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Mali

Last Updated: December 28, 2011

Senior Program Officer:

Jonas Mbwangue, MPA

  • Program Activities
  • Health Sector Architecture
  • Health Financing
  • Budgeting
  • Budget Flows and Reporting
  • Budget Performance
  • Parliamentary Notes
  • Immunization Performance Indicators
  • Disease Burden
  • Useful Links

    • Program Activities:

    • 14-20 December 2008: Program Officer Jonas Mbwangue held introductory meetings with Ministry of Health, GAVI partner and key parliamentarians.
    • 28 January - 2 February 2009: Program Officer Jonas Mbwangue and Dr. Michael McQuestion met with Mali's Interagency Coordinating Committee and GAVI partner agency counterparts.
    • July 2009: Program Officer Jonas Mbwangue conferred with parliamentarians, external partners and MoH counterparts in Dakar.
    • August 2009: First SVI-sponsored parliamentary briefing held in Bamako.
    • November 2009: Two workshops were held; the first was to guide West African nations on how to review their cMYP with regard to WHO, UNICEF and GIV guidelines. The second workshop focused on the role of partners, including WHO, UNICEF, and others, in supporting the financial sustainability of EPI.
    • December 2009: Eight counterparts from Ministry of Health, Ministry of Finance and parliament attended the SVI-organized parliamentary briefing in Dakar, Senegal.
    • March 2010: Mr Mbwangue attended the cMYP Review Meeting for West Africa organized by WHO.
    • April 2010: Mr Mbwangue organized a meeting with Malian MP and MOH/MOF-staff to document their experience on decentralization, shared in the April 29-30 Workshop in Yaounde-Cameroon.
    • September 2010: Senior Program Officer Jonas Mbwangue and Director Mike McQuestion organize an SIF meeting in Mali to discuss strategies in establishing a National Immunization Trust Fund for the country.
    • March 2011: Mr. Mbwangue conferred with parliamentarians and government counterparts in Bamako to plan the next parliamentary briefing and follow up legislative projects for immunization financing.
    • April, June, September 2011: Mr. Mbwangue met with ICC partners and government and parliamentarian counterparts in Bamako.
    • October 2011: Third Sabin parliamentary briefing held at Assemblee Nationale, Bamako.

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      Health Sector Architecture:

      • Mali is a SWAp country.
      • Mali is a fully-inaugurated IHP+ country; its compact was approved in April 2009. Read more here.
      • . Mali’s EPI Program is located in the Immunization Section of the Disease Control and Prevention Division, National Health Directorate, Ministry of Health. In an October 2011 briefing, MPs suggested the EPI be reorganized from a program to a division to facilitate oversight.
      • Support for Mali's EPI Program is coordinated by an Inter-agency Coordinating Committee for Immunisation (IACC). The IACC met twice in 2009.
    • Mali's 703 communes receive and administer federal transfers to finance basic health services. Collectivites participate actively in the budgeting process (microplannification.)

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      Health Financing:

      • In 2007, Malians spent US$67 per capita on health. Health accounted for 12% of recurrent government expenditures. (Source: Countdown to 2015 Report, 2010)
      • In 2008, Mali received US$57.4m in Official Development Assistance for health, up from US$42.5m in 2007. (Source: OECD Creditor Reporting System)
      • Highly Indebted Poor Countries (HIPC) / Multilateral Debt Relief (MDR) Initiatives: Mali began receiving HIPC debt relief credits in September 2000. As of mid-2009, the country had received credits totaling US$2.01b (of a total commitment of $2.90b). As per the Poverty Reduction Strategy Paper (PRSP), the government has used these savings to invest more in poverty-reducing programs, including PHC delivery (from $155.4m in 2001 to $560.7m in 2007). (Source: HIPC and MDRI- Status of Implementation: September 15, 2009)

      • Immunization Financing
        • In 1996, Mali established a budget line item for vaccine and financed most of its vaccine needs through the African Vaccine Independence Initiative. Since then, one percent of Mali’s debt relief (HIPC) fund has been dedicated for vaccine purchase
        • According to the World Health Organization, the Government of Mali spent US$2.1m on its routine EPI program in 2000, representing 41 percent of all routine EPI expenditures. For 2002 the figure was $2.3m (18 percent).The country received its first GAVI grant in 2003. In 2006, the government spent $145,088 on its routine immunization program. The figures for 2007-2010 were, respectively, $1.9m, $1.1m, $2.3m and and $6.6m.
        • According to the 2007-2011 cMYP, $9.4m were spent in 2005 specifically on the routine EPI program ($19 per infant born that year). Adding in shared health services expenditures to support EPI increases this to $12.1m ($25 per infant). The government financed $4.0m of the specific routine EPI expenditures (33 percent), about $8 per infant.
        • The overall pattern suggests an increasing government investment from 2009.
        • The 2012 EPI budget is slated to increase from CFA 3.3 billion (US$7.1m) to CFA 6 billion ($12.8m).
        • Amount spent (USD) by the government of Mali on routine immunization per infant (2000-2010)
          Mali routine imm spending 2000 2010_0.jpg

        • Source:
          1. WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Mali. All data derived from the WHO/UNICEF Joint Reporting Form as follows:
          a: C_6450. This % excludes any external financing from donors.
          b: C_6490. This % includes all recurrent, immunization-specific spending financed solely with government funds. This includes vaccines, injection supplies, salaries, and per diems of health staff working full-time on immunization, transport, vehicles, and cold chain maintenance, training, social mobilization, and monitoring and surveillance. "NA" indicates data not available.

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      Budgeting:

      • Mali's 2006 Poverty Reduction Strategy Paper (PRSP 2007-2011) provides policy linkage to the country's budget. It complements the Department of Health's long-term sectoral plan (PRODESS-II).
      • By law, Mali's annual budget must balance. Budgets cannot exceed a certain percentage of GDP
      • The government proposes annual and estimated medium-term budgets to parliament.
      • In 2012, the health sector will represent 12.05% of the federal budget, the Ministry of Economy and Finance reported.

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        Budget Flows and Reporting:

        • Mali has met its 2008-2011 GAVI co-financing requirements.

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          Budget Performance :

          • In 2008, Mali's routine EPI Program immunized 521,142 children with DTP3 and spent around US$27 per DTP3 immunized child (US$14,163,420 total), up from $25 per DTP3 immunized child in 2006. (Source: GAVI Annual Progress Report, 2008 and GAVI Annual Progress Report, 2006)
          • For 2008-2010, reported the Ministry of Budget and Finance, Mali's EPI Program used all of its government budget: Absorptive capacity 100%. The Treasury disbursed its approved budget on time: Cash hoarding was not a problem.
          • The Ministry of Budget and Finance is requesting the Ministry of Health undertake three budget reforms starting with the proposed 2013 budget. The first is to change the sector budget headings (to facilitate output-based budgeting reforms). The second is to provide a more detailed justification for the EPI budget. A third request is to link the EPI program budget request to actual vaccine coverage at subnational levels (to facilitate decentralization).
          • Country Policy and Institutional Assessment:
            The World Bank 2007 CPIA gave Mali's budget and financial management systems (Indicator #13) a score of 3.5, down from 4.0 in 2005. (mean 2007 score for all IDA countries: 3.2) Read more here.

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          Parliamentary Notes:

          • Mali has a unicameral parliament parliament (Assemblée Nationale). The Finance Committee (Commission des Finances) and Committee for Health and Social Development (Commission Sante et Developpement Social) provide health sector and immunization program oversight.
          • Mali's President is elected separately from Parliament. The President unilaterally names Cabinet ministers. Ministers cannot also be Members of Parliament. The President's power to dismiss ministers is restricted. Mali's Parliament is relatively vulnerable. It can censure Cabinet or the President but doing so empowers the President to dissolve Parliament.
          • In 2009, the MoH began inviting members of the budget and health committees to participate in budget arbitrage meetings.
          • In an October 2011 Sabin-supported briefing, MPs stated that insufficient travel budgets prevented them from providing effective oversight for EPI and other government programs.
          • The presidential election is scheduled for April 2012. The parliamentary election follows in July 2012 (Source: ElectionGuide).
          • Loi 98-036 states the government’s responsibility to control epidemic diseases through obligatory immunizations.
          • Chapter III, Article 17 of Mali’s Constitution (1992) recognizes citizens’ right to health.
          • In an October 2011 briefing, MPs agreed to undertake a projet de loi with the Ministry of Health which will update immunization legislation, including assuring public financing for routine immunization.

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            Immunization Performance Indicators:*

            Percent of districts reporting at least 80% coverage (DPT3), 2008*: 81%

            Percent of districts reporting at least 80% coverage, DPT3, 2001-2008

            *Source:
            WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Mali. Data derived from the WHO/UNICEF Joint Reporting Form, Indicator GSA17ap. "NA" indicates data not available.

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            Disease Burden:

            Population (2008): 12,706,000
            Births (2008): 542,000
            U5 Deaths (2008):
            - total 100,000
            - preventable by routine EPI: 14,0001
            - preventable by routine EPI and new vaccines: 25,0002

            (Source: UNICEF "State of the World's Children" 2009 )

            1 Assumes use of BCG, DPT, polio, and measles vaccines prevent 14% of U5 deaths.
            2 Assumes use of BCG, DPT, polio, measles, HepB, Hib, yellow fever, and pneumococcal antigen-containing vaccines prevent 25% of U5 deaths.

            Note: Vaccine preventable death estimates assume that force of infections, individual susceptibility, and probability of exposure are constant at all mortality levels.

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            Useful Links:

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