Malaria is one of the most serious threats to health in Mali. It is the subject of extensive training sessions for women who join the Saving for Change groups, and many of the women learn for the first time that the disease is transmitted by mosquito bites.
But once they know this they take serious action, learning how to prevent the disease by sleeping under nets treated with insecticide, and filling in puddles and other places where mosquitoes can breed. They take special care to help pregnant women get access to government-sponsored prenatal care, which includes a free mosquito net.
A recent survey of villages where Saving for Change groups have been formed is showing that 75 percent of members understand that mosquitoes transmit malaria, while only half of non-members in the communities know this. Seventy percent of members knew that mosquito nets are an effective way to prevent malaria, compared to only 40 percent of non-members. More than half of members said they slept under a bed net the previous evening, compared to just 30 percent of others in the community. And more than 40 percent of Saving for Change members said they had purchased a bed net since joining a group, evidence that the availability of information about the value of bed nets contributed to changes in behavior.
Overall, malaria killed 22,000 people in Mali in 2005, and ranked third among all causes of death after respiratory infections and diarrheal diseases, according to the World Health Organization's latest figures. The death toll for children is particularly severe. Mali ranks 175 out of 177 countries in the rate of death from all causes of children under five, at 218 per 1,000, and malaria causes about 17 percent of those deaths.
"Malaria is a crucial problem in Mali," says Macky Doucouré, president of the non-governmental group CAEB, one of Oxfam's Saving for Change partners in Mali. "The majority of deaths of pregnant women are due to malaria. More women in Mali die from malaria than they do from AIDS...as many as die in childbirth."
The death toll is heavy, but so is the price to stay alive, as many families struggle to find money to transport sick people to clinics, and buy medication. "Some families have to spend as much as 60 percent of their income on health care," Doucouré said. This is why malaria is an important topic when it comes to community finance programs: nothing will destroy a family's assets like chronic illness.
Once women are organized into Saving for Change groups it is easier for them to work together to educate people in their village about malaria and take steps to prevent it. "It is a really big change for people to understand that there are things they can do in their own villages to prevent malaria," Doucrouré said.
He described one village where women in a Saving for Change group took some extraordinarily active steps. "They decided to create their own committee to help women prevent malaria, and encourage the use of insecticide impregnated mosquito nets at night while people are sleeping. Each night members of the committee would visit homes to make sure women and their children were sleeping under their mosquito nets, and they would even fine women not using the nets 50 CFA or maybe 100 CFA [10 or 20 cents]."
"Creating a committee to prevent and help people treat malaria is a significant innovation for these families and their village, and it was made possible by the Saving for Change group financed by Oxfam—it is something the women created themselves to deal with the problem, it did not come from outside the village."