Towards Universal Health Coverage in Mali: The Pivotal Role and Limitations of Community Health Workers in the Fight Against Malnutrition 2010-2024

Context: Faced with barriers to accessing healthcare, Mali undertook a reform of its community health system in 2010. This study evaluated the contribution of Community Health Workers (CHWs) in the fight against malnutrition in five regions (Kayes, Koulikoro, Sikasso, Ségou, Mopti) in Mali.
Methodology: A cross-sectional analytical study was conducted. It combined a retrospective review (2010-2024) of DHIS2 data and a perception survey (2024-2025) of stakeholders and beneficiaries. Quantitative data from questionnaires were entered and analyzed using SPSS software (version 25.0) . Retrospective modeling was performed using the Lives Saved Tool integrated into Spectrum software, and qualitative interviews were conducted with 385 stakeholders and beneficiaries.
Results: Our study found that the profile of community health workers (CHWs) reveals a high proportion of women (68.24%) and a high level of professional experience (57.85% aged 28 to 38). Clinically, CHWs managed a cumulative total of 142,327 cases of moderate acute malnutrition (MAM) and 520,439 cases of severe acute malnutrition (SAM). While user satisfaction is high (97.92%), accessibility is hampered by a critical lack of transportation (4.6%) and frequent stockouts of essential supplies (62.86% availability). Average coverage of target populations remains limited to 14.42% for MAM and 27.89% for SAM.
Conclusion: The Essential Community Care strategy in Mali has proven its ability to manage simple cases of malnutrition, treating over half a million cases in ten years. Despite the expertise and social commitment of community health workers, coverage remains limited by critical mobility (4.6%) and logistical disruptions. Sustaining these gains requires increased professionalization and a more secure supply chain.

ASC, Malnutrition, Mali, DHIS2, Community Health, Resilience.

1. UNICEF, WHO, World Bank. Nutrition and Food Security [WHO] [Internet]. Geneva; 2025 [cited 15 March 2026]. Latest estimates of child malnutrition. Available from: [Google Scholar] [Crossref]

2. https://www.who.int/teams/nutrition-and-food-safety/monitoring-nutritional-status-and-food-safety-and-events/joint-child-malnutrition-estimates/latest-estimates [Google Scholar] [Crossref]

3. World Health Organization. Key Facts [WHO] [Internet]. Geneva: World Health Organization ; 2024. Malnutrition: Key Facts. Available at: https://www.who.int/news-room/fact-sheets/detail/malnutrition [Google Scholar] [Crossref]

4. World Health Organization. Key Facts [WHO] [Internet]. Geneva; 2022 [cited 8 March 2026]. Malnutrition: Key Facts. Available from: [Google Scholar] [Crossref]

5. https://www.who.int/fr/news-room/fact-sheets/detail/malnutrition [Google Scholar] [Crossref]

6. WHO. Global Strategy for Human Resources in Health: Vision 2030 [Internet]. Geneva: World Health Organization ; 2016. Report No. Available at: [Google Scholar] [Crossref]

7. https://iris.who.int/bitstream/handle/10665/250368/9789241511131-eng.pdf?sequence=1 [Google Scholar] [Crossref]

8. CHIC. Case for Community Health Workers: Champions of the Health System [Internet]. Community Health Impact Coalition; 2024. Available at: https://joinchic.org/resources/the-case-for-chws-champions-of-the-health-system/ [Google Scholar] [Crossref]

9. Perry HB, Zulliger R, Rogers MM. Community Health Workers in Low-, Middle-, and High-Income Countries: An Overview. Annual Review of Public Health. 2014;35: 399-421. [Google Scholar] [Crossref]

10. UNICEF, WHO, World Bank. Levels and trends in child malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates. Key findings of the 2023 edition. New York, NY: United Nations Children's Fund; 2023. Report No. [Google Scholar] [Crossref]

11. FAO, IFAD, UNICEF, WFP, WHO. The State of Food Security and Nutrition in the World 2024. Rome: Food and Agriculture Organization of the United Nations; 2024. Report No. [Google Scholar] [Crossref]

12. CILSS. Harmonised Framework for the identification of areas at risk and populations in food and nutritional insecurity in the Sahel and West Africa. Dakar, Senegal: Permanent Inter-State Committee for Drought Control in the Sahel; 2024. Report No. [Google Scholar] [Crossref]

13. UNICEF. Child Food Poverty: Nutrition deprivation in early childhood. New York: United Nations Children's Fund; 2024. Report No. [Google Scholar] [Crossref]

14. UNICEF. Severe wasting: An overlooked child survival emergency in the Sahel. UNICEF West and Central Africa Regional Office; 2023. Report No. [Google Scholar] [Crossref]

15. LeBan K, Kok M, Perry HB. Community health workers at the dawn of a new era: 9. CHW relation-ships with the health system and communities. Health Research Policy and Systems. 2021;19(Suppl 3):116. doi:10.1186/s12961-021-00756-4 [Google Scholar] [Crossref]

16. Glenton C, Javadi D, Perry HB. Community health workers at the dawn of a new era: 5. Roles and tasks. Health Research Policy and Systems. 2021;19(Suppl 3):128. doi:10.1186/s12961-021-00768-0 [Google Scholar] [Crossref]

17. VanderZanden A, Amberbir A, Sayinzoga F, Huda FA, Ntawukuriryayo JT, Mathewos K, et al. Evi-dence of health system resilience in primary health care for the prevention of under-five mortality in Rwanda and Bangladesh: Lessons from an implementation study during the MDG era and early COVID-19 pandemic. Journal of Global Health. 2024;14: 05023. doi: 10.7189/jogh.14.05023 [Google Scholar] [Crossref]

18. INSTAT. Demographic and Health Survey in Mali (EDSTM-VII) 2024-2025: Preliminary Report [National Report]. Bamako, Mali: National Institute of Statistics (INSTAT ); 2025. Report No. [Google Scholar] [Crossref]

19. MSDS. National Anthropometric Nutrition and Retrospective Mortality Survey (SMART 2025) [Technical Report]. Bamako, Mali: Ministry of Health and Social Development; 2025. Report No. [Google Scholar] [Crossref]

20. Directorate General of Health and Public Hygiene of the Ministry of Health of Mali. National Strategic Plan for Essential Community Healthcare (ECH). [Strategic document]. Bamako, Mali: Ministry of Health and Social Development; 2021. [Google Scholar] [Crossref]

21. Sacko M, Sangho O, et al . Impact of the essential community care strategy on the management of acute malnutrition in Mali: a survival analysis. Malian Journal of Science and Technology. 2024; 2(29 ): 15-28. [Google Scholar] [Crossref]

22. Glenton C, Javadi D, Perry HB. Community health workers at the dawn of a new era: 5. Roles and tasks. Health Res Policy Syst. 12 Oct 2021;19(Suppl 3):128. doi:10.1186/s12961-021-00748-4 PubMed PMID: 34641903; PubMed Central PMCID: PMC8506082. [Google Scholar] [Crossref]

23. LeBan K, Kok M, Perry HB. Community health workers at the dawn of a new era: 9. CHWs' relation-ships with the health system and communities. Health Res Policy Sys. Oct 12, 2021;19(3):116. doi:10.1186/s12961-021-00756-4 [Google Scholar] [Crossref]

24. WHO . Global strategy on human resources for health: Vision 2030. Geneva: World Health Organiza-tion; 2016. Report No. [Google Scholar] [Crossref]

25. CHIC. The Case for CHWs: Champions of the Health System. Community Health Impact Coalition [Internet]. 2024 [cited 19 March 2026]. Available from: https://joinchic.org/resources/the-case-for-chws-champions-of-the-health-system/ [Google Scholar] [Crossref]

26. VanderZanden A, Amberbir A, Sayinzoga F, Huda FA, Ntawukuriryayo JT, Mathewos K, et al. Evi-dence of health system resilience in primary health care for preventing under-five mortality in Rwanda and Bangladesh: Lessons from an implementation study during the Millennium Development Goal pe-riod and the early period of COVID-19. J Glob Health. 5 Jul 2024;14: 05023. doi: 10.7189/jogh.14.05023 [Google Scholar] [Crossref]

27. World Health Organization. WHO's 2024 Global Health Expenditure Report Highlights Health Financing Challenges and Calls for Prioritization of UHC | The Oligo News [Internet]. 15 Dec 2024 [cited 19 Mar 2026]. Available from: https://www.theoligo.com/whos-2024-global-health-expenditure-report-highlights-challenges-in-health-financing-and-calls-for-uhc-prioritization/ [Google Scholar] [Crossref]

28. Pilar Charle-Cuellar, Noemi Lopez-Ejeda, Magloire Bunkembo, Abdias Ogobara Dougnon, Hassane Toukou Souleymane. Management of severe acute malnutrition by community health workers: Initial findings from Action Against Hunger research | FRN [Internet]. 2020 [cited 19 Mar 2026]. Available from:https://www.ennonline.net/fex/60/fr/prise-en-charge-de-la-malnutrition-aigue-severe-par-les-agents-de-sante-communautaires [Google Scholar] [Crossref]

29. Sacko M, Sangho O. Performance evaluation of Community Health Workers in the management of malnutrition in rural areas of Mali. Malian Journal of Science and Technology. 2024. [Google Scholar] [Crossref]

30. Mali: IPC Analysis of Acute Malnutrition, June 2024 - May 2025 (published 22 November 2024) - Mali | Relief Web [Internet]. 2024 [cited 31 March 2026]. Available from: [Google Scholar] [Crossref]

31. https://reliefweb.int/report/mali/mali-analyse-ipc-de-la-malnutrition-aigue-juin-2024-mai-2025-publie-le-22-novembre-2024 [Google Scholar] [Crossref]

32. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet. August 3, 2013; 382(9890 ): 452‑77. doi: 10.1016/S0140-6736(13)60996-4 PubMed PMID: 23746776. [Google Scholar] [Crossref]

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