Abstract
BackgroundIn Mali, nomadic populations are spread over one third of the territory. Their lifestyle, characterized by constant mobility, excludes them from, or at best places them at the edge of, health delivery services. This study aimed to describe nomadic populations’ characteristics, determine their perception on the current health services, and identify issues associated with community-based health interventions.MethodsTo develop a better health policy and strategic approaches adapted to nomadic populations, we conducted a cross-sectional study in the region of Timbuktu to describe the difficulties in accessing health services. The study consisted in administering questionnaires to community members in the communes of Ber and Gossi, in the Timbuktu region, to understand their perceptions of health services delivery in their settings.ResultsWe interviewed 520 individuals, all members of the nomadic communities of the two study communes. Their median age was 38 years old with extremes ranging from 18 to 86 years old. Their main activities were livestock breeding (27%), housekeeping (26.4%), local trading (11%), farming (6%) and artisans (5.5%). The average distance to the local health center was 40.94 km and 23.19 km respectively in Gossi and Ber. In terms of barriers to access to health care, participants complained mainly about the transportation options (79.4%), the quality of provided services (39.2%) and the high cost of available health services (35.7%). Additionally, more than a quarter of our participants stated that they would not allow themselves to be examined by a health care worker of the opposite gender.ConclusionThis study shows that nomadic populations do not have access to community-based health interventions. A number of factors were revealed to be important barriers per these communities’ perception including the quality of services, poverty, lifestyle, gender and current health policy strategies in the region. To be successful, future interventions should take these factors into account by adapting policies and methods.
Highlights
In Mali, nomadic populations are spread over one third of the territory
The constant mobility of nomadic populations excludes them, or at best places them at the edge of health delivery services
This study aimed to describe nomadic populations’ characteristics and determine factors limiting nomads’ access to current health services and identify accessibilityrelated health intervention issues among the nomads
Summary
In Mali, nomadic populations are spread over one third of the territory. Their lifestyle, characterized by constant mobility, excludes them from, or at best places them at the edge of, health delivery services. In rural areas of Mali, especially in the northern part of the country, local populations experience the highest infant mortality rates (191 per 1000 births). Health services and human resources are generally concentrated in the populated urban areas of the country. Wealth and natural resources are unequally distributed across the country. Those living in the northern regions of the country suffer from recurring periods of drought and widespread food shortages [5, 6]
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