After almost a decade at the Executive Board of UNAIDS, Michel Sidibé was appointed Minister of Health in Mali last May. A true defender of…

AN EMBLEMATIC FIGURE IN THE MINISTRY OF HEALTH AND SOCIAL AFFAIRS

Mali: interview with Michel Hamala Sidibé

After almost a decade at the Executive Board of UNAIDS, Michel Sidibé was appointed Minister of Health in Mali last May. A true defender of social justice, Michel Sidibé is now fully committed to improving the health situation in Mali. Interview.

Michel Sidibé

54 ÉTATS: What are the dominant pathologies in Mali and what is the maternal and infant mortality rate?

Michel Hamala Sidibé: Mali is facing new challenges that require a multi-sectoral, innovative and coordinated approach.

The security crisis in north-central Mali has been catastrophic for our country, with the deterioration of the health infrastructure, the theft of medical equipment, and death threats to the medical staff leading to medical deserts. In view of this picture and since taking office, we are working to restore hope to our people and to strengthen the bonds of trust between citizens and public authorities by substantially contributing to the provision of basic and essential services. making health a vehicle for peace and reconciliation.

In addition to endemic diseases such as malaria, which remains the leading cause of death in Mali, and the epidemics of HIV, tuberculosis and hepatitis, we still face the problem of emerging diseases commonly called chronic noncommunicable diseases (CNCD). such as diabetes, hypertension and cancers .... Health indicators in Mali remain particularly worrying and contribute greatly to the loss of human capital accumulated by a country where almost half of the population is under the age of 16 years.

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After 30 years of steady decline, infant mortality has increased sharply from 95 to 101 deaths per 1,000 live births between 2012 and 2018, and maternal mortality remains one of the worst in the region, with 325 deaths per 100,000. live births in 2018.

54 ÉTATS: You have a solid knowledge of public health issues, thanks to your past position at UNAIDS. You have been in office since May 2019, what place will you give to the fight against AIDS, to related diseases, in particular tuberculosis and cervical cancer and to their integration into a broader health policy?

Michel Hamala Sidibé: My recent appointment as Minister of Health and Social Affairs in Mali is a great honor for me and allows me to rediscover my country after years of international commitment in the fight against pandemics and mainly against AIDS and other related conditions.

With regard to AIDS, we have a concentrated epidemic with a prevalence of 1.1% or less.


    My years of experience should be an asset and quickly promote the achievement of global goals in Mali

With the emergence of self-tests, we will quickly put in place strategies to detect the largest number of our fellow citizens who remain sero-ignorant. We have already initiated reforms in this direction and made commitments with the creation of an integrated HIV / Tuberculosis / Hepatitis program. Moreover, given the critical mass of new cases of cervical cancer recorded per day and the increasingly difficult access difficulties, concomitantly we are putting in place advanced and specific strategies for promote the early diagnosis of cervical cancer and promote the vaccination of young girls against the papilloma virus.

54 ETATS: The journey of care for people with cancer remains complex, sometimes chaotic. How to simplify and humanize it?

Michel Hamala Sidibé: Indeed, following budget cuts, Mali has spent only 0.85% of GDP on health care and 4.32% of the revised national budget in 2018, and 0.05% of GDP and 0.2% of the national budget specifically for primary health care. However, as soon as I took office, I asked the relevant services of the Ministry to assess the path of the cancer patient, and this work demonstrated the evidence of the complex, titanic and especially very expensive path that increases the rate of lost of sight and consequently the rate of cancer-related deaths. The problem is not so much the lack of qualified human resources, but rather the management of a recurring and growing insecurity situation in a large part of our territory that disrupts and disrupts our health system at times. The geographic and financial accessibility of populations to health services is always uncertain, and therefore creates a mismatch between supply and demand for services. This promotes a medical desert in some areas.

54 ETATS: Where is the issue of social security in Mali? How does care work for people who are unable to pay for medical care and expenses?

Michel Hamala Sidibé: The financing of health in Mali remains inadequate with a too important contribution of the population through the direct payments and a weak coverage in mutuelles of health. Also, human resources that are poorly distributed, insufficient, poorly performing and not very motivated (training, use, motivation).

Mali has made a leap forward with the implementation of its social protection scheme through the creation of the Compulsory Health Insurance (AMO)

However, in 2009 Mali made a leap forward with the implementation of its social protection scheme through the creation of the Compulsory Health Insurance (AMO) which is one of the most important reforms in Mali.

It is an insurance for the benefit of the civilian and military officials, the deputies, the workers and the leaders of the United States. It is based on the principle of solidarity and risk pooling.

Moreover, I must remember that Mali is resolute in the fight against social inequalities.

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Our decentralization strategy gives us the opportunity to set up a true health democracy by involving the state services and the territorial communities (communes and circles). This means that the poor are fully supported for their medical care, exams and checkups as well as hospital costs with state responsibility 85% and 15% remaining the responsibility of the communities.

In February 2019, the President of the Republic launched the most ambitious health reform in the history of Mali
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Also, in February 2019, the President of the Republic launched the most ambitious health reform in the history of Mali

It has recognized the total free primary care for pregnant women and children under five, the upgrading of the technical platform, the deployment and training of tens of thousands of community health workers to act at the same time. closer to 18 million Malians, scattered over a territory as large as twice France.

54 ETATS: And finally, for lack of qualified human resources, do you think that the future of health sector in Mali is in telemedicine?

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Michel Hamala Sidibé: The disinvestment by the Government of Mali in the primary health care sector following the Bamako Initiative and the introduction of cost recovery must be rectified.

I remain convinced that telemedicine and in general E-health is a credible and indispensable alternative that must guide and guide our policies and strategies of care offers.

Today, we are in the midst of an almost successful discussion with partners to develop health innovation through the digitization of health centers at the base by connecting them to each other.

This is a project to improve primary health care through the restructuring of about 500 Community Health Center (CsCom) relying on the digital solution.

This solution will involve the establishment of tele-medicine, tele-assistance and tele-expertise. We want to move towards a resilient digital health ecosystem. The choice of the CsCom is not fortuitous because we are convinced that the improvement of the health of the Malians, through the improvement of the supply of local care that is the first link in the health pyramid.

Our ambition is to build a strong health system by thoroughly reforming the system while relying on innovation to achieve it. With this interconnection, our vision is to make Mali the first pole of excellence in digital health in Africa. The immediate benefits that could be gained include:

- Bringing care closer to the people

- Improve the quality of care

- Expand the offer of first level care

- Rationalize the management of primary health care structures

- Establishment of an innovative and intelligent business model ...

In the coming months, we will organize an international fair for health innovation in Mali.

 

Priscilla Wolmer
Directrice de la rédaction