Can a low income country move towards universal health coverage?

Mali is a vast and troubled country. Much of it is lawless Sahara desert, where UN peacekeepers have failed in recent years to root out jihadists and criminal gangs. To the south, where the Sahara ends and the Niger river flows, Malians are living on the front line of climate change, with increasingly extreme floods and droughts. A bloody conflict between rival communities in central Mali became so bad in May that it triggered a change of government. Two thirds of the country is a no-go zone, according to the UK government’s travel advice.1

Yet in the middle of all this, Mali is introducing an ambitious new plan for universal healthcare. “With this programme, we will drive change and move to building a healthy society,” said health minister Michel Sidibé in a telephone interview.

His troubled west African nation of 18 million people is badly in need of better and more accessible healthcare. Malian women have the fourth highest fertility rate in the world (six children per woman on average). The country has some of the worst health indicators, with child mortality at 106/1000 live births and maternal mortality at 587/100 000.2 It is among the 25 poorest countries in the world.3