Conflict, displacement and sexual and reproductive health services in Mali: analysis of 2013 health resources availability mapping system (HeRAMS) survey

Abstract

ObjectiveLittle is known specifically about the effects of conflict and displacement on provision of sexual and reproductive health (SRH) services. We aimed to understand the association between levels of conflict and displacement and the availability of SRH services in post-conflict Mali.MethodsA national assessment was conducted between April and May 2013 employing Health Systems Availability Mapping System (HeRAMS). Data from 1581 primary care facilities were analysed, focusing on SRH services. Descriptive analyses and multivariable logistic regression models were used to examine the availability of SRH services by different levels of conflict and displacement.FindingsOf 1581 facilities, 1551 had data available to identify the details of service provision. The majority of the facilities were part of the public sector (79.1 %), identified as basic community primary care facilities (71.9 %). Overall 15.7 % of the facilities were in the zones under occupation, 40.3 % in the areas with high concentration of displaced population and 44 % in areas with low concentration of displaced populations. Between zones of low concentration of displaced populations and under occupation the likelihood of service availability varied between OR: 2.9 (95 % CI 2.0–4.4) for basic emergency obstetric care and OR: 41.7 (95 % CI 20.4–85.3) for family planning. All of the services within the three domains of SRH were more likely to be available in the low and high concentration displaced population areas compared to the facilities in the under occupation zones, after adjusting for other facility-related variables.ConclusionAreas with high concentration of displaced population had less service availability, and areas formerly under occupation had the least service availability. This suggests that those living in conflict areas, and many of those who are internally displaced, have poor access to essential SRH interventions. The systematic measurement of the availability of health services, including SRH, is feasible and can contribute to recovery planning in post-conflict and humanitarian settings.

Effects of conflict on child health: Evidence from the 1990–1994 Northern Mali Conflict

“…8 MPA, with support from the Malian army, fought against the Popular Liberation Front of Azawad and ARL. 9 Tuncalp et al (2015) analyzed data on health-care facilities collected during the 2012 northern Mali conflict and found that facilities in conflict areas lacked several services such as prenatal care, skilled care during childbirth, and postnatal care because of the medical supply chain, and even qualified health-care workers. 10 Table A1 in the Appendix provides detailed information on these conflicts.…”

“…It was observed in the Malian conflict that in areas with fierce battles, regular markets were closed and access to health facilities was disrupted (Tuncalp et al, 2015), and the security was compromised such as robbery and private punishment (Poulton & ag Youssouf, 1998). There must have been other ways that conflict affects civilians (Kadir, Shenoda, & Goldhagen, 2019).…”

Factors Impacting Family Planning Use in Mali and Senegal

“…In comparison, Senegal is considered to be one of the more politically stable countries in West Africa [7]. According to Tunçalp et al (2015), significant strains were placed on the few reproductive services available in the south of Mali as more internally displaced women relocated there [8]. However, the health systems in both countries have been severely compromised by a long-term lack of investment [9].…”

Patient-centred attitudes among medical students in Mali, West Africa: a cross-sectional study

“…In addition to the aforementioned challenges of delivering patient-centred care in sub-Saharan Africa, providers in Mali face unique challenges of maintaining quality services in a highly decentralised, primary healthcare system 28 and ensuring access to care in hard-to-reach rural and conflict-ridden areas. 29 Our objectives were to assess patient-centred attitudes among medical students, determine if patient-centred attitudes vary according to academic year and demographic factors and test the construct validity and internal consistency of the PPOS in this setting.…”