Case study: implementing a mobile human health and animal health service for Mali’s pastoral communities

Agronomes et Vétérinaires Sans Frontières is a member of VSF International

Since 2004, Agronomes et Vétérinaires Sans Frontières has worked with partners to deliver a mobile health clinic to both people and animals in the dispersed northern regions of Mali.  

The problem

Northern Mali has an extremely dispersed population over a vast area, with just 0.5 people every kilometre square. The majority of people rely on animals for an income, whether they own the animals themselves, or work for someone else as a herder. This means people rely on the trade of animals and their products to be able to secure their own health and feed themselves, as well as clothe themselves and accumulate savings. They also supply a very large amount of food to consumer markets in Mali’s growing cities.

Many farmers are pastoralists who move their animals to different places in the dry season and wet season. Northern Mali has very few basic social services, and previous animal and human health programmes have failed because they have not adapted to pastoralists’ nomadic way of life.

For example, animal vaccination campaigns and treatments would only take place when communities were passing through a particular region. This meant many people would try to treat their animals themselves, or would rely on ‘quacks’ who may use incorrect doses, or illegal or counterfeit medicines.

For some, it can take two days by donkey or camel to reach the nearest community health centre. Trying to reach a static health centre can result in the loss of a full day’s income. Wealthy people who can afford mobile phones, can pay for human and animal health professionals from the south to come and visit them.

The approach

In 2004, Agronomes et Vétérinaires Sans Frontières and the Association for Endogenous Development in the Sahel set up a mobile health centre, which takes a One Health approach, by aiming to secure human and animal health at the same time. It also places special emphasis on tackling zoonotic disease (disease that passes from animals to humans), which is a major challenge in rural communities where people and animals live so closely together.

The project has grown from one mobile clinic, to five mobile teams that cover an area of more than 50,000km2. Teams carry out seven-day rounds across 12 sites, following a schedule defined by community representatives in collaboration with the project team. The team is made up of a driver, a community guide, doctor or nurse, midwife and livestock technician. Community members who are farmers and traditional midwives are involved in monitoring sick people and animals in between visits.

The team provides consultations for community members, as well as screening and care for cases of malnutrition in adults and children. For animals, they provide consultations, regular treatments for parasites, and vaccination against local disease outbreaks. They also provide sessions to raise awareness of preventative care, as well as local laws relating to transhumance (the seasonal movement of livestock to different grazing areas). On return from a tour, the project team delivers a technical report to the regional health and livestock services, based in Timbuktu, who are kept fully informed of activities.

Additionally, the team can provide surveillance of diseases in both people and animals over vast territories. This reduces the risk of epidemics, and means the emergence of new diseases can be identified as quickly as possible.

This mixed approach makes it possible to pool resources between animal and human health, by sharing fixed costs such as the costs of interpreters, fuel, rental cars, and the cold chain (management of temperature-controlled medicines and vaccines).

Northern Mali has experienced instability and insecurity for some time, with NGOs often being targeted by insurgents. Using unmarked rental cars is one way to ensure the team’s security. Services are also provided for free so that teams are not carrying cash with them.

Results

When the mobile clinic first began, uptake of services was very low. Community members were reluctant to have children vaccinated or to allow women to have prenatal consultations. This has changed dramatically over time, as the mobile teams have built trust with communities. For instance 60% of pregnant women now use the services, and animal consultations have risen from 0 in 2004, to over 150,000 in 2021.

The number of animals treated is also related to environmental changes. Increasing scarcity of pasture can result in weakening of livestock herds. The mobile team have organised deworming campaigns and vaccination campaigns during these periods, which increases the number of animals treated. These campaigns are now organised each year to respond to changes in the environment. Moreover, the decrease in rainfall and increase in climatic shocks means people will move around with their livestock even more than they do now. This makes a mobile mixed health service, which can work in harmony with nomadic ways of life, essential to securing the health of people and their animals.

What next?

The Malian government stipulates that animal health care and human health care must be provided for free in the northern region. But at the moment, this mixed mobile service is supported by external funding from the EU, the Humanitarian Aid department of the European Commission (ECHO) and the Auvergne-Rhône-Alpes region of France, and the service is implemented by NGOs who could withdraw at any time.

It is recommended to institutionalise this type of mixed health mobile service to be able to mobilise public investments, and for local authorities include this type of service in community development plans. Local authorities can learn from how NGOs have pooled resources to deliver this kind of service, and must ensure One Health is at the centre of community development projects. In these pastoral contexts, there is no human health without animal health.

Thank you to Agronomes et Vétérinaires Sans Frontières and Vétérinaires Sans Frontières International. For more information please contact Marc Chapon (m.chapon@avsf.org) or Stefano Mason (s.mason@avsf.org)

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