R4D is leading an impact evaluation and a series of learning activities to explore the effect of USAID investments in accountability, governance and financing activities on behaviors for health and use of services at community and health centers.
The Challenge
Mali’s decentralized national healthcare system continues to face challenges, particularly in financing and governance at the local level. These challenges contribute to the fact that maternal and infant mortality rates are still among the highest in the world with 325 maternal deaths per 100,000 live births and 118 out of 1,000 children dying before age five.
The Opportunity
To address these issues and achieve sustained improvements in health, USAID/Mali is supporting two flagship programs as part of the Integrated Health Project (IHP):
- Household and Community Health – Keneya Nieta (KN)
- Health Systems Strengthening, Financing and Governance – Keneya Sinsi Wale (KSW)
KSW and KN operate at different levels but work in synergy. KSW works primarily at the regional and aire de sante level to strengthen health systems and competencies in areas such as leadership; workforce development; system management; quality of care; supervision; data for decision-making; and health governance and financing. KN works at the village level to sustainably deliver a community-based essential package of health services (SEC). Working in tandem, these two flagship activities are designed to increase Malians’ ability to plan, finance, and manage the health system and their own health at the family, household, community, district, regional and national levels.
Through meaningful citizen participation in governance, decentralization, and budgetary management, KN and KSW aim to improve access to high quality health and WASH services, increase demand for and use of those services, and improve the adoption of healthy behaviors at the individual and household level.
R4D’s Work
RF MERL is an initiative of the Monitoring, Evaluation, Research and Learning Innovations (MERLIN) Program within the USAID Bureau for Policy, Planning and Learning. RF MERL partners with USAID Operating Units and implementing partners through a participatory co-design process that supports program design, adaptive management, data-driven decision making and scale-up.
RF MERL is working with USAID/Mali, KN and KSW to conduct an impact evaluation and a series of learning activities on USAID accountability, governance and financing interventions implemented by KN and KSW to evaluate a number of outcomes at the CSCom and community level. The adaptive learning activities allow for rapid testing and iteration of activities selected and prioritized by the USAID implementing partners. The combined approaches will contribute to understanding whether community-based activities are effective in supporting sustainability and resilience of health systems and their key components in Mali.
