A Bright Future Ahead—Reducing Maternal and Infant Mortality in Mali

Tacko was experiencing a difficult childbirth. The village midwife quickly realized the baby's head was too large for the mother's pelvis and Tacko was carted from her village to the district health centre in Kayes, a remote region of Mali. There, a doctor performed a Caesarean section. Both mother and child survived.

What might seem a routine procedure in some countries is hardly routine in Mali, where the maternal mortality rate is one of the highest in the world. Tacko's life was saved by a program established in Kayes in 2003 to reduce maternal mortality. This program aims to provide better, more accessible care in obstetric emergencies. In a few years, remarkable progress has been made.

Canada's financial and technical support has led to a better referral and evacuation procedure. Women can be transported to the nearest district health centre. There is a better system of radio communication between front-line health centres and district centres, and ambulances have been procured. This has reduced treatment times-a key factor, as it is crucial to act quickly when complications arise in childbirth.

In Kayes, those who play a role in the system work well together and enjoy solid political support. For example, the government has reduced the cost of emergency response in childbirth. Caesarean sections have also been performed free of charge since 2005. Women thus have much better access to such care, which has a direct impact on maternal mortality statistics.

In addition to better access to emergency obstetric care, its quality has improved. Canadian technical support to the regional health directorate, medical staff, and paramedics (nurses, midwives, etc.) has helped build capacity.These teams have also improved their analyses of the causes of maternal and neonatal mortality. Better understanding of the causes of mortality makes it possible to remedy weaknesses in the system and to save other women's lives. The quality of services has thus improved. In only a few years, the number of Caesarean sections has tripled. Previously, 1 out of 7 women died in obstetric emergencies; this figure has dropped to 1 out of 25.

Better awareness of the importance of quality care has brought about another significant change among medical staff: listening. "Teams are gradually developing the ability to listen to people and consider what they have to say,'' says Dr. Sékou Dramé, regional health director for Kayes. ''We used to think we knew it all. These women have not been to school, but they have experience. More and more, they are demanding quality services. With mothers acting as watchdogs, we are able to question ourselves. This makes us more aware." This change in attitude among medical staff promises a healthier future for women in Mali.

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Conceiving new ways to get development results

After decades of experience learning what works-and what doesn't-in international assistance, Canada and its international partners are increasingly managing development programs for better results. That means doing what makes sense: supporting the leadership of developing countries in determining their own development success; choosing partners, goods, and services based on their efficiency and expertise rather than their nationality; building and using the institutions of developing countries for sustainability; and coordinating efforts among donors.

Making aid more effective also means making choices about where to focus efforts. No single donor, including Canada, is capable of being everywhere and doing everything.

Working in health in Mali, a sector where Canada is the third-largest donor in the country, is an example of focus that makes sense for Canada. Mali is one of the poorest countries in the world, and its government has demonstrated its commitment to poverty reduction. Canadians have been partnering with Malians for more than three decades, working to eradicate river blindness and guinea worm disease, prevent and treat HIV/AIDS, improve food security and nutrition, and now, to strengthen health care systems and help train health care professionals.

These efforts are helping people like Tacko live longer, healthier, lives. That's getting results!