One Finger Cannot Lift a Pebble

Mali has one of the world's highest fertility rates, where the average woman will give birth six times in her lifetime, and approximately 24 percent of women in Mali report that they wish to avoid pregnancy but are not using a modern method of contraception. Access to family planning helps women prevent unplanned pregnancies, encourages healthy spacing and timing of future pregnancies, and experience better reproductive health outcomes. Family planning is particularly critical for women and girls during times of crisis when high rates of unplanned pregnancy, unsafe abortion, and maternal death are magnified.  

The USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project has partnered with the Ministry of Health in Mali since 2017 to store and distribute family planning and reproductive health commodities (FP/RH) to women nationwide. Following the August 2020 coup, restrictions under section 7008 of the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2020 and similar provisions in prior acts were applied to assistance that benefits the Government of Mali. 

Given the application of Section 7008, GHSC-PSM could no longer partner directly with Mali's transition government to store and distribute FP/RH commodities. 

GHSC-PSM needed to act quickly to form new partnerships with local actors that could warehouse and distribute the USG-donated FP/RH contraceptives it procures and manages to the communities that need them.

GHSC-PSM contracted JIGI, a local nongovernmental organization (NGO) that operates a medical warehouse in Mali's capital, Bamako, to store these contraceptives and used a local transportation company to distribute them to 573 community health centers in Mopti, Segou, and Mali's most populated region, Sikasso. According to Moussa Koita, M&E specialist, JIGI, "Some sites were out of stock for more than three months…several women had visited the health center but had to go home empty-handed due to the lack of available family planning products."

GHSC-PSM also partnered with USAID Keneya Sinsi Wale (a U.S. government-funded health systems strengthening, governance, and finance activity with a local supply chain component) to coordinate the distribution of contraceptives to the community. 

In the Kayes region, the project partnered with another USAID-funded activity, Momentum Private Healthcare Delivery, to pick up contraceptives from the JIGI warehouse and distribute them to 13 community health centers.

In the Koulikoro region, GHSC-PSM subcontracted with JIGI to distribute contraceptives to 10 health districts and worked with JIGI and USAID's NPI EXPAND project to distribute the contraceptives to the communities. 

These partners met weekly and worked together, under the leadership of the USAID Mission in Mali, to monitor the effectiveness of the distribution activities, discuss community health center feedback, and ensure the effective distribution of contraceptives.

Thanks to these partnerships, all community health centers in these regions now routinely receive a six-month supply of contraceptives, providing nearly 302,971 people with a year's worth of protection. These distributions require a massive effort to reach communities across Mali. Providing a six-month supply of contraceptives allows partners to be efficient with time and budget while maximizing safety because security and infrastructure challenges (many roads are impassable during the rainy season) make more frequent distributions cost prohibitive. 

"Being close to these populations allowed me to understand that they were very fragile. They always tried to protect me so that I could meet their health expectations despite the insecure situation. Such cases made it clear how important our work is in such situations" - Ousmane Niare, Health Worker