Malaria Management in the Decentralized Health System of Mali: A case study of three rural communities in the Mopti Region

Sorayya Khan

Research output: ThesisDoctoral Thesis

1802 Downloads (Pure)


Renewed international calls for the fight against malaria have led to initiatives that have espoused community participation as a crucial strategy in its prevention and treatment. Concurrently, the introduction of decentralization within the neo-liberal paradigm has called for increased participation of communities in their own development planning. The considerable debate on the benefits of participation in development more broadly, and particularly in health has not led to a vast in-depth analysis into participation in malaria management. Through an examination of the existing institutional structures of participation within the framework of a decentralized health system in Mali, this detailed empirical study examines to what extent health decentralization and the discourse of participation has worked in rural Mali with a focus on malaria management. In an area of high malaria morbidity and mortality and inadequate health service provision, it investigates the constraints in accessing knowledge, prevention methods and treatment for malaria. Through a mixed-method approach, data was gathered with a survey of 300 households in three villages of the Mopti region, complemented by interviews, group discussions with diverse stakeholders at different levels. The study is a novel contribution to the literature on the influence of decentralization on malaria management. Decentralization in rural Mali is not clearly understood at the village level, reinforcing existing power relations of local governance and community health structures. Lack of financial resource transfer to the commune, the lowest level of administration, significantly inhibits effective health service delivery. Different understandings of the role of the CHW, low levels of recognition of the relais communautaires (community health workers) in the communities, and a strong hierarchical structure of established modes of governance and social relations affect access health care.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
  • Willis, Katie, Supervisor
Award date1 Oct 2011
Publication statusUnpublished - 2011

Cite this