Safe Motherhood: A Review - Family Care International

Mali
National Programs, Policies,
and Budgetary Commitments for Safe Motherhood
Mali is a landlocked Sahelian country
located in the heart of West Africa,
with a surface area of 1,241,238 sq km, a
population of 11.6 million (2005), and an
average population density of 9 inhabitants
per square kilometer. In terms of basic and
economic indicators, Mali ranks near the very
bottom among countries worldwide. Mali is
the fourth poorest county in the world (after
Niger, Burkina Faso, and Ethiopia), with 64%
of the population living in poverty. Food
absorbs close to 60% of household budgets. 68
Nevertheless, in the past decade the economy
has improved and notable progress has
been achieved, a result of controls on
public spending, sound management of
the devaluation of the CFA franc, and the
implementation of an ambitious policy for
economic and social development. Major
programs have been introduced, particularly
in the areas of health, education, rural
development, and agriculture. These sectoral
programs are linked together under the
Strategic Framework for Poverty Reduction
(SFPR), adopted in 2002.
Maternal mortality levels in Mali have
remained stagnant over the last 15 years: the
number of maternal deaths per 100,000 live
births was 700 in 1987, 577 in 1996, and 582
in 2001. 69 Factors contributing to this slow
progress include:
68 DNSI, 1993.
69 Demographic and Health Survey for Mali I, III, and III.
• A critical shortage of human resources,
particularly of medical practitioners
capable of performing cesarean deliveries.
Specialized training is not available
at the local level and fellowships for
training abroad have become increasingly
difficult to obtain. Huge overcrowding of
educational establishments (e.g., 15,000
students enrolled at a school built initially
to accommodate 200), coupled with the
shortage of teachers (instructor/student
ratio of 1:80) and the lack of a continuing
education system, make it impossible to
ensure quality training for students. Medical
students today, unlike their predecessors,
no longer learn to perform cesareans, which
underscores the urgent need to ensure
proper training.
• Poor distribution of human resources,
especially midwives, of whom more than
60% are concentrated in urban areas. While
they are plentiful in the nation’s capital, they
are critically lacking in underserved areas,
such as the northern regions.
• Poor quality of services, a result of
inadequately trained personnel; high
turnover rates; uncaring provider attitudes;
services that are unaffordable for most
Malians; stock shortages of drugs;
irregularity of supervision; unsatisfactory
health facilities at all levels of the health
system; and deficiencies in health
recordkeeping.