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How politically unstable Mali beat trachoma

On Wednesday, the World Health Organisation (WHO) announced that Mali became the 17th country to receive official validation of trachoma no longer being a public health problem.

This is a major milestone since WHO and The Carter Center’s joint programme conducted surveys in 1996 where 10 million people were considered at risk for trachoma.

Trachoma is a bacterial infection which affects the eyes. 

According to the centers for disease control and prevention, trachoma causes more vision loss and blindness than any other infection in the world.

The challenges they have surmounted, including political instability and immense conflict throughout their vast and population-dense region, make Mali different from other countries that have been certified. ion.

News24 spoke to three public health experts from The Carter Center who were involved in the Mali mission to get a glimpse into how devastating and challenging trachoma in the country was .

Dr Kelly Callahan, who has more than 25 years experience in neglected tropical disease control, elimination, and eradication said combined effort and consistency was integral in the fight. 

Every other country faced with trachoma and any other public health crisis should take note.

I would advise all countries battling trachoma to focus on the power of partnership and to be persistent. It is amazing what can be done together with many different and disparate partnerships – Mali harnessed the power of partnership with various partners over time with each partner focused on the same impact goal.

“They organised the partnership work by assigning each partner to focus on different geographical regions and aspects of focus within the SAFE Strategy (Surgery, Antibiotics, Facial Cleanliness and Environmental Improvement),” she said.

There is a saying in West Africa, “little by little the bird builds its nest” – and that is what Mali did with each partner, persistently, by all bringing their “building materials” to the trachoma focus, she added.

Dr Kashef Ijaz has worked to control, prevent, eliminate, or eradicate six tropical diseases in 18 nations.

He provided leadership in the trachoma fight in Mali.

He told News24 that the political situation in Mali was one of the biggest challenges not only for trachoma but other public health problems.

“The political impasse does not allow basic services such as the provision of water and sanitation, and that keeps people stressed and anxious and locked in cycles of poverty. The mental health toll of the political impasse is enormous,” he said.

Beating trachoma in Mali came at a cost of about R380 million (about US$20 million).

However, it was not enough to put in place lasting infrastructure for the future.

He said:

Unfortunately, this investment was not enough to build significant health infrastructure and to provide appropriate water and sanitation services everywhere in Mali – so a gap has been left behind.

Part of the money was sourced from the Conrad N. Hilton Foundation and the Lions Clubs International Foundation.

Mali’s public health sector remains fragile and there’s a need for more donor agencies to stay put despite the socio-political disturbances.

“The WHO conducted the Joint External Evaluation from June 27-30, 2017, to assess public health and international health regulations core capacities. This evaluation demonstrated low scores and poor capacity across 19 technical areas. 

“This low score demonstrates that Mali continues to need health system strengthening and investment, to not only deal with similar diseases, like the eradication of Guinea-worm disease but also to build and maintain appropriate water and sanitation services,” he added.

Dr Sadi Moussa The Carter Center’s representative in Mali reiterated the lack of political goodwill during the fight to eradicate trachoma, particularly inconsistencies in the Ministry of Health.

“In dealing with trachoma in Mali, challenges I experienced during my time have been insecurity, staff turnover, political instability like changing Minister of Health many times over the years and malgovernance,” he said.

He added that conflict in the region delayed and even made the situation more complicated because the safety of health workers was not guaranteed.

“In Mali, I think there was a link between conflict and public health crises. With conflict, access to areas that need interventions is limited; with population movement due to conflict, diseases like trachoma spread into other regions.

“Health workers flee areas with conflict and cannot support an ailing population. Populations are abandoned in terms of health care and general public health interventions. We observed that public health crises increase when conflicts set in,” he said.

The News24 Africa Desk is supported by the Hanns Seidel Foundation. The stories produced through the Africa Desk and the opinions and statements that may be contained herein do not reflect those of the Hanns Seidel Foundation.

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