Fatoumata has created a new approach to health delivery on which the emphasis is on creating human vitality by including playgrounds, vocational training with a base in Bamako and center in five regions. She is changing public perception about what it means to be healthy. The approach has been replicated in Guinea and Burkina Faso, and is now widely accepted beyond the Sahel.
The New Idea
Fatoumata looks always for strategies to reduce the distance between those who need the information and services and the professionals who can deliver them. She revolutionized family planning services offered by local health clinics to reach far more of those living in rural communities by distributing family planning information and materials at a local level. In 1993, Fatoumata has developed an approach offering for the first time in Mali prevention services. By creating centers that incorporated a wide range of activities, Fatoumata removed the stigma associated with going to clinics and made reproductive health issues as one element among other opportunities available to the community such recreation and training activities.
To promote youth and adolescent health, Fatoumata pioneered contraceptive and reproductive health services designed for and with young people. Using peer to peer approach, young volunteers are trained and become the voice of Fatoumata’s team within the community. They hold information sessions and individual discussions addressing the issues of reproductive health, nutrition, and family planning.
Fatoumata is also actively involved in the dialogue concerning health at the national level, assisting in training, implementation, monitoring and evaluation of Mali’s health policies.
Mali is a landlocked country in West Africa. Malaria threatens the entire population and is the leading cause of morbidity and mortality. It largely affects pregnant women and children under five, who suffer over two episodes per year on average. Mali’s maternal and child health indicators, while improving in recent years, still remain among the worst in the world. The high fertility rate, low contraceptive prevalence rate, and high unmet need for family planning collectively have been described as a national crisis. Malnutrition is a major contributor to maternal and child death and disability; 38 percent of children suffer from chronic under nutrition. Nearly 12 million people are at risk of one or more neglected tropical diseases. Although Mali’s HIV prevalence rate is low – an estimated 1.3 percent – compared with other sub-Saharan countries, pockets of higher prevalence exist among Mali’s most at-risk populations. Although insufficient, the Malian government with the support of international organizations created many health centers in the country to facilitate access to care especially for rural communities. With highly uneven geographic distribution of doctors, particularly of midwives, various financial and cultural barriers to using the increasing number of health facilities, the population often does not approach an appropriate health-care provider in the event of sickness.
But in the 90s, preventable infectious diseases were not developed in Mali and one of the reasons is because of superstition and ignorance. Indeed, most of the population is living in rural areas and the levels of illiteracy are high, particularly among women. There are very formidable challenges in disseminating health information in rural areas.
Half of Mali’s population is under the age of 15, and two-thirds are younger than 25 years of age. Practices such as early and forced marriage and genital mutilation are still common, damaging the health of young people. The overall ratio of female genital mutilation/cutting in women is estimated at 85%. Like all of their peers in the world, they need to healthy recreation space are developed so they are not exposed to harmful temptations. The vast majority of them are not aware of sexually transmitted diseases and teen pregnancy risks.
Understanding that communities are more resistant to a call of change when it is coming from a stranger in their midst, Fatoumata has targeted key people in whom they trust to be involve in awareness campaigns on the importance of prevention. She set up a multidisciplinary team of health care professionals, social sciences, communication, education, community development and products communication tools (modules, data sheets, audio visual cassettes, magazines, box pictures, and posters) to train populations on family planning, use of contraceptives, reproductive health management. Thus she involved men, youth, religious and community leaders who become relay. She strengthens the leadership of women in health, social development, education, promotion of their rights and participation in local governance. She calls upon the military authorities and the army health service for the reduction of excessive maternal and infant mortality in Mali by promoting Optimal spacing of birth. For a greater expansion of her activities, Fatoumata made skills transfer to NGOs so they appropriated her mission.
To warn young people about the risks of pregnancy and sexually transmitted diseases, Fatoumata decided to attract them with recreation places. In her organization's headquarters (ASDAP Association for the Support of Development of Population Activities) she built a multifunctional recreation and training center for the community and offers services such as an internet cafe, computer classes, fitness Center with facilities and teams for basketball, volleyball, bowls and soccer and conference space. While there, youth follow the PRADO (Program for teen) and receive advice and education with regard to sexuality, and psychological counseling.
ASDAP has a center that houses a dedicated health clinic where Bamako’s youth can access free and anonymous testing for HIV and STIs, treatment for sexual health concerns, consultations and materials for family planning and contraception. There are also two clinics offering youth health service packages in the towns of Segou and Koutiala.
Fatoumata has also launched Peer to Peer Program for youth to volunteer to spread knowledge and facilitate healthy behaviors in the communities. After a training, each peer educator is trained to inform their friends, families, and classmates of the circumstances facing them concerning STIs/HIV/AIDS, family well-being, nutrition, family planning, female genital mutilation, and much more. ASDAP continues to support the peer educators after the trainings through supplying materials, assisting in education sessions, and in quarterly meetings.
Over the years Fatoumata has developed programs touching infant survival, promotion of abandonment of female genital mutilation, prevention and treatment of HIV/AIDS and STIs, nutrition, food security, promotion and protection of women’s and children’s rights, the reinforcement of health systems. ASDAP is operating in 25 health districts, nearly 300 health areas (about 30% of national coverage). This led to the adoption by communities of better health behaviors like safe motherhood and the prohibition of the practice of female circumcision by the health ministry. This has also improved socio-health indicators such increasing contraceptive prevalence rate in rural areas (over 28%).
Her model for neighborhood information and support in rural health care and peer education has been adopted by Malian government and studied by practitioners throughout the region from Guinea Conakry to Burkina Faso and has been copied by NGOs and government programs.
Being a Malian State midwife and working in rural areas, Fatoumata empathized with rural women in their difficult situation. In his first post in Pays Degon (Mali), she was affected about the situation of women there: lack of water, important housework, and especially in case of maternity, they had to walk more than 15 KM to get to a health center. She began to think about developing new ways of improving health with community participation. She had the idea to train young adults, men and women who speak the local language of the village, while ensuring that they do not go to drain. Their training includes information on general health (hygiene, water hygiene, nutrition, malaria, pregnancy, ST, HIV, family planning). Once formed, they answer questions about health issue from the villagers, provide services (identify fever in time, family planning services, basic health advice). They are now called the community health workers. Through this initiative, Fatoumata obtained financial support to train agents in several villages. In 1989, as the program has been successful, the Health Ministry decided to adopt the strategy of community-based distribution of services throughout Mali. In 1993, the creation of ASDAP was possible thanks to the good results of the initial program. And then in 1995, with CEDPA (Washington) and UNFPA, Fatoumata initiated the first program "Peer Education" for teenagers and young people of Mali.
She said that the feeling of having been the trigger for a positive and innovative change motivates her to continue her efforts to improve the quality of life for youth and women
She was in 2009 a partner of Ashoka and was mentoring a woman in the Maternal Health Youth Champion for the changemaker competition. This was a highly successful collaboration.