Mali: Service Quality

Amid rapid urbanization throughout sub-Saharan Africa, many health systems face a multitude of barriers to providing equitable access to high-quality primary health care due to extreme poverty, a lack of basic infrastructure, and environmental degradation. These conditions have carried significant implications for health equity and disease burden among populations living in urban areas.12 In health systems hindered by limited resources and infrastructure, leveraging community-based interventions to improve timely access to effective care is critical for increasing the utilization of vital services that improve health outcomes.3 Several governments in the sub-Saharan African region have worked to strengthen community-based care through the roll-out of integrated community case management (iCCM), a program that trains and supports community health workers (CHWs) to diagnose, treat, and refer children in their local communities.3 Currently, Mali is testing alternative models of iCCM delivery in peri-urban and rural areas through proactive community case management (ProCCM), a model for integrating iCCM into health systems at scale.1

At its core, the ProCCM model is designed to remove individual, local, and system-level barriers to timely care through proactive population outreach and rapid access to detection and evidence-based treatment.1 Reducing access barriers from the patient perspective improves utilization of services. CHWs conduct daily door-to-door screenings to identify new patients who need care followed by a free evaluation - including diagnostics, treatment, referral, and counseling and follow-up activities. Areas in sub-Saharan Africa that have implemented the ProCCM intervention have shown documented improvements in early access to care, an increase in patient-provider contacts, and a reduction in under-five child mortality.1 In its current form, the ProCCM model focuses on the detection and early treatment of the leading causes of under-five child mortality (neonatal illness, malaria, pneumonia, and diarrhea) rather than comprehensive primary care services. However, the ProCCM model is an important demonstration of leveraging CHW-led interventions to improve population health outcomes and strengthen the capacity of health systems to promote early and equitable access and facilitate a usual source of care.  


  1. Johnson AD, Thiero O, Whidden C, Poudiougou B, Diakité D, Traoré F, et al. Proactive community case management and child survival in periurban Mali. BMJ Glob Health. 2018 Mar 12;3(2):e000634.
  2. United Nations, Department of Economic and Social Affairs, Population Division UN. World Urbanization Prospects: The 2014 Revision. United Nations, Department of Economic and Social Affairs, Population Division; 2015. Report No.: (ST/ESA/SER.A/366).
  3. UNICEF WHO. Integrated Community Case Management (iCCM): An equity-focused strategy to improve access to essential treatment services for children. United Nations Children’s Fund; 2012.