The premise of the scheme, which launched in 2008, is simple: community health workers spend at least two hours, six days a week searching for patients door-to-door, providing free care to whoever needs it. Mali has long struggled to contain preventable infectious diseases such as malaria, pneumonia and diarrhoea. Consequently, the country has the world’s sixth highest under-five child mortality rate, estimated at 115 deaths for every 1,000 births according to the most recent figures available. But by turning conventional healthcare on its head – sending health providers to patients at no cost, instead of requiring them to seek out fee-paying medical attention – Yirimadio achieved a spectacular turnaround. Between 2008 and 2015, the child mortality rate dropped from 154 deaths to seven for every 1,000 live births.
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“These results are unprecedented. They are extraordinary,” said Johnson. “But that’s not what we want. We want these results to become boring and normal. That’s the real challenge.”
Communities participated in the initiative during a hugely challenging period in Mali that brought a coup d’etat, al-Qaida occupation in the north, and the west African Ebola outbreak. “Amid global efforts for universal health coverage and child survival, these findings reset the goalposts for what be achieved, in even the most challenging settings,” said Johnson.