Muso commits to expand its Ultra-Rapid Health System to reach 100,000 people within one year in Yirimadjo, Mali. Muso has developed a model health system that is optimized for unprecedented speed. The system is based on a simple premise: early access to already proven tools can avert nearly all under-five child deaths. To achieve this, the model deploys proactive doorstep health care: Community Health Workers (CHWs) to actively search for patients door-to-door, and communities organizers to engage early in prevention and care. This opens a route to rapid access.
Muso will achieve this commitment by undertaking three strategies: 1) Early Warning: A network of religious leaders, civil society actors, and community members is mobilized to identify sick children and bring them to CHWs early in the course of their illness. 2) Doorstep Care: CHWs conduct active case finding visits door-to-door to provide a package of outreach, prevention counseling, diagnosis, treatment, referral, and follow up. 3) Clinic Capacity: At the primary care level, Muso's model promotes access by removing out of pocket fees at the point of care, constructing new infrastructure, and staff training.
All elements of the health system will be implemented through the public sector, in close collaboration with Muso's Ministry of Health MOH) partners. The Malian MoH is interested in applying the best strategies from this partnership to its upcoming national scale-up of Community-Based Health Systems.
October - December 2014: Training of 75 Community Health Workers
April - June 2015: Training of 20 Community Health Workers
October 2014 - September 2015: CHWs will conduct more at least 10,000 active case finding home visits monthly.
October 2014 - September 2015: Data on quantity, speed, and quality of care will be collected and analyzed monthly by CHW supervisors, program leadership, and Ministry of Health Partners.
June 2015: Annual randomized household survey will be conducted to track population-level indicators of rapid access to care and under-five child mortality.
July - October 2015: Annual randomized household survey data entered, cleaned and analyzed.
November - January 2016: Analysis synthesized and conclusions shared with partners.
Despite considerable progress in child survival in recent years, only 13 of 61 countries with high under-five mortality rates are currently on track to meet the fourth Millennium Development Goal: A 2/3 reduction in child mortality by 2015. In 2013, 6.3 million children died before they could reach age five. Mali, with the world's seventh highest rate of under-five child mortality, is at the epicenter of this global crisis.
The leading causes of under-five child mortality, neonatal illness, malaria, pneumonia, and diarrheal disease, progress and kill rapidly. But they are also preventable and curable. The tools to avert millions of child deaths annually already exist; they are low cost and research-proven. The great challenge is early access. These tools are not getting to the children who need them quickly enough due to health systems that are poorly designed, inaccessible to the poor, or absent altogether.
A study of the Muso health system published by researchers at Harvard, UCSF and the Malian Ministry of Health found that in the area of intervention, the rate of under-five mortality was 155/1000 at baseline and 17/1000 at year three. During the same period, the number of patient home and clinic visits increased tenfold. Muso CHWs are accessing 90% patients when sick in 72 hours and 50% in 24 hours. If these results could be replicated and brought to scale, the lives of millions of children could be saved annually; the MDG4 objective could be achieved and far surpassed.