Cargando…

C’est vraiment compliqué: a case study on the delivery of maternal and child health and nutrition interventions in the conflict-affected regions of Mali

ABSTRACT: BACKGROUND: Mali is currently in the midst of ongoing conflicts which involve jihadist groups, rebels, and the state. This conflict has primarily centered in the North of the country. Humanitarian actors delivering services in these geographies must navigate the complex environment created...

Descripción completa

Detalles Bibliográficos
Autores principales: Ataullahjan, Anushka, Gaffey, Michelle F., Tounkara, Moctar, Diarra, Samba, Doumbia, Seydou, Bhutta, Zulfiqar A., Bassani, Diego G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254666/
https://www.ncbi.nlm.nih.gov/pubmed/32514301
http://dx.doi.org/10.1186/s13031-020-0253-6
_version_ 1783539584096796672
author Ataullahjan, Anushka
Gaffey, Michelle F.
Tounkara, Moctar
Diarra, Samba
Doumbia, Seydou
Bhutta, Zulfiqar A.
Bassani, Diego G.
author_facet Ataullahjan, Anushka
Gaffey, Michelle F.
Tounkara, Moctar
Diarra, Samba
Doumbia, Seydou
Bhutta, Zulfiqar A.
Bassani, Diego G.
author_sort Ataullahjan, Anushka
collection PubMed
description ABSTRACT: BACKGROUND: Mali is currently in the midst of ongoing conflicts which involve jihadist groups, rebels, and the state. This conflict has primarily centered in the North of the country. Humanitarian actors delivering services in these geographies must navigate the complex environment created by conflict. This study aimed to understand how humanitarian actors make decisions around health service delivery within this context. METHODS: The current case-study utilized a mixed methods approach and focused on Mopti, Mali’s fifth administrative region and fourth largest in population. Latent content analysis was used to analyze interview transcripts guided by our research objectives and new concepts as they emerged. Indicators of coverage of health interventions in the area of maternal and child health and nutrition were compiled using Mali’s National Evaluation Platform and are presented for the conflict and non-conflict regions. Development assistance estimates for Mali by year were obtained from the Developmental Assistance for Health Database compiled by the Institute for Health Metrics and Evaluation. Administrative data was compiled from the annual reports of Mali’s Système Local d’Information Sanitaire (SLIS), Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). RESULTS: Our data suggests that the reaction of the funding mechanisms to the conflict in Mali was a major barrier to timely delivery of health services to populations in need and the nature of the conflict is likely a key modifier of such reaction patterns. Concerns have been raised about the disconnect between the very high administrative capacity of large NGOs that control the work, and the consequent burden it puts on local NGOs. Population displacement and inaccurate estimates of needs made it difficult for organizations to plan program services. Moreover, actors delivering services to populations in need had to navigate an unpredictable context and numerous security threats. CONCLUSIONS: Our study highlights the need for a more flexible funding and management mechanism that can better respond to concerns and issues arising at a local level. As the conflict in Mali continues to worsen, there is an urgent need to improve service delivery to conflict-affected populations.
format Online
Article
Text
id pubmed-7254666
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-72546662020-06-07 C’est vraiment compliqué: a case study on the delivery of maternal and child health and nutrition interventions in the conflict-affected regions of Mali Ataullahjan, Anushka Gaffey, Michelle F. Tounkara, Moctar Diarra, Samba Doumbia, Seydou Bhutta, Zulfiqar A. Bassani, Diego G. Confl Health Research ABSTRACT: BACKGROUND: Mali is currently in the midst of ongoing conflicts which involve jihadist groups, rebels, and the state. This conflict has primarily centered in the North of the country. Humanitarian actors delivering services in these geographies must navigate the complex environment created by conflict. This study aimed to understand how humanitarian actors make decisions around health service delivery within this context. METHODS: The current case-study utilized a mixed methods approach and focused on Mopti, Mali’s fifth administrative region and fourth largest in population. Latent content analysis was used to analyze interview transcripts guided by our research objectives and new concepts as they emerged. Indicators of coverage of health interventions in the area of maternal and child health and nutrition were compiled using Mali’s National Evaluation Platform and are presented for the conflict and non-conflict regions. Development assistance estimates for Mali by year were obtained from the Developmental Assistance for Health Database compiled by the Institute for Health Metrics and Evaluation. Administrative data was compiled from the annual reports of Mali’s Système Local d’Information Sanitaire (SLIS), Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). RESULTS: Our data suggests that the reaction of the funding mechanisms to the conflict in Mali was a major barrier to timely delivery of health services to populations in need and the nature of the conflict is likely a key modifier of such reaction patterns. Concerns have been raised about the disconnect between the very high administrative capacity of large NGOs that control the work, and the consequent burden it puts on local NGOs. Population displacement and inaccurate estimates of needs made it difficult for organizations to plan program services. Moreover, actors delivering services to populations in need had to navigate an unpredictable context and numerous security threats. CONCLUSIONS: Our study highlights the need for a more flexible funding and management mechanism that can better respond to concerns and issues arising at a local level. As the conflict in Mali continues to worsen, there is an urgent need to improve service delivery to conflict-affected populations. BioMed Central 2020-05-27 /pmc/articles/PMC7254666/ /pubmed/32514301 http://dx.doi.org/10.1186/s13031-020-0253-6 Text en © The Author(s). 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Ataullahjan, Anushka
Gaffey, Michelle F.
Tounkara, Moctar
Diarra, Samba
Doumbia, Seydou
Bhutta, Zulfiqar A.
Bassani, Diego G.
C’est vraiment compliqué: a case study on the delivery of maternal and child health and nutrition interventions in the conflict-affected regions of Mali
title C’est vraiment compliqué: a case study on the delivery of maternal and child health and nutrition interventions in the conflict-affected regions of Mali
title_full C’est vraiment compliqué: a case study on the delivery of maternal and child health and nutrition interventions in the conflict-affected regions of Mali
title_fullStr C’est vraiment compliqué: a case study on the delivery of maternal and child health and nutrition interventions in the conflict-affected regions of Mali
title_full_unstemmed C’est vraiment compliqué: a case study on the delivery of maternal and child health and nutrition interventions in the conflict-affected regions of Mali
title_short C’est vraiment compliqué: a case study on the delivery of maternal and child health and nutrition interventions in the conflict-affected regions of Mali
title_sort c’est vraiment compliqué: a case study on the delivery of maternal and child health and nutrition interventions in the conflict-affected regions of mali
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254666/
https://www.ncbi.nlm.nih.gov/pubmed/32514301
http://dx.doi.org/10.1186/s13031-020-0253-6
work_keys_str_mv AT ataullahjananushka cestvraimentcompliqueacasestudyonthedeliveryofmaternalandchildhealthandnutritioninterventionsintheconflictaffectedregionsofmali
AT gaffeymichellef cestvraimentcompliqueacasestudyonthedeliveryofmaternalandchildhealthandnutritioninterventionsintheconflictaffectedregionsofmali
AT tounkaramoctar cestvraimentcompliqueacasestudyonthedeliveryofmaternalandchildhealthandnutritioninterventionsintheconflictaffectedregionsofmali
AT diarrasamba cestvraimentcompliqueacasestudyonthedeliveryofmaternalandchildhealthandnutritioninterventionsintheconflictaffectedregionsofmali
AT doumbiaseydou cestvraimentcompliqueacasestudyonthedeliveryofmaternalandchildhealthandnutritioninterventionsintheconflictaffectedregionsofmali
AT bhuttazulfiqara cestvraimentcompliqueacasestudyonthedeliveryofmaternalandchildhealthandnutritioninterventionsintheconflictaffectedregionsofmali
AT bassanidiegog cestvraimentcompliqueacasestudyonthedeliveryofmaternalandchildhealthandnutritioninterventionsintheconflictaffectedregionsofmali