Community Health Volunteer, Bala Diakite, vaccinates a child in the village of Banankoro, Kayes Region.
Key results reflecting positive change over the past decade (1996 - 2006):
Maternal, child and infant mortality:
• Neonatal mortality from 60 to 46/1000 LB, or 23% decline
• Postnatal mortality from 62 to 50/1000 LB, or 19% decline
• Infant mortality rate from 123 to 96/1000 LB, or 22% decline
• Mortality <5 years from 238 to 191/1000 LB, or 20% decline
Infant Immunization (<1yr) :
• DTP3 37 to 68% or 31% increase
• Measles from 51 to 68%, or 25% increase
• No vaccine from 23 to13% or 43% progress
Prenatal Care and Childbirth and Breastfeeding:
• CPN1 from 47 to 70%, or 33% increase
• Assisted births from 40 to 49%, or 19% increase
• Exclusive breastfeeding <6 months from 15 to 38%, or 60% progress
• Chronic malnutrition (height for age) from 14.5 to 19.3% or an increase of 25% (-3SD) and from 30 to 38% or an increase of 21% (-2SD)
• Acute malnutrition (weight for height) from 6.2 to 5.9% or 5% reduction (-3SD) and from 23.3 to 15.2% or a reduction of 35% (-2SD)
• Underweight (weight for age) from 16.5 to 9.7% or a reduction of 41% (-3SD) and from 40 to 26.7% or 32% reduction (-2SD)
• Overall prevalence from 1.7 to 1.3% or a reduction of 23.5%
• Prevalence among men from 1.3 to 1% or a reduction of 23%
• Prevalence among women from 2 to 1.5% or a reduction of 25%
Children react during a "triggering session", part of a community-led total sanitation demonstration where food and feces are placed near each other to show transmission of disease by flies.
UNICEF plays an important role within the coordination and implementation of national WASH strategies and policies.
Our main achievements are:
• Introduction of the Community Led Total Sanitation (CLTS) Approach, adopted as the national strategy for the development of rural sanitation
• Coordinated and developed of a National Strategic Plan to develop a WASH in Schools programs at scale, giving 60 per cent of existing schools the same WASH standards: water and sanitation, child-friendly infrastructure and equipment, hygiene promotion and local governance for the management of the school. UNICEF, Dubai Cares and DANIDA developed two large scale WASH in schools programs in 1050 locations in Mali.
• Strengthened the monitoring and evaluation mechanisms of the Water and Sanitation Sector; UNICEF is acting as the focal point for the Country Status Overview/UN-Water Global Assessment of Sanitation and Drinking-Water Mechanism (CSO/GLASS) and for the JMP program together with WHO
• Strengthened the review/planning process of the National Water and Sanitation Program;
• Support to the national decentralization process towards all communes of Segou, Gao and Kayes Regions (267 communes in total) for the management and the planning of Water and Sanitation activities.
Throughout 2009, UNICEF contributed to develop sustainable access to safe water for most vulnerable communities:
• Construction of new water infrastructures for communities and health centres:
o 33 boreholes for 33 health units in Koulikoro, Kayes and Segou regions,
o 43 new wells dug and equipped with hand pumps in the Guinea worm endemic areas of the regions of Mopti and Gao serving 34,902 inhabitants,
o 100 broken pumps rehabilitated in the Guinea worm endemic districts of Koro, Mopti and Douentza in the region of Mopti to meet the potable water needs of 110,323 people.
o One (1) solar panel powered water supply system installed to benefit to 4,800 inhabitants in the village of Golombo and its surrounding areas,
o 5 solar panel powered water supply system in 5 schools covering 1,184 pupils per year and the surrounding inhabitants
o 4 boreholes in guinea worm endemic areas of Kidal (around 1,600 beneficiaries)
• Strengthening the national operation and maintenance (O&M) framework of rural water supply facilities, by providing capacity-building for the management of water supply facilities to 267 communes in Gao, Segou and Kayes regions and by strengthening the Public/Private Partnership for the provision of WASH services through implementation with the support of UNICEF HQ of a study on the Handpump Market in Mali, which details the important role of the private sector for the operation and maintenance of hand-pumps.
• Through the development of the self-supply approach: 108 masons trained + 1 rope-pump manufacturer) resulting in the rehabilitation of around 80 domestic wells (28 of which are equipped with rope-pumps)
Main outcomes for Hand Washing with Soap are as follows:
• Around 35,000 children participated in the 2009 national campaign which included the diffusion of 3,000,000 telephone text messages, the broadcast of movie-clips and songs in the main national languages through national media (TV/radio) thanks to the contribution of most popular national artists, the donation of 15,000 domestic hand-washing devices, 200 hand washing facilities for schools, 20,000 pieces of soap, 15,000 T-shirts, 10,000 caps and the distribution of 22,000 promotional posters/leaflets (including around 1000 devices for schools in Gao Region, 50 hand washing facilities for schools, 2500 pieces of soap, 1,500 T-shirts, 1000 caps and the distribution of 3,000 promotional posters/leaflets). As a result, around 70% of the Malian population has been reached to HWWS during 2009 campaign.
• A national campaign is planned every year by the Ministry of Health and its partners and the campaigns become more and more efficient.
• During the 2010 campaign, through the first “Tour du Mali Cycliste”, around 30,000 mothers and children were reached through interpersonal communication and 70% of the country’s population was reached through massive media coverage for a whole week for “the 4 behaviours that save lives”: exclusive breastfeeding, sleeping under mosquito net, oral rehydration therapy and zinc during diarrhoea, and HWWS.
Community-led Total Saniation (CLTS):
Initial community led total sanitation (CLTS) pilots in 15 villages in 2009 were extremely successful. The pilot communities were declared “Open Defecation Free (ODF)” within three months, without subsidy; raising the sanitation coverage from 30 per cent on average to 100 per cent (14,000 people gained access to improved sanitation and acquired safe hygiene practices for an overall cost of less than three USD/capita). A team of ten national CLTS specialists were trained and are now implementing regional training workshops to develop CLTS in many different areas.
In total, 294 representatives from main institutions, National NGO networks and INGOs have been trained to facilitate the development of CLTS throughout Mali. The CLTS approach was successfully “triggered” in 261 villages (representing a total population of 201,200 inhabitants) where, among other achievements, the communities committed themselves to build over 8,900 new latrines. Among these villages, 178 are in the process of certification of their ODF status.
The overall CLTS process (triggering, follow-up, certification and post-follow-up) is now autonomously adopted and developed by governmental counterparts according to a methodology designed jointly with UNICEF and which is now fully assimilated by the national stakeholders. Based on these first results, the objective in 2010 is to trigger CLTS in 500 additional communities using the local community leaders as facilitators and to raise the number of new latrine built by 10,000.
WASH in schools:
UNICEF facilitated the national and regional institutions from these four sectors (Education, Health, Water Supply, and Sanitation) to work together in order to produce a National Strategic Plan for the Promotion of Hygiene in Schools for the 2010-2014 period. To complete this Strategic Plan, a specific Hygiene Education Manuel adapted to the context of Mali is currently being finalized.
These achievements strengthened the environment component for hygiene promotion based on capacity building of national stakeholders (health staff, teachers, etc.) and on an improved strategic/operational framework. The work has allowed the leveraging of important financial resources to improve WASH in schools at the required scale: 4,700,000 USD from DANIDA and 16,000,000 USD from Dubai Cares. As a result, UNICEF is recognized as a lead agency for the development of the sanitation subsector and specifically for the development of WASH in schools programs.
The promotion of School Sanitation and Hygiene Education in the regions of Gao and Mopti included:
• The provision of reliable facilities for clean water supply, separate excreta disposal facilities for girls and boys as well as equipment for Hand Washing With Soap (HWWS).
• In terms of the construction of new drinking water facilities, 30 schools hosting 7,648 pupils have been provided with 30 new productive wells equipped with hand pumps in the region of Gao. In addition, five schools have had their water source upgraded into 5 solar water supply systems.
• Concerning school sanitation facilities, 39 schools have been provided with 200 latrine cubicles in Gao Region to enable separate excreta disposal blocs for girls and boys while 80 cubicles have been built in 24 schools in Mopti region for the same purposes serving a total of around 17,000 pupils on a yearly basis. All these facilities are equipped with hand washing components.
These new interventions have helped to cut down the ratio of pupils per latrine cubicles from 250 – 120 students/cubicle in 54 schools to an average of 50 to 65 pupils/cubicle.