation: CHW, community health worker.*Capital costs include cost of providing living and working space to CHWs at the village level.

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Proximity of CHW-Covered Villages to Non-Covered Villages and Distribution of Non-Covered Villages in 2015, Mali

    Abbreviation: CHW, community health worker.

  • FIGURE 3
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 3

    Geospatial Distribution of Technical Efficiency Opportunities for the Community Health Worker Program in 2015, Mali

  • FIGURE 4
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 4

    Geographic Distribution of Allocative Efficiency Opportunities for the Community Health Worker Program Across Health Districts in 2015, Mali

  • FIGURE 5
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 5

    Geographic Redistribution of Community Health Worker Program Theoretical Funding Surplus, 2015, Mali

  • FIGURE 6
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 6

    Distance-Based Geospatial Redistribution of Community Health Worker Program Funding Surplus, 2015, Mali

  • Figure9
    • Download figure
    • Open in new tab
    • Download powerpoint

    Community health worker in Mali assesses temperature. © 2018 Souleymane Bathieno/Health Policy Plus

Tables

  • Figures
  • Additional Files
    • View popup
    TABLE 1.

    Summary of Type of Data Used, Sources, and Collection Periods, Interlinked Analysis of Community Health Worker Programs, Mali

    Type of Data and Collection PeriodPrimary SourcesSecondary Sources
    CHW situational analysis (September 2016 to February 2017)
    Program level (regions and health districts)
    - Population breakdown, health system levels, numbers and geographic distribution of CHWs, CHW financing sources and amounts spent, ratios of CHWs per population and community or household
    - Questionnaires and data collection sheets filled by: National Statistic Office, National Health Directorate, MOHSA Division of Equipment and Finance, CHW program implementing partners, Regional Health Directorates, local authorities
    - Interviews with ECC managers, head of Health Facilities Regulation Division, Drug and Pharmacy Director, health district managers
    - Baseline year reports from CHW implementing partners, local health information system, national health accounts, ECC national reviews, regional ECC managers
    - Mali Demographic Health Survey (fifth edition)
    - Health area microplanning monitoring guide (2014)
    Costing CHW provided services (February to April 2017)
    Country-level (baseline year)
    - National and sub-national population figures and growth rate, gender/age breakdown, per household
    - Annual inflation rate, currency exchange rate
    CHW specific inputs
    - CHW cadre information & training, supervision & program management
    - ECC package, number, and types of services delivered
    - Standard treatment guidelines
    - Equipment, medicine, and capital costs
    Capital costs
    - Description of assets, expected quantities, replacement frequency, and costs
    Standard treatment guidelines
    - Description, target population, time per service, and quantities of tests, medicines, and supplies
    - Interview with head of statistics office of Mali National Statistic Office
    - MOHSA human resources directorate records
    - Consultative meetings with expert panel
    - Mali general population census 2009
    - National ECC implementation guide (Dec. '15)
    - MOH district-level records, local Health Information System report for baseline
    - Mali Demographic Health Survey 2013, 2018
    - Government of Mali reference price listing for goods and services for 2015
    - CHW standardized treatment chart for childhood sickness (June 2016)
    District-level cost efficiencies, geospatial mapping, and analysis (March to June 2019)
    Calculated estimates
    - Normative cost per CHW service
    - Number of services per person in target population by type of service in baseline year
    AuthorsN/A
    Geospatial data
    - Geocoded villages; administrative boundaries for health districts, municipalities, and communes; population
    N/A- United Nations Office for the Coordination of Humanitarian Affairs Humanitarian Data Exchange Portal
    - Mali National Health Directorate GIS database
    Geospatial mapping outputs
    - Thiessen polygons for CHW covered villages
    - Point, choropleth, and Euclidean distance maps
    AuthorsN/A
    • Abbreviations: CHW, community health worker; ECC, essential community care; MOHSA, Ministry of Health and Social Affairs.

    • View popup
    TABLE 2.

    Overview of the CHW Program in Mali, 2015, from Situational Analysis Results

    RegionKoulikoroKayesMoptiSegouSikassoBamako Districta
    Target population (total living in rural areas)1,477,040961,2891,181,4861,281,1471,622,344N/A
    Population covered by CHWs869,282286,779680,261712,351648,353N/A
    Population covered by CHWs, of rural population, %5930585640N/A
    No. villages17611369189620031629N/A
    No. villages covered by CHWs621256306412591N/A
    No. health districts covered1088810N/A
    No. CHCs196217168195237N/A
    No. CHCs affiliated with CHWs161143146172230
    No. active CHWs526248305448660150
    CHW of total CHWs, %23111319286
    No.funding sources776662
    Spending, USD2,356,6332,284,9332,540,4021,977,5453,127,960723,825
    Spending of total spending, %18182015246
    • Abbreviations: CHC, community health center; CHW, community health worker.

    • ↵a Bamako is an atypical district that does not meet any criteria stated in the ECC national implementation guide, both in terms of services provided and the determination of the target population. For more information, please consult the CHW landscape analysis report available at: http://www.healthpolicyplus.com/ns/pubs/7153-7273_MaliSituationalAnalysisJuly.pdf

    • View popup
    TABLE 3.

    Costing CHW-Provided ECC Services (Selected Outputs), Mali, 2015

    Coverage of needs,a %Unit Cost Breakdown (US$)Total time required to provide services,b hoursTime available spent on service,c %Total cost, US$ (Share of total cost, %)
    Cost per serviceTotal Direct costTotal indirect cost
    Curative services
    Malaria rapid screening test31.43.820.852.9755,8991.28639,847 (8)
    Uncomplicated malaria management4.06.763.493.2644,9921.03829,141 (10)
    Moderate acute malnutrition management33.633.8424.948.9036,9160.851,249,206 (15)
    Preventive services
    Newborn follow-up5.63.070.112.9726,9540.62248,554 (3)
    Education on lactational amenorrhea method6.83.840.133.715,2240.1248,173 (1)
    Oral contraceptives (pill) provision6.84.680.973.716,4590.1572,578 (1)
    Provision of contraceptive injections6.81.140.400.744,8680.1166,600 (1)
    Promotive services
    Home visits66.46.150.215.9380,1881.84739,212 (9)
    Monitoring and evaluation
    Activity reportingN/A74.823.6271.20209,9524.81,963,577 (23)
    • View popup
    TABLE 4.

    Technical and Allocative Efficiency Gaps in Kayes Region, Mali, 2015

    Health DistrictRural Population [A]Covered Population [B]Number of CHW [C]Average Spending per CHW, US$ [D]Actual Spending on Covered Population, US$ [E] = [C] x [D]Normative Cost for Covered Population, US$ [F]Technical Efficiency Surplus (Deficit), US$ [G] = [E] − [F]Normative Cost for Rural Population, US$ [H] = [F] / [B] x [A]Allocative Efficiency Surplus (Deficit), US$ [I] = [E] − [H]
    Kayes210,22861,361459,213.44414,604.77196,305.62218,299.15672,559.72(257,954.96)
    Bafoulabe77,33233,009349,213.44313,256.9499,135.01214,121.93232,249.0381,007.91
    Diema99,19936,222279,213.44248,762.86184,383.3164,379.55504,959.41(256,196.55)
    Kenieba106,73218,313149,213.44128,988.1546,319.4482,668.71269,959.42(140,971.27)
    Kita267,63582,779829,213.44755,502.02117,566.54637,935.49380,107.51375,394.51
    Nioro102,44414,55489,213.4473,707.5136,937.5036,770.02259,998.97(186,291.46)
    Yelimane42,04314,584139,213.44119,774.7121,981.8597,792.8663,369.6556,405.06
    Oussoubidiagna55,67625,957259,213.44230,335.9849,890.50180,445.48107,011.73123,324.26
    • Abbreviations: CHW, community health worker; ECC, essential community care.

    • a Estimated by dividing the actual number of services provided by the expected number of services.

    • b Total time required to provide each service is calculated by multiplying the expected time spent on service (in minutes) by the reported service volume for the year. The estimates are then converted in CHW hours.

    • c Percentage of CHW time available spent on services is calculated by dividing the total time required to provide the services reported for the year and the total time available for providing EC.

Additional Files

  • Figures
  • Tables
    • 20-00404-Saint-Firmin-Supplement.pdf
  • Supplemental material

    • Supplement -

      Supplement

PreviousNext
Back to top

In this issue

Global Health: Science and Practice: 9 (Supplement 1)
Global Health: Science and Practice
Vol. 9, No. Supplement 1
March 15, 2021
  • Table of Contents
  • About the Cover
  • Index by Author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Global Health: Science and Practice.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Community Health Worker Program Sustainability in Africa: Evidence From Costing, Financing, and Geospatial Analyses in Mali
(Your Name) has forwarded a page to you from Global Health: Science and Practice
(Your Name) thought you would like to see this page from the Global Health: Science and Practice web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Community Health Worker Program Sustainability in Africa: Evidence From Costing, Financing, and Geospatial Analyses in Mali
Patrick Pascal Saint-Firmin, Birama Diakite, Kevin Ward, Mitto Benard, Sara Stratton, Christine Ortiz, Arin Dutta, Seydou Traore
Global Health: Science and Practice Mar 2021, 9 (Supplement 1) S79-S97; DOI: 10.9745/GHSP-D-20-00404

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Community Health Worker Program Sustainability in Africa: Evidence From Costing, Financing, and Geospatial Analyses in Mali
Patrick Pascal Saint-Firmin, Birama Diakite, Kevin Ward, Mitto Benard, Sara Stratton, Christine Ortiz, Arin Dutta, Seydou Traore
Global Health: Science and Practice Mar 2021, 9 (Supplement 1) S79-S97; DOI: 10.9745/GHSP-D-20-00404
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Statistics from Altmetric.com

Jump to section

  • Article
    • ABSTRACT
    • BACKGROUND
    • METHODS
    • RESULTS
    • DISCUSSION
    • CONCLUSION
    • Acknowledgments
    • Funding
    • Competing interests
    • Translation
    • REFERENCES
  • Figures & Tables
  • Supplements
  • Info & Metrics
  • Comments
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Calculating the Costs of Implementing Integrated Packages of Community Health Services: Methods, Experiences, and Results From 6 sub-Saharan African Countries
  • Google Scholar

More in this TOC Section

  • Applying a Theory of Change for Human Resources Development in Public Health Supply Chains in Rwanda
  • Presenting a Framework to Professionalize Health Supply Chain Management
  • People that Deliver Theory of Change for Building Human Resources for Supply Chain Management: Applications in sub-Saharan Africa and Southeast Asia
Show more ORIGINAL ARTICLE

Similar Articles

Subjects

  • Cross-Cutting Topics
    • Health Workers
Johns Hopkins Center for Communication Programs

Follow Us On

  • LinkedIn
  • Facebook
  • RSS

Articles

  • Current Issue
  • Advance Access Articles
  • Past Issues
  • Topic Collections
  • Most Read Articles
  • Supplements

More Information

  • Submit a Paper
  • Instructions for Authors
  • Instructions for Reviewers

About

  • About GHSP
  • Advisory Board
  • FAQs
  • Privacy Policy
  • Contact Us

© 2025 Creative Commons Attribution 4.0 International License. ISSN: 2169-575X

Powered by HighWire