Børnedødeligheden i dele af Mali er faldet dramatisk takket være ny sundhedsmodel, hvor sundhedspersonale aktivt opsøger patienterne og tilbyder tidlig behandling. Der er god brug for forbedring; ifølge UNFPA dør i gennemsnit 165 under-fem årige for hver 1000 børn, der fødes. Det tal er kun højere i DR Congo og Sierra Leone.
DAKAR, 13 December 2013 (IRIN) – The mortality rate among children under age five living in Yirimadjo, Mali, southeast of the capital, Bamako, decreased by nearly tenfold over three years after the Malian Ministry of Health and NGOs Tostan and Muso introduced a new healthcare model: proactively seeking out patients and treating them early.
Tifoldingt fald
A study on the programme, by researchers from Harvard Medical School and the University of California San Francisco (UCSF), published this week in PLoS ONE, found under-five mortality dropped from 155 deaths per 1,000 children to 17 deaths per 1,000.
“The intervention was based on a simple but powerful hypothesis,” said Ari Johnson, a researcher at UCSF School of Medicine and co-author of the study.
“If we reorganize and redesign the way health systems reach patients early, could it be possible to avert a large number of child deaths?”
Dramatiske resultater
While under-five child mortality rates have been declining throughout Mali over the past decade – from an average of 197 deaths per 1,000 in 2002 to 130 per 1,000 in 2012, according to the researchers, this intervention has produced dramatic results.
Johnson said that to get there, the new interventions challenged some core conventions about how health systems work.
Proaktiv indsats
“When I see patients [in the US], for example, I’m sitting in a clinic or a hospital waiting for them to come to me,” he said. “That’s how healthcare generally works in Mali and the US and the rest of the world. It’s a reactive system,” Johnson said. “But what if instead… the health system deployed providers to proactively search for patients in their homes and then also deployed community organizers to mobilize community members to bring their kids in early – the first day they were sick?”
That was the idea behind the new healthcare delivery system that was rolled out in Yirimadjo.
Timingen er vigtig
Because the primary causes of child mortality – both in Mali and around the world – are so time-sensitive, with many illnesses progressing rapidly following the first symptoms, NGOs Muso and Tostan focused the healthcare redesign on “ultra-rapid access” to care and prevention services.
Tostan’s founder and executive director Molly Melching said the approach could be described as “proactive doorstep care.”
Community health workers were trained to actively seek out sick patients, as well as pregnant women, and connect them with services, either within their own homes or at the local health centre.
A network of community organizers also employed a rapid referral network, in which individual households were taught to identify sick children and bring them for treatment at the first sign of illness.
Holdbar forandring
At the same time, education and empowerment programmes worked to teach people to solve the root causes of poverty that cause disease.
This means engaging people to understand their rights and responsibilities in terms of health, development and child protection, said Melching.
“Our goal has always been to educate people at the grassroots level, and give them the information they need to make decisions and to make the development of their community their own,” she said.
“That’s how change becomes sustainable.”
Gratis sundhed
The programme also involved removing user fees for those who cannot afford to pay, given that user fees are one of the greatest barriers to achieving universal health coverage.
The approach increased the number of patient visits, either in the home or at clinics, tenfold between 2008 and 2011.
The rate of early treatment for malaria in children nearly doubled during that same time, said researchers.
While none of the elements of the new healthcare delivery system are new – each had previously been tested, and many are currently operating at scale in some form or another across sub-Saharan Africa – this was the first time an intervention brought together all of these key strategies and redesigned how they work to optimize healthcare delivery, Johnson said.
FAKTA:
Ifølge FN’s Befolkningsfond UNFPA’s nyeste State of World Population rapport ligger Mali med 165 døde under-femårige ud af 1000 børn på en tredjesidste plads, når det gælder børnedødeligheden.
I DR Congo er børnedødeligheden 180 per 1000 børn, mens det tilsvarende tal for Sierra Leone er 187.
Til sammenligning er børnedødeligheden i Danmark 4 per 1000 børn.
