Impact evaluation of the interrelated household and community health (Keneya Nieta) and the health systems strengthening, governance and financing (Keneya Sinsi Wale) activities in Mali

The accountability, governance, and financing intervention implemented at the health zones level by KSW include the following activities:
• Improving transparency in health service management and decision-making at community level
• Enhancing accountability mechanisms in place at community and district levels
• Improving health governance at district and regional levels
• Improving community-level health governance
• Contributing to evidence and learning for sustainable health financing strategies
• Improving financial management and budget implementation at regional, district, and local levels
• Improving transfer of resources from mayors’ offices to ASACO
• Improving community financial management systems

The accountability, governance, and financing intervention implemented at the villages level by KN include the following activities:

• Increasing financial literacy, financial planning, and use of savings for health at the individual, HH, and community levels
• Improving individual, HH, and community livelihood strategies and income management to generate resources for health
• Organizing communities to finance, and maintain local emergency transportation from HHs to health centers
• Provision by individuals, HHs and communities sustained financial and in-kind support to CHWs and community volunteers
• Improving community members’ understanding of the roles and responsibilities of the different actors in the health system, and their own roles and responsibilities in providing oversight and shaping the delivery of local health services
• Increasing community health leadership roles held by diverse people across the spectrum of gender, age, and roles in the community
• Ensuring the monitoring and supervision by community members of the health services and hold the service providers, the managers, and local elected officials responsible for the availability and quality of the health services and systems
• Increasing in the community health leadership positions occupied by various persons according to their sex, age, and role within the community

2022-04-04

2024-06-30

% of Children 12-23 months fully immunized (All vaccines appropriate for the age group)
% Children who receive Penta 3 by 12mo
Antenatal care coverage - at least four visits (%)

The impact evaluation combines a cluster-randomized stepped wedge design and a traditional parallel cluster randomized control trial. The cluster randomized stepped wedge design for the AGF interventions implemented at health zones by KSW and a traditional parallel cluster randomized control trial design for the AGF interventions implemented at village level by KN. For the cluster randomized stepped wedge design, the health zones will receive the intervention in the staggered fashion spread over three years. For a traditional parallel cluster randomized control trial design for the AGF interventions implemented at village level by KN, we have two groups, a treatment group which will receive the intervention for at least two years and a comparison group which will not receive the intervention.

Not available

Randomization done in office by a computer

Health zone (Aire de santé)

Yes

84 health zones

84 health zones, 84 community health centers, 252 village health committees and 2,772 women and 2,772 children (12-23 months)

42 health zones, 42 community health centers, 252 village health committees and 1386 women and 1386 children (12-23 months) by treatment arm

We have 86% statistical power to detect an increase of 10 percentage points of % of Children 12-23 months fully immunized (All vaccines appropriate for the age group)