The Value of Community Care

Community health workers provide essential healthcare for three million Malians.

By Mackenzie Schiff

“Our health system starts with community health workers,” says Vamara Abdoul Koné, mayor of Kapolondougou, Mali. “If community health workers fail, the entire health system fails.”


The Malian government increased its investment in essential community healthcare, opening more than 1,300 community health centers since 1989.

Despite this remarkable progress, over 40 percent of Mali’s population lives more than five kilometers from the nearest health center — a distance too far, expensive, and difficult for most rural families to travel.

“Imagine bringing a sick child…all the way to the community health center,” says Assitan Alice Sonogo of rural Tiékorobougou. “It’s too expensive.”

When children fall ill or women go into labor, millions of Malians cannot access the care they need.


That’s where community health workers (CHWs) come in: approximately 3,000 dedicated, skilled health workers providing lifesaving services for families in the rural communities where they live and work.

“Having a CHW has been a great thing for the village,” Assitan continues. CHWs provide curative, preventative, and promotive care for more than three million Malians, and the World Health Organization estimates a 10:1 return on investment.

“We have seen the importance of CHWs,” says Village Health Committee president Klonan Sanogo. “Before, many people did not know how to prevent diarrhea, coughing, and malaria…With [CHWs’] courage and work, these illnesses have decreased.”

Demographic Health Survey results from approximately five years before and after CHWs began working (2006 and 2018, respectively), illustrate their contribution to improved health outcomes. Infant and child mortality dropped from 191 deaths per 1,000 live births to 101 and the percentage of women using contraception more than doubled from 8.2 to 17.2 percent.


Currently, over 80 percent of CHW funding comes from external donors, leaving the program vulnerable to donors withdrawing funds. For this reason, the USAID-funded Health Policy Plus project is generating evidence and engaging the private sector and local leaders in support of a decree formalizing the rights, responsibilities, and status of Malian CHWs.

Legal recognition of CHWs as an official cadre of health workers would obligate Mali’s government to pay them stipends and provide management support. The decree is now being reviewed by government councils.


“We need…various forms of support, such as training…to help us improve our skill levels and enhance our services” explains Nana Sogoba, a CHW in Tiékorobougou.

Since 2013, Nana’s work has had a transformative impact.. “Since Nana started working in our village, childhood diseases have decreased and births are better spaced,” says village chief Nomonkon Koné.

“Nana deserves to be helped and supported,” Chief Koné concludes. “She knows her work, and she does it with a good heart.”



USAID-funded project strengthening and advancing health policy priorities in family planning/reproductive health, HIV, and maternal health

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Health Policy Plus

USAID-funded project strengthening and advancing health policy priorities in family planning/reproductive health, HIV, and maternal health