1
Mid-Term Evaluation Report
Of
Child Survival Project
Kita District, Mali
For
Plan International USA, Inc.
Childreach
Cooperative Agreement No: HFP-A-00-01-00046-00
September 30, 2001, - September 29, 2006
Report Prepared 
By
Aguibou Coulibaly, Plan - Mali
Souleymane Bagayoko, Plan - Mali
Pierre-Marie Metangmo, Plan – USA
Laban Tsuma, Plan - USA
Sandra Wilcox, Consultant
December 2004 – January 2005
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ACKNOWLEDGEMENTS
The principal author of this report would like to thank the staff of the Kita Program Unit 
for its support, hard work and patience during the period of the mid-term evaluation. 
They gave freely of their time despite their busy schedules and responsibilities. It is also 
important to acknowledge the high degree of dedication and professionalism that they 
bring to their work. It is evident in the quality of the programs that the Program Unit 
manages under very difficult circumstances. It is also important to acknowledge the hard 
work and dedication of the Kita District health team who despite their pressing 
commitments, made significant contributions as members of the evaluation team. The 
useful insights and contributions of Plan/ Mali’s National Child Survival Coordinator, 
and its Health Coordinators for Banamba and Kangaba, were also appreciated, as were 
those of the representatives from the FELASCOM, the Kayes Regional Health Office, 
and the Kita Social Service Office.
The efforts and support of Plan International USA and its Health Program Coordinator 
must also be acknowledged for their guidance before, during and after the evaluation.
Despite the best efforts of both the Kita PU and the headquarters staff, factual errors may 
persist in the report. They must be considered the responsibility of the principal author 
who tried to grasp the complexity of the environment in a short period of time. She hopes 
that she was successful.
3
ACRONYMS
ANC Antenatal Care 
ARAFD/C Consortium of local NGOs (ACD, ARAFD and ODILE)
ASACO CSCom Health Board/ Community Health Association
BCC Behavior Change Communication
CBOs Community-based Organizations
CDC Community Development Coordinator
CPO Country Programme Outline
CPM Chief of Medical Post
CSCom Community Health Center
CSP Child Survival Program
CSRef Referral/ District Health Center
CSV(VHC) Village Health Committee
DIP Detailed Implementation Plan
DNS National Health Directorate
DRDS-ES Regional Directorate of Social Development and Economic
Solidarity
DRS Regional Health Directorate
EVP/EPI Extended Vaccination Program
FELASCOM National Association of Community Health Associations
HC Health Center
HIS Health Information System
IEC Information, Education, Communication
IMCI/PCIME Integrated Management of Childhood Illness
ICPM Chief Nurse of medical Post
KPC Knowledge, Practice, Coverage
LQAS Lot Quality Assurance Sample
MOH Ministry of Health
NGO Non-Government Organization
NICRA Negotiated Indirect Cost Rate
ORS Oral Rehydration Solution
PDRIK Kita Integrated Rural Development Project (Debt Relief )
PRA Participatory Rural Appraisal
PU Plan Program Unit (Regional Office)
PUM Plan Program Unit Manager
SE Child Survival
SSSC District Health and Social Development Service
TBA Traditional Birth Attendant
TT Tetanus Toxoid
UNICEF United Nations International Children’s Emergency Fund
USAID United States Agency for International Development
USNO Plan United States National Office
WHO World Health Organization
WRA Women of Reproductive Age (15-49)
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Table of Contents
Acknowledgements
Acronyms
A. Executive Summary 5
B. Assessment of Progress toward objectives 13
 
B.1. Technical Approach 13
B.2. Cross-Cutting Approaches 19
a) Community Mobilization 19
b) Communication for Behavior Change 21
c) Capacity Building 22
i) Strengthening the PVO Organization 22
ii) Strengthening the Local Partner Organizations 22
iii) Health Facilities Strengthening 22
iv) Strengthening Health Worker Performance 25
v) Training 25
d) Sustainability Strategy 27
C. Program Management 28
C.1. Planning 28 
C.2. Staff Training 29
C.3. Supervision of Program Staff 30
C.4. Human Resources and Staff Management 30
C.5. Financial Management 31
C.6. Logistics 31
C.7. Information Management 32
C.8. Technical and Administrative Support 33
E. Conclusions and Recommendations 33
F. Results Highlight 37
III Action Plan 38
IV. Attachments 42
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A. Summary
The Plan- Kita Child Survival Project is located in the southeastern section of Kita 
district in southern Mali. The project targets 52,091 women of reproductive age, 10,418 
infants 0-11 months and 36,464 children ages 1-4. Plan has been working in the region 
since 1994 in areas of integrated health and development. It has been working with the 
same project NGO partner, ARAFD/C, during this time. According to the 1996 DHS, 
infant mortality is 135 per 1000 live births and child mortality is 259 per 1000. Principal 
causes of death are malaria, diarrhea and measles with underlying complications 
attributed to malnutrition. Utilization of health services was extremely low, (8%). The 
program approach is to strengthen and improve the quality of the existing health care 
system. This approach comprises two strategies: (1) Training and building the capacity of 
health personnel and supporting community health committees (ASACOs) in order to 
increase utilization of health care services, and (2) Supporting implementation of IMCI 
skills/ training in the CSComs. The project’s four intervention areas are reduction of 
morbidity and mortality associated with Malaria (35%), reduction of morbidity and 
mortality through control of Diarrheal Disease (20%), increasing immunization 
coverage (35%) in the district for children and pregnant women , and reduction of 
morbidity and mortality associated with Pneumonia (10%).
As can be seen from the LQAS results achieved in year 3, the project is making 
substantial progress towards achievement of its objectives. The project has either 
surpassed or achieved most of its year 3 objectives. It has been particularly successful in 
increasing immunization coverage. The percentage of fully vaccinated children in Kita 
district increased from 30 percent at the baseline to nearly 70 percent at the November 
LQAS. Other notable achievements include the strengthening of the CSCom health 
committee or ASACOs management capabilities. For the first time, project CSComs are 
now able to fully support the health center staffs and maintain regular supplies of 
essential medicines. These achievements are due to improved ASACO management 
skills, improved quality of care through IMCI training and increased community 
mobilization activities through village relays and Village health Committees. 
The main concerns (constraints) revolve around whether the communities and CSComs 
will be able to maintain the level of health achievements after the project phases out of 
their areas. All actors believe that the phase-in/ phase-out period (2 years) is too short. 
To address this, the project is proposing to conduct an evaluation of the CSComs that 
have been phased out of and make recommendations for follow-up strategies. Other 
constraints concern the lack of anticipated support from PIDRIK for building and 
equipping of 10 CSComs in the district, which was to complement CS project support. 
This was to have occurred at the beginning of the project and although the support is still 
promised, so far it has not arrived. Plan and the MOH are addressing the shortfall by 
contributing extra resources, but there is a question as to whether the project will be able 
to reach and strengthen all 26 CSComs as planned.
The CS Project has done an impressive job of strengthening the skills and capacities of 
district health staff through training. The IMCI training has been particularly well 
6
received and has greatly improved the quality of care at the health centers. The project 
has also supported immunization efforts through transportation assistance and fuel. The 
project has also provided equipment for all project CSComs. The CSCom health 
committee (ASACO) management skills have also been strengthened through the project, 
as have the village health committees. The project has also greatly improved the skills of 
the NGO partner staff in the areas of community mobilization. 
The conclusions, challenges and recommendations are discussed below:
Conclusions
Successes
· As noted in the LQAS results, the project is making good progress in achieving its 
projected results. It has already either met or surpassed most of its year 3 
objectives. Perhaps the biggest success is the achievement of almost 70 percent of 
children who are fully vaccinated. The recognition of this achievement on the 
part of the MOH is a huge indication of the project’s success. Prior to project 
initiation, the MOH had targeted Kita District as having the worst immunization 
levels in the country. Now they are sending a team to verify the results and are 
using it as a model for other districts.
· The project has also achieved tremendous success in mobilizing communities to 
use health services. The relays, animators and VHCs have been very effective in 
mobilizing their communities to seek care and preventive services, especially 
immunizations and prenatal care. The number of referrals by village relays 
increased from 27 in 2003 to 118 in 2004. The project staff have also been 
innovative in helping health center staff bring services to the villages. This has 
been by supporting the work of the CSCom vaccination staff and by encouraging 
the matrons to accompany them and offer prenatal consultations in the villages at 
the same time.
· Another contribution has been the strengthening of the management skills of the 
ASACOs. Every ASACO visited had its accounting and bank books in order. 
Also, every ASACO was able to meet its financial obligations of supporting the 
salaries of the CSCom staffs. Given the poverty of the region, this is a 
commendable achievement and may be the only country/ region where local 
government health services are completely supported by community constituents.
· The project has done a good job of developing a community-based health 
information system. There is good evidence that the information is being used by 
the communities and CSComs for planning and for making health care decisions.
· The IMCI training that was instigated by the project, has greatly improved the 
quality of care at the CScoms. The health staff are now able to perform broad 
diagnosis of child illness and provide counseling for caregivers. This improved 
quality of care seems to be partially responsible for the increase in visits for 
services. 
· Plan has done a good job of strengthening local partner technical capacities. The 
local NGO staff now possess health and mobilization skills that they are able to 
use in other areas. 
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· Despite the unavailability of the originally planned support, the project has been 
able to meet all the designated equipment needs for the project CSComs and 
provide material support for outreach activities. 
Challenges
· One of the biggest issues is the sustainability of program inputs and whether the 
phase in/phase out timeline is too short. The project has achieved tremendous 
success in getting people to use preventive and curative services. All the project 
inputs such as IMCI training of providers, formation of relays and VHCs and 
corresponding community mobilization activities, and strengthening of the 
ASACOs so they can fulfill their management mandate, have contributed to the 
increase use of services and the self-sufficiency of the CSComs. The question is 
whether the ASACOs, VHCs and relays are sufficiently capable at this point to 
continue CSCom support activities on their own. There is concern that the 
organizational support structures are not in place yet for them to do this.
· It is clear that the relays need a lot of motivation to continue their activities. They 
are asked to maintain 7 registries, organize meetings, follow-up on referrals, 
mobilize villages for immunizations, and generally address health issues in the 
villages. The project animators who live in the area are doing a good job of 
training and motivating them but once the project phases out, they will no longer 
do this. 
· The project has had to work around the fact that PIDRIK has not come through 
with the promised constructing and equipping of 10 CSComs for the district 
health system. Plan and the CSRef have been able to come up with some extra 
resources but it is unclear whether they will be able to fully equip and construct 
all 26 CSComs as planned.
· The project has done a good job of working with community HC and relays and 
training them in areas of community mobilization and in the health intervention 
areas. However, there is still work to be done in the area of IEC/ BCC. Many 
villagers are still unaware of proper care related to CDD, such as exclusive 
breastfeeding and handwashing. Likewise some villages are very aware of malaria 
prevention and use of bednets while others are not as attuned. The project lacks an 
overarching BCC strategy that targets specific behaviors and includes specific 
communication interventions. The project is also lacking in IEC materials that 
the relays and animators could use to reinforce health messages. In the DIP the 
project had planned to develop materials but was unable to with the budget 
adjustments.
8
· Given the difficult roads and the large distances to be traveled, particularly with 
the 5 new CSComs that are located at the other end of the district, the project staff 
will need significant travel time and vehicle support for supervision and support 
activities. This will infringe on the vehicle support already required for on-going 
monitoring activities in the current project areas. In addition, the motorbikes that 
the animators use are almost worn out and require significant repairs.
Recommendations
· The project should conduct an evaluation of the CSCom areas that it has phased 
out of to see how well the health agents, ASACOs, VHCs and relays are doing in 
managing the health activities without project support. If there are problems then 
the project should take steps to address them in a timely manner.
· In order to strengthen the sustainability of the relays, the evaluation team 
recommended that the Chef du Post become the supervisor of the relays and their 
activities. This could be done at the time of regular outreach visits to the villages 
and/or through monthly meetings of all the relays at the CSCom. There are some 
administrative arrangements that need to be made in order for the CDP to 
supervise the village relays but once this is done there would be a system in place 
for on-going supervision of village health activities. This could start by having the 
CSCom team and the animators conduct joint team supervisions in the 
surrounding villages. Then after the animators leave, the supervision system 
would be in place. This would strengthen the sustainability of relay and village 
health committee activities. The on-going supervision of the relays would also 
strengthen their motivation, particularly if they were seen as working with the 
chef du Post who is very respected in the area. The evaluation team also 
recommended that the project staff and district health staff attend quarterly 
supervision meetings done at the CSComs. Their presence would encourage the 
other actors (ASACOs, CSCom staff, VHCs and relays) to attend and get 
involved in the process. They also pointed out that if the district staff were there, 
there would be more likelihood that the mayors would participate in the relay 
supervision meetings. This is important given that the mayors have access to their 
own source of funds and would be more likely to spend them on relay activities if
they were involved in their management.
· If PIDRIK comes through with funding this year for the construction of the 10 
CSComs that they are promising, then the project needs to work with them and 
the MOH to see how to equip the facilities and carry out the corresponding 
community activities with the limited project resources. If PIDRIK does not come 
through with the anticipated funding, then the project needs to decide how many 
more CSComs it can realistically work with by the end of the project. Once the
CS project has the results of the CSCom phase-out evaluation discussed above, it 
will be able to decide whether it should put more resources into new CSCom 
9
areas or if it should devote them to strengthening the sustainability of the old 
ones.
· Recommend that the project contract a short term BCC consultant to help them 
design a strategy that includes behavior change targets and strategies as well as 
awareness raising communications activities. It would be useful to employ more 
entertaining cultural formats that could be used to create interest in the villages 
such as stories, songs, street theater, and other methods. 
· The CS project needs to follow through on its original plan to acquire and/or 
develop IEC materials that are appropriate for the target audiences. The health 
messages need to be reinforced through support materials. Also the materials 
would help the relays with their educational tasks.
· If resources permit, the project should consider acquiring another vehicle for the 
work in the new CSComs in the far northern section of the district. It should also 
consider replacing some of the worn out motorbikes being used by the animators.
· In order to strengthen some of the intervention activities, the project should 
consider providing breastfeeding technical assistance to improve technique and 
promote exclusive breastfeeding in the communities.
Action Plan
III. Action Plan
Recommendation Steps that need to be 
taken to effectively 
address recommendation
Actor who 
will be 
responsible 
for each step
Timeline. By 
when each 
step shall 
have been 
accomplished
The project should conduct an 
evaluation of the CSCom areas that it 
has phased out of to see how well the 
health agents, ASACOs, VHCs and 
relays are doing in managing the 
health activities without project 
support. If there are problems then the 
project should take steps to address 
them in a timely manner.
1) Develop TOR of the 
survey
 2) Identify the 
institution, which will 
carry out the survey and 
negotiate a contract for 
carrying out the survey
3) Organize a workshop 
for the validation of the 
protocol before the 
starting of the survey. 
1) Dr 
Bagayoko 
PSE 
Coordinator
 2) Dr 
Aguibou 
Coulibaly
3) Dr 
January 05
March 05
April 05
10
Bagayoko
2. In order to strengthen the 
sustainability of the relays, the 
evaluation team recommended that the 
Chef du Post become the supervisor of 
the relays and their activities. This 
could be done at the time of regular 
outreach visits to the villages and/or 
through monthly meetings of all the 
relays at the CSCom. There are some 
administrative arrangements that need 
to be made in order for the CDP to 
supervise the village relays but once 
this is done there would be a system in 
place for on-going supervision of 
village health activities. This could 
start by having the CSCom team and 
the animators conduct joint team 
supervisions in the surrounding 
villages. Then after the animators 
leave, the supervision system would be 
in place. This would strengthen the 
sustainability of relay and village 
health committee activities. The on￾going supervision of the relays would 
also strengthen their motivation, 
particularly if they were seen as 
working with the chef du Post who is 
very respected in the area. The 
evaluation team also recommended 
that the project staff and district health 
staff attend quarterly supervision 
meetings done at the CSComs. Their 
presence would encourage the other 
actors (ASACOs, CSCom staff, VHCs 
and relays) to attend and get involved 
in the process. They also pointed out 
that if the district staff were there, 
there would be more likelihood that 
the mayors would participate in the 
relay supervision meetings. This is 
important given that the mayors have 
access to their own source of funds 
and would be more likely to spend 
1) Make administrative 
arrangements (making 
memorandum of 
understanding, entering 
of the supervision 
responsibility in the job 
description of heads of 
post)
2)Define and negotiate 
the implementation of a 
mechanism of joint 
supervision of health 
activities in villages 
with a schedule of 
implementation and 
budget
3) Develop and 
negotiate the 
implementation of a 
plan of organization of 
meetings with actors 
(mayor, CSREF, PSE 
team)
1) Head of 
district health 
center
 2) Elie 
Coulibaly 
Responsible 
for SE 
Monitoring 
and 
Evaluation
3) Dr 
Souleymane 
Bagayoko
January 05
January 05
February 05
11
them on relay activities if they were 
involved in their management.
3. If PIDRIK comes through with 
funding this year for the construction 
of the 10 CSComs that they are 
promising, then the project needs to 
work with them and the MOH to see 
how to equip the facilities and carry 
out the corresponding community 
activities with the limited project 
resources. If PIDRIK does not come 
through with the anticipated funding, 
then the project needs to decide how 
many more CSComs it can 
realistically work with by the end of 
the project. Once the CS project has 
the results of the CSCom phase-out 
evaluation discussed above, it will be 
able to decide whether it should put 
more resources into new CSCom areas 
or if it should devote them to 
strengthening the sustainability of the 
old zones.
(We purpose to reformulate this 
recommendation as below due to the 
fact that the extension of the project is 
no longer linked to PDRIK)
 
On the basis of the results of the 
CSCom Phase out study as 
recommended above, determine with 
the ministry of health and the other 
partners if more resources must be put 
into new health zones or if these must 
be devoted to reinforce the 
sustainability of the old zones.
See Action plan
Recommendation 1
12
4. Recommend that the project 
contract a short term BCC consultant 
to help them design a strategy that 
includes behavior change targets and 
strategies as well as awareness raising 
communications activities. It would 
be useful to employ more entertaining 
cultural formats that could be used to 
create interest in the villages such as 
stories, songs, street theater, and other 
methods.
1) Develop terms of 
reference of the 
consultation and plan 
financial resources for 
that purpose
2) Identify the 
consultant and get the 
protocol of agreement 
signed
3) Designing strategy 
and train actors of the 
implementation 
Dr Bagayoko
Dr Bagayoko
Consultant 
(under the 
supervision of 
Dr Bagayoko
March 05
March 05
May 05
5) The CS project needs to follow 
through on its original plan to acquire 
and/or develop IEC materials that are 
appropriate for the target audiences. 
The health messages need to be 
reinforced through support materials. 
Also the materials would help the 
relays with their educational tasks.
1) Plan financial 
resources for the 
acquisition of adequate 
supports
2) Make census of 
existing IEC materials at 
the level of CNIECS 
and ensure the obtaining 
of more. 
3) Put IEC materials at 
the disposal of actors 
(animators and Relays) 
Dr Bagayoko
Dr Sita Sidibe
Dr Sita Sidibe
May 05
Jun 05
Jun 05
6) If resources permit, the project 
should consider acquiring another 
vehicle for the work in the new 
CSComs in the far northern section of 
the district. It should also consider 
replacing some of the worn out 
motorbikes being used by the 
animators
1) Plan for the 
purchasing of a vehicle 
and motorbikes for the 
project
PUM Kita
February 05
7) In order to strengthen some of the 
intervention activities, the project 
should consider providing 
breastfeeding technical assistance to 
improve technique and promote 
exclusive breastfeeding in the 
1) On the basis of the 
results of LQAS survey, 
identify communities
where there is less 
breast-feeding and work 
with partners (NGOs) to 
Dr Bagayoko January 05
13
communities. develop a special action 
plan to promote 
exclusive breast-feeding 
in these communities 
2) Conduct a 
communication 
campaign targeting 
behavior change on 
breast-feeding in these 
communities 
3) Evaluate action of 
the campaign
NGOs (under 
the 
supervision of 
Dr Bagayoko)
Elie Coulibaly
February 05
August 05
B. Assessment of Progress toward Program Objectives
B.1. Technical Approach
Overview
Plan International is implementing a five-year Child Survival project in partnership with 
the Mali Ministry of Health, ARAFD/C – a local consortium of NGOs, and local 
municipalities in Kita District, located in the southeastern part of Kayes Region, in the 
republic of Mali. Kita’s total population in 2001 was estimated at 315,520 people of 
whom the project will cover 260,458 people by its fifth year. Estimated beneficiaries 
include: 52,091 women of childbearing age, 10,418 infants ages 0-11 months, and 36,464 
children ages 1-4 years. Plan has been working in Kita District since October 1994, 
carrying out integrated health and hygiene, reproductive health, education, water and 
sanitation, environment, and micro-credit activities. It has been working with the local 
NGO partner, which has extensive experience in training and delivery of health 
messages. Health indicators for Kayes Region and Kita District lag behind those of Mali
as a whole. According to the 1996 DHS, infant mortality in Kayes was 135/1000 and 
under-five mortality was 259/1000. The major causes of death of children in Kayes 
region are malaria, ARI, diarrhea, malnutrition and measles. 
Challenges to health of women and children include: poor road conditions and long 
distances to health centers, the insufficient number of first level health centers (only ten 
of the currently proposed 46 health centers are functional), inadequate quality of health 
services provided due to insufficient training of personnel, and low income and 
purchasing power of the population, combined with high user fees of health centers. 
Utilization of health centers is very low (around 8% of the eligible population) and 
traditional healers are often sought for medical advice before health care providers. 
14
The program approach is to help strengthen the existing health care system and improve 
quality of services. This approach comprises two strategies: (1) Training and building the 
capacity of health personnel and supporting community health committees (ASACOs) in 
order to increase utilization of health care services, and (2) Supporting IMCI 
implementation in CSComs. The four interventions are: i) Malaria (35%): Reduction of 
mortality and morbidity associated with malaria in children and pregnant women, through 
prevention education, promotion of use of impregnated bed nets, improved treatment of 
malaria, and prenatal chemo-prophylaxis. ii) Diarrhea (20%): Reduction of diarrhea￾associated mortality and morbidity through a) teaching and promoting prevention 
measures in the home, b) strengthening mothers’ capacity to recognize and provide home 
treatment for mild diarrhea with fluid and dietarymanagement, and c) strengthening 
mother’s capacity to identify signs of moderate and severe diarrhea, know sources of 
care, take the child for care, and comply with health provider recommendations. iii) 
Immunizations (35%): Increased immunization coverage in the program area for all 
infants by the end of the first year of life, and tetanus toxoid (second dose) immunization 
for pregnant women, increased measles vaccination (including twice yearly vitamin A) 
and prevention of measles-caused diarrhea and death. And iv) Pneumonia (10%): 
Reduction of pneumonia-associated mortality through prompt, appropriate and 
standardized pneumonia case management, a sustainable supply of antibiotics at the 
health centers (CSComs), prompt recognition by relays of pneumonia signs (fever, fast 
breathing) and referral of suspected cases to the nearest health center, and appropriate 
mothers’ care-seeking behavior.
B. 1. b. Progress by Intervention Area
As can be seen from the table below recording key LQAS results achieved in year 3, the 
project is making substantial progress towards achievement of its objectives. As 
demonstrated, the project has either surpassed or achieved most of its year 3 objectives.
Tab l e 1 : Evolution of indicators in the Kita project zone, June 2004
I ndicators Yr 3 % 
Ob jective 
Resu lts
Mars 03
Resu lts Nov. 
03
Resu lts 
June 04
Ch il dren that have an 
i mmun ization card 
65 68 .42 86 . 84 90.73
Ch il dren fully vaccinated 65 33 . 55 50. 00 69.54
Women with a consultation 
card/bookl et 
40 59 . 21 83 . 55 84.87
Women havi ng attended at l east 
three ante -natal consultations 
40 29 . 61 53 . 02 55.92
Women havi ng taken iron folic 
acid during last pregnancy 
75 58 . 55 76 . 32 79.61
Women havi ng taken ch l oroqu i ne 
during last pregnancy 
70 65 81 . 58 82.23
15
I ndicators Yr 3 % 
Ob jective 
Resu lts
Mars 03
Resu lts Nov. 
03
Resu lts 
June 04
Women havi ng received at least 
two doses of ATV
40 35 32 . 89 78.95
Women havi ng been attended by
a trained wo rker during childbirth
75 75 54. 61 65.13
Women havi ng taken Vit. A within 
40 days after chil dbirth 
35 - 8 . 55 40.13
Ch il d havi ng s l ept under an 
i mp regnated bednet 
30 20 6 . 25 22.45
Women knowi ng 2 s i gns 
i ndicating a child needs care 
50 45 67 . 10 90. 59
Ch il dren who when s ick received 
at least the same amount , or 
mo re, to drink as usual 
50 40 82 . 95 68 . 53
Ch il dren who when s ick received 
at least the same amount , or 
mo re, to eat as usual 
50 45 43 . 72 50. 34
Women knowi ng how to descr i be 
ORS preparati on 
50 40 35 . 09 77 . 14
Immunization (35%): Goal: To increase immunization coverage in the program area for 
all infants by the end of the first year of life, and tetanus toxoid (second dose) 
immunization for pregnant women, increased measles vaccination (including twice yearly 
Vitamin A) and prevention of measles-related diarrhea and death.
Perhaps the biggest achievement of the project to date has been its high level of 
vaccination coverage. With almost 70 percent of the children in the district completely 
immunized, the project is close to achieving its overall objective of 80 percent. The Kita 
district was selected for this project because it had the lowest immunization levels in Mali 
and was of great concern to the MOH. If they do achieve 80 percent coverage, Kita will 
be the only district in Mali to do so. To achieve this record level, the project has gone 
beyond working in the designated 13 CSComs (health center areas). Because the District 
Health System does not have CSComs in 30 areas, the project agreed to support 
additional vaccination posts and support for mobile teams and CBOs in these 30 areas. 
The project covered all costs related to continuous operation of the cold-chain system and 
supported maintenance and repair of cold-chain logistics. The MOH is sending a team to 
validate the LQAS findings in early 2005. If their results concur with the LQAS findings, 
Kita will be the district with the highest immunization rates in Mali and the MOH will be 
using it as a model.
According to the DIP, the MOH rate for fully vaccinated children in the Kayes region in 
2001 was 13.5 percent. Also only 40 percent of women had received two doses of anti￾tetanus vaccine during their last pregnancy. As we can see, the rate is now 78 percent in 
the Kita district. Issues also revolved around availability of vaccination cards, now close 
to 91 percent of children have them.
16
The project followed the strategies planned in the DIP in order to improve immunization 
coverage. Working with the MOH and ASACOS, they established the monthly outreach 
services with associated communities, supported bi-annual measles campaigns, ensured 
that quality vaccines were administered and provided training to CSCom health workers, 
particularly the vaccination staff. 
Malaria (35%): GOAL: To reduce mortality and morbidity associated with malaria in 
children and pregnant women, through prevention education, promotion of use of 
impregnated bed nets, improved treatment of malaria, and prenatal chemo-prophylaxis.
Malaria is the primary cause for medical visits and causes 13 percent of deaths in Mali. 
One child in five dies of malaria before the age of five and has an average of 2 episodes 
per year. According to community-based project data, malaria continues to account for 
the bulk of childhood deaths. 226 out of 360 childhood deaths (63%) in the project area 
were attributed to malaria. The bulk of childhood deaths (237) 65% occurred in children 
between 0-11 months of age. In depth investigation by the project revealed that most 
malaria related deaths occurred during the rainy seasons. This finding was validated by 
the evaluation team when they visited local sites and reviewed census data kept by the 
relays and local health committees. The project staff have used these findings to show 
the local health committees the importance of using impregnated bed-nets during the 
rainy seasons. 
Although there is good evidence that the message about using bed-nets is reaching the 
communities, there are still a number of traditional beliefs that influence behavior in this 
regard. Evaluation team member were told that malaria was not found in rural areas, only 
in cities. Others stated that the nets were inconvenient to use, among other things.
The numbers of referrals have increased. There is documentation that in the second year, 
27 referrals were made from communities to CSComs and in year 3 this increased to 118. 
The evaluators noted that many referrals were made by the relays for malaria treatment at 
the CSComs. This is an indication that the relays and animators are getting the message 
out to mothers to send children with fever to the health centers, and that this is being done 
at early stages of disease. There is also evidence that the IMCI training provided to the 
CSCom staffs has dramatically improved the quality of care offered at the centers and 
thus improved access.
Although the project has not developed an on going cost recovery program for bed-nets, 
they have developed an innovative strategy with the CSRef to offer free bed-nets, made 
available through UNICEF and Plan/ France, to fully immunized children and pregnant 
mothers who attend prenatal care. This strategy plus the relay mobilization activities are 
contributing to increased use of nets. According to the November LQAS the use of nets 
(34.4) is a little above the objective for year 3 (30%) but it may be difficult to reach the 
final program objective of 60 percent. During year 2 of the project, Plan distributed 1000 
treated bed-nets to the initial 8 CSCom villages. The nets were sold at low cost and the 
funds used to support the local health committees. 
17
 
During year two the project partner NGO, ARAFD/C trained community health workers 
(Relays) and produced a module adapted to their educational levels. The training 
included information on the four intervention areas including malaria prevention, 
recognition, referral and treatment follow-up. The relays also promote presumptive 
treatment for pregnant women.
Diarrhea (20%): Goal: To reduce diarrhea associated mortality and morbidity through 
a) teaching and promoting prevention measures in the home, b) strengthening mothers 
capacity to recognize and provide home treatment for mild diarrhea with fluid and dietary 
management, and c) strengthening mother’s capacity to identify signs of moderate and 
severe diarrhea, know sources of care, take child to care, and comply with health provider 
recommendations.
To date, the project has supported training for CSCom health workers and community 
health workers in diarrhea management. These courses have been part of the general 
training given to community health workers (relays), community health associations 
(CBOs) and to government health center staffs. The training includes the four 
intervention areas plus clinical and community IMCI training. As a result of the training, 
the government health workers, community health association workers, and NGO staff 
organized and conducted education sessions for mothers and community health workers 
(relays). The training enables these groups to recognize uncomplicated cases and treat 
appropriately at home with fluids and ORS, and to refer children presenting danger signs 
to the appropriate health centers. All of the government health staff have been trained in 
IMCI which includes diarrhea case management and treatment.
According to the LQAS data, the project is on track with some of the diarrhea related 
indicators and not yet so with others. According to the November LQAS, 26 percent of 
mothers (target 40%) were exclusively feeding their 0 to five month old babies. Given 
the difficulties of convincing mothers to exclusively breastfeed, it may be difficult to 
achieve the 60 % end of project goal without additional training and motivation. The 
evaluation team noted that while the majority of mothers breastfeed, they are not using 
appropriate latching-on techniques and did not seem to understand the importance of 
exclusive breastfeeding. 
The women interviewed during the team evaluation in the villages appear to have a good 
understanding of methods for preventing diarrhea. They know that hand washing is 
important and when to do it but according to the LQAS, a very small percentage of 
women (.8%) are actually washing their hands before food preparation. The project staff 
indicated that the reason this was so low was because many women do not wash with 
water but use ash or other local products to clean their hands. 
According to the June O4 LQAS, 68.5 percent (target 50%) of children are receiving the 
same amount or more fluids when they are sick and 50 (target 50%) percent received the 
same amount or more food than usual. It was noted during the evaluation team field 
interviews that although many women understood the importance of giving fluids during 
18
diarrhea and how to prepare ORS or home fluids, most preferred to treat their child with 
antibiotics because it stops the diarrhea.
So although the project is making progress in diarrhea home management, it seems there 
is more to be done in the education of community members about exclusive 
breastfeeding, hand washing and the importance of fluids and food during diarrhea 
episodes.
Pneumonia Case Management (10%): Goal: To reduce pneumonia associated 
mortality through prompt, appropriate and standardized pneumonia case management 
(IMCI), a sustainable supply of antibiotics at the CSComs, prompt recognition by relays 
of pneumonia signs (fever, fast breathing) and referral of suspected cases to the nearest 
health center and appropriate care-seeking behavior. 
As part of the project’s training program, all health facility staff have been trained in 
pneumonia case management through the IMCI program. In addition, community IMCI 
training has been beneficial in educating mothers and relays on recognition of danger 
signs. The mothers knowledge and recognition of fever and fast breathing and health 
care seeking behavior have significantly improved (68%) over baseline (30%) indicating 
that the training and education activities are effective. As a result the numbers of referrals 
to CSComs for fever are steadily increasing. Approximately 60 percent of health center 
staff have been trained to recognize and treat respiratory problems and know when to 
refer severe cases to the district hospital.
As a result of project work with the CSComs and ASACOs, the evaluation team noted 
that all the pharmacies at the CSComs were stocked with the essential medicines and 
were able to appropriately account for and order medicines as required. There were no 
complaints about shortages. This is a definite improvement as the DIP noted that most of 
the CSComs in the district did not have adequate supplies of medicines to treat 
pneumonia or other diseases.
Generally, the CS project has followed the work plan outlined in the DIP. There have 
been very few changes in the implementation.
Perhaps the one problem that was not anticipated in the DIP concerns the anticipated 
support expected from PIDRIK (Projet de Developpement Rural Integre de Kita). 
PIDRIK is a coordinating entity for a five-year rural development project that originated 
out of the cotton industry and the needs of local cotton producers, but is now backed by 
the government of Mali. It is funded by the government of Mali, OPEC, Islamic 
Development Bank of Mali and CMDT, in the amount of 19 billion CFA. In the DIP it 
was stated that PIDRIK would be working in several development projects in the Kita 
area which would complement and support the CS project activities. Areas that PIDRIK 
would work in included literacy programs, agricultural development of lowland 
floodplains, road and bridge development, 50 new wells, and infrastructure. The CS 
project and CSRef expected them to build and equip 10 CSComs in accordance with the 
district health and development plan. Unfortunately, this has not occurred. Each year 
19
PIDRIK has promised to build the 10 CSComs and they are saying they will do this in 
2005 but to date this has not occurred. For this reason, the project had to increase Plan’s 
counterpart funding of the project and pull funds from some of the project areas in order 
to work with the first 8 CSComs. In 2005 they will begin working in 5 additional 
CSComs. At this point the project is not sure if it will be able to reach all 26 CSComs. If 
PIDRIK comes through in 2005 with the construction of 10 CSComs there is still a 
question as to whether they will also cover the costs for equipping the facilities. 
B.2. Cross-cutting Approaches
B.2.a Community Mobilization
In general the community mobilization activities are carried out by the ARAFD/C NGO 
animators. One animator is assigned to each project CSCom. Originally there were 13 
animators but currently there are 5 who work with the current 5 project CSComs. An 
additional 5 have been hired to work in the new CSComs beginning in 2005. These 
animators work with village relays and village committees to conduct mobilization and 
education activities. Two relays are selected by each village to work with the project and 
they receive on-the-job training from the animators. Each CSCom is responsible for 
several villages of varying sizes. 
Each animator received training on the project intervention areas: malaria, diarrhea, 
pneumonia, immunization, community IMCI and MARP (survey methods). The 
animators also received finance and administration training to facilitate work with the 
ASACOs and help them organize and manage their budgets for the CSComs. They 
believe that the work they do with the ASACOs has really made a difference. During the 
field visits it was evident that the ASACOs were able to collect enough fees from clinic 
visits to cover the salaries of the CSCom personnel. This has been a major achievement 
in the region. In fact 2004 was the first year that many of the ASACOs were able to meet 
the salary requirements. They were also able to maintain supplies of essential medicines 
in all the CSComs, which had not been the case at the time of the DIP. The ASACOs will 
continue to be responsible for managing the CSComs after the project phases out. During 
the evaluation team visits, they seemed confident that they would be able to do this. They 
demonstrated a good level of understanding of the health problems facing the 
communities. The issue with the ASACOs is their own sustainability, they are sustained 
by the fees paid by the village members and the villages don’t always participate. Also 
the ASACO board changes every three years, so there is a need for re-training. 
The animators and relays have been very involved in mobilization of community groups, 
particularly for immunizations. In fact, the district’s dramatic increase in vaccination 
levels is partially credited to their mobilization efforts. They have formed and work with 
women’s groups and educate them about the intervention areas. Some of the animators 
have recognized that men are the principal decision makers and have begun to work with 
the men in the villages in order to address health issues. This has happened when they are 
working with the women and discover that they can’t afford to pay for the immunization 
or maternity cards. In this case the animators and relays arrange meetings with the men 
20
in order to address this. They also invite the mayor to these meetings. In addition they 
have done general activities such as community diagnosis and problem identification and 
facilitated group consensus on solutions. In general the animators felt that the training 
had helped them become better mobilizers. They had learned new skills and techniques 
for working with the villages. 
The evaluation team found that the communities visited really liked the mobilization 
work of the relays and the ASACOs. Also the relays have done a good job of keeping 
track of village health status through the census/ registry activities, and informing the 
village committees about problems that need to be addressed, such as high numbers of 
malaria cases etc. 
A major issue is that there are not always enough relays particularly in the larger villages 
where two volunteers are not enough to cover all the inhabitants and the village chief 
may not wield enough influence to get the community to fully participate in health 
activities. 
There is a consensus among the animators and the evaluation team that it is too early to 
phase out of the community activities. There has been a delay in the phase out of about 6 
months but many feel that it is still too early to phase out. They feel that the communities 
need more education inputs and follow-up activities.
There have been some issues regarding selection of relays. Although the communities 
select the relays according to the needs of the project, some of the relays have not 
demonstrated the commitment necessary to carry out expected activities. In these cases, 
the animators have had to bring the problems to the attention of the VHCs or village chief 
and these then decide on replacements. 
The animators interviewed also think there may be problem in keeping the relays 
motivated. There is a lot of work expected of the volunteer relays who have to fill out 7 
registries and keep them updated on a regular basis. This relay motivation issue is a major 
challenge for the animators. The relays do use the registries and reports and do follow-up 
on the vaccinations and pre-natal visits with the families. However, when the animator 
contracts weren’t renewed for 4 months between June- September of 2004, and the 
animators were not active in the villages, many relays stopped working. So the animators 
do not think they will continue once the project phases out of the CSComs. However, 
some villages have taken the work of the relays seriously and in order to support them 
have formed work groups to tend the relay’s crops while the relay works on health 
education in the village. Other CSComs are offering free health care for the relays and 
their families.
The relays interviewed stated that they have received regular supervision and support 
from the animators (at least 2 visits during the past 3 months). They were pleased with 
the quality of supervision received. The major issue is that the animators, who are 
supervised by the project, are not sufficiently integrated with the CSCom staff who are 
supervised by the MOH. The evaluation team believes that for continuity, the relays need 
21
to be supervised by the CSCom staff. Then once the project phases out, the CSCom staff 
will continue monitoring the relays. However, because the animators and relays have 
been organized by the project, they do not fall in the CSCom system of supervision and 
so far there has not been joint supervision.
B.2.b. Communication for Behavior Change
The key behavior change strategies employed by this project revolve around community 
organization. When the project begins in an area, ARAFD/C begins working with the 
villages to put a 5-member Village Health Committee (VHC) in place. The committee 
then works with them to select 2 people as relays. The VHCs and relays are then trained 
in all the project intervention areas by the animators. This on-the-job training prepares 
these two entities to do mobilization and IEC activities, home visits, and community 
education sessions with the video projectors. Then the second part of the strategy is that 
through the trained relays and VHCs, skills are transferred to the communities through 
women’s groups and other community forums.
Unfortunately the planned development and purchase of IEC materials has been delayed. 
The funds were used on other project activities. At the beginning of the project 
ARAFD/C and the training coordinator were told that materials would be provided by the 
project but unanticipated expenses caused the project to divert funding to other areas. To 
date the project has provided video players and televisions to each of the CSComs but 
they lack videos for them. Also the ASACOs have to provide fuel for the generator in 
order to run the TV/video. The NGO has asked the project for picture boxes, flip charts 
and posters. 
The methods employed for BCC include group discussion, videos, home visits and 
meetings/ assemblies. So far the project has not developed more entertaining formats 
such as skits, role plays, songs or story telling. For the most part the messages that are 
delivered are technically accurate. The problem is that the messages may not be reaching 
everyone. To address this, the project began signing agreements with local radio stations 
in 2004 and the animators have been invited to speak about health issues, though this is 
not done on a regular basis. In some instances ARAFD/C has purchased time on local 
radio or TV stations.
In order to influence behavior change, the project decided to locate the animators in the 
CSCom village. They felt that the animator was likely to be more influential if they were 
living in the areas.
Behavior change is measured generally through the LQAS monitoring system used by the 
project. They have been able to measure how many children are vaccinated, how many 
pregnant mothers are seeking prenatal care, use of home-based fluids for diarrhea etc. 
After the LQAS, all the animators are convened by the project as well as the village 
chiefs and ASACO members, and informed of the results. In addition, the registries 
maintained by the relays keep current information about health problems of children 
under five and women of fertile ages. They also record information about referrals to the 
22
HCs for care and follow-up activities back in the communities. The follow-up notes give 
information about how well the mother is following the doctor’s recommendations.
The registries kept by the relays have proven to be a useful means for motivating 
communities to address health problems. For example, last year the project became 
aware of a diarrhea problem in one of the CSComs through the relays who informed the 
animators of diarrhea related deaths. When the animator realized what had happened, he 
decided to educate all the relays in the CSCom about recognition of diarrhea danger 
signs, home management and referral.
The evaluation team found that there is evidence of increased attendance at the CSCom 
clinics by the project villages. There is a shared common understanding of local health 
problems and increased awareness on the part of the villagers about these problems. 
There has been an increase in the numbers of women attending prenatal clinics and being 
vaccinated for TT. There is increased use of impregnated mosquito nets, particularly by 
young children and pregnant women. The main weakness identified by the team was that 
there was not enough involvement of men or other decision makers (grandmothers or 
mothers-in-law) in the management of women’s and children’s health.
B.2.c. Capacity Building Approach
B.2.c.i. Strengthening the PVO Organization
The organizational capacity building indicators stated in the DIP are directed at partner 
organizations and not Plan. However, the CS project has had a beneficial effect on Plan/ 
Mali. For example, the CS project is being used as a model for Plan’s program Unit 
Offices throughout Mali which all have health officers who are implementing child health 
activities. In fact three of the health officers were members of the CS evaluation team. 
According to these officers, they are focusing on the same interventions as the CS 
project.
For the Kita Program Unit area, the director commented that the CS project has allowed 
him to expand beyond the Plan villages where they have foster children. He sees that the 
project has allowed them to better organize and strengthen these additional communities. 
He stated that the originality of the project approach is helping Plan to strengthen the 
Mali decentralization system in his region. He sees the community based organizations 
taking on their roles in health care. No longer is it just the health worker who deals with 
community health but now it is the whole community. So when the health worker leaves, 
the system will continue. He also sees great value in the use of community based data and 
he is encouraging the DHO to consider extending this practice through out Kita district as 
well as other areas where Plan works.
Plan International has been strengthened by this CS grant in several ways. The 
headquarters has just gone through a change in technical backstopping staff, and this 
evaluation provides a training ground for the new staff member. Plan HQ will be able to 
transfer technical and managerial skills to other child survival projects that are currently 
23
implemented by Plan globally as well as provide technical guidance and comments on 
development of Plan private funded CS proposals. 
B.2.c.ii Strengthening Local Partner Organizations
B.2.iii Health Facilities Strengthening
A major focus of the project’s capacity building efforts have been on the CSComs and 
district health system. The project conducted a Health Facilities Assessment of the initial 
8 CSComs during the first year. This was coordinated by the DHO. Each year the project 
receives a list from the CSComs regarding materials and equipment needed. The project 
staff then visits the CSComs and identifies the needed items that are within the capacity 
of the project. During this initial assessment, they also evaluated the training needs of the 
Chef du Post, the Matrons and other staff. After this first experience, the project realized 
that all staff needed upgraded training and that all the CSComs had the same staff 
training needs. The IMCI training met the needs. The project has received a request and 
bought new equipment for the 5 new CSComs that it will be entering in 2005. The 
CSRef will decide how the equipment is to be distributed among these centers.
The project believes that in order to build MOH capacity, it is necessary to go one step at 
a time. Each partner has a copy of the DIP that has been translated into French and it 
outlines each partner’s role and responsibility. Each partner has received training in the 
health sector policies, good governance and decentralization. The district MOH requests 
training from the project on a yearly basis. The project also has on-going training 
activities with the Ngo staff (animators). The Plan staff works closely with the NGO 
animators to solve problems when they arise. The project also organizes quarterly partner 
coordination meetings. These include the CSRef, the NGO (ARAFD/C), Plan and the 
ASACOs. For each ASACO, the 2 relays and the VHC are also invited to attend. In 
addition there are meetings held at the health area chaired by the ASACOs who make 
their reports discussing activities, problems, and solutions. They also review problems 
from the previous quarter and plan what is to be addressed during the next quarter. The 
project is usually invited to these. The DHO commented that he would like to see more 
coordination between project staff and district health staff at the CSCom/ area level. The 
evaluation team also identified a need to have the community relays who are currently 
supervised by the project animators, also be supervised by the MOH Chef du Post at the 
CSComs. Currently the MOH does not have authority over the relays. However, the 
proposed arrangement, which would require an agreement between the CSRef and the 
project, would assure that the relay work would continue after the animators leave the 
CSCom. 
Everyone agreed that it would be good to have the project staff, including the animators, 
attend the quarterly CSRef meetings. That way everyone would be on the same page 
when planning health activities in the district and in the specific health areas. The DHO 
felt that it was important for the CDPs and the animators from the same areas to be 
working together. He also felt that this was a way to involve the relays (through the 
animators who supervise them) and bring them into the CSCom supervision system.
24
In general, the project has assured that the CSComs have functioning stocks of medicines 
that are replenished on a regular basis. So far the project has assured this in the 8 
CSComs that they are working in. In addition, it is obvious that there are increasing 
numbers of satisfied users because the number of users of services are increasing at the 
CSCom health centers. 
Regarding the ASACOs, the evaluation team found that they had a good understanding of 
their roles and responsibilities. They assured that the health centers had and maintained 
appropriate supplies and equipment, such as cold-chain. They assured good vaccination 
levels in their areas. There were good management systems in place at the centers that 
showed well organized accounting documents, account balances and that financial reports 
are made at the general assemblies. There was evidence of regular meetings with area 
partners (CSRef, NGO and Plan). There was also evidence of statutes and by-laws. On a 
less positive note, the ASACOs visited still do not have their legal agreements with the 
Government. There was also limited representation of women on the committees. Some 
of the committees were also having difficulty collecting the financial fees that are to be 
paid by the villages for the support of the ASACOs. 
To the project staff, one of the biggest challenges is getting the ASACOs to the point 
where they will take on the total management of the CSCom health system. They would 
like to see the ASACOs take on a stronger leadership role in making decisions about how 
to improve clinic functioning and see each ASACO solve its own problems. The 
evaluation team thought it was a positive sign that when asked about sustainability, one 
of the ASACOs (Sangdianbo) asked Plan to help them identify a new partner to help 
them continue after the CS project phases out. According to project staff, before the CS 
project the ASACOs would not have been interested in financial planning or technical 
assistance.
The project has also worked to strengthen the NGO consortium ARAFD/C. An 
assessment was done of the lead NGO, ARAFD, by Plan when they first started working 
with them in the 1990s. Since they are the only agency working in public health Kita, 
Plan asked them to work in consortium with another NGO on this project. Initially, 13 
animators were hired. In July of 2004, 8 were phased out and 5 remained. There have 
been problems in the contracting of the animators. The project had under budgeted the 
amount of funds needed to subcontract ARAFD/C to take care of all the IEC and 
community mobilization activities, including hire the animators. One of the problems was 
that Plan only gave ARAFD/C yearly contracts. As a result, ARAFD/C only hired the 
animators for the length of time they had in their contracts. Since the NGO is completely 
dependent on Plan or other donors to pay staff, they could not maintain the staff if the 
contracts were not renewed immediately. This occurred in 2004 when the project had 
exhausted the sub-contract line item and it took several months for Plan to help them 
modify the budget and add funds for the subcontract. As a result, all the animators were 
laid off for 4 months. This created a huge lapse in field activities. Data wasn’t collected 
from the villages, people were not educated, mobilizations were delayed etc. According 
to the PUM, this problem has been resolved and the new animators will be given 2 year 
contracts that will last them through the project. They will also be paid for any time 
25
worked when the contract was not viable. The project will be working with another NGO, 
AMOCO, in the 5 new health areas that it will phase into in 2005.
According to the NGO coordinator, the organization and staff have benefited greatly 
from all the training and support that they’ve received from the project. The NGO 
received management training in Bamako and technical training in Kita. The coordinator 
says that this has really enhanced the skills of the staff and that after the project ends, 
they will be able to market themselves as skilled BCC and mobilization experts who 
know how to work with communities in the region.
B.2.iv. Health Worker Performance
As mentioned in the above section, when the project conducted its health facility 
assessment (HFA), they also assessed the skills of the health workers in the various 
health areas where the project planned to work. From the HFA results, they knew that 
there was a big need for skills and found it necessary to train all the staff at the CSComs. 
The project staff realized that only providing training on the four health interventions 
would not be enough. They realized that the IMCI training was more comprehensive and 
would be the most practical, given the needs identified. Because the IMCI approach 
trains clinicians to conduct a thorough diagnostic when treating a child for any ailment, 
there was a better chance of catching any additional health problems or needs (such as 
immunizations or nutrition counseling) than would occur if the clinician only treated the 
most immediate problem. Also the IMCI training curriculum and support materials are so 
user-friendly that the project felt this would be the most helpful training for the health 
facility staffs. Following this decision, the project training coordinator as well as a doctor 
from the CSRef were selected to be trained as IMCI trainers. Once trained, these two 
trainers then proceeded to train the CSCom health agents in Kita district. The staff at the 
CSComs and the project staff all commented that the IMCI training has been the most 
useful for them. They believe they are making fewer errors in diagnosis because the 
materials are so helpful in leading them through the diagnostic process. After training 
has been completed, the CSRef staff visits the sites and follows-up with the health agents 
on site. Also if project staff notice any problems or lack of skills at the field site, they 
discuss it with the CSRef who then follows up in the field. In fact this occurred at one 
site (Sanguana). The project had provided materials and support for vaccination 
activities in the area but the CDP was not doing the immunizations in the villages. When 
the project staff complained to the DHO about this, he followed up and replaced the 
health agent with someone who was more enthusiastic about visiting the villages.
During the team evaluation of the CSCom sites, it was noted that the health agents had 
received a lot of training by the project but the training that they appreciated the most was 
the IMCI training. The agents were functioning well, had a good understanding of their 
mission, were able to use the SIS effectively and were well integrated with the 
communities around them. As noted in other sections of this report, the only weaknesses 
identified were that the referrals from the village relays were not recorded in the CSCom 
information registries and the relays were not receiving enough supervision from the 
CDPs.
26
B.2.c.v. Training
As can be seen in the training plan located in the annex, the project has conducted several 
training programs at all different levels, for Plan project staff, NGO animators, district 
and area health staffs, vaccinators, ASACO members, relays, and village health 
committee members. However, the key training intervention has been the clinical IMCI 
training described above. The project is now organizing clinical IMCI training for the 5 
new health areas that they will be phasing into in 2005. 
In addition to clinical IMCI, the project has also introduced community IMCI. The 
community training module was developed by UNICEF for Mali. Again the CS project 
training coordinator was trained as a trainer for community IMCI along with Plan Mali’s 
National Coordinator for Child Survival. In addition to Kita, they have collaborated in 
providing this training in Plan’s other PUs. The staff believe that the community IMCI 
has been critical in preventing childhood mortality. Through the training given to 
animators and relays, mothers in the villages are able to start treating sick children before 
going to the health centers. They are also made aware of the need to go to the center and 
because the quality of care has been improved, receive adequate treatment. 
Although communications training was provided to Plan and Ngo staff in 2004, there is 
still a need to provide more BCC training to the animators and relays. They need more 
skills and techniques for communicating with the communities. This training is needed 
for the new animators who will be working in the new Health Areas and refresher 
training is needed for the existing animators. The training coordinator also believes that 
the project needs more time to bring about behavior change in these villages. He thinks it 
is too early to phase out of the villages and that the relays and VHCs aren’t yet ready to 
manage the process on their own. Two staff were also given communications training in 
Belgium. However, these were not the staff directly responsible for communications 
activities. 
The training Coordinator also recognizes the need for IEC materials. He conducted an 
assessment of the kinds of materials needed and then went to Bamako and met with the 
government agency in charge of IEC materials development. He identified what was 
needed and made arrangements to buy them. However when he returned to Kita, he 
learned that the funds that were to be used for purchasing materials had been diverted to 
other priorities. Despite the problems, he does believe that the video players that he was 
able to buy for 6 CSComs and videos have been very useful as discussion tools.
As evidence that the training has been useful, the training coordinator notes that the 
ASACOs now have clear financial accounting books and bank books. This was not the 
case at the start of the project. He also noted a definite change since the baseline 
assessments of the CSComs. The registries and support materials are clearer. They are 
able to conduct social mobilization activities, they can now manage the CSCom funds, 
and there are much better relationships between the ASACOs and the health staffs.
27
Other evidence of training impact is found in the numerous well-organized record books 
kept by the village relays. In addition, the community mobilization training has resulted 
in increased attendance at clinics. At the time of the baseline assessment, only 20 percent 
of prenatal patients visited the health centers for care, now 60 percent are being seen at 
the facilities or in outreach visits. The same is true for the number of children vaccinated. 
At the time of the baseline only 25-30% of children were fully vaccinated, now that is 
closer to 70 percent. 
The training coordinator noted that he is getting numerous requests for training from 
villages and the government health offices. He and the project cannot provide all the 
training requested but he thinks that some things should be prioritized. For example, 
there is a need to train the village health committees and relays on how to reimpregnate 
their mosquito nets. This will require additional resources from donors but he believes it 
is critical if the project does not want to lose the edge it has gained in combating 
childhood malaria. 
B.2.d. Sustainability Strategy
Progress towards objectives:
1) stimulate community participation and ownership: There appears to be good progress 
in the area of participation. Each of the CSCom villages have established village health 
committees and have relays working on the health issues and documenting community 
health status. Although the LQAS did not measure sustainability indicators, the mid-term 
evaluation team found that the villages visited had a very positive impression of the CS 
activities and were participating in education sessions and village health committee 
events. The mothers group participants stated that the activities had increased their 
knowledge about child health, particularly immunizations. Although the VHCs have 
become increasingly active in health promotion, there is still a sense that it is too early to 
phase out and that more training and support is needed in the communities.
2) increase the capacity of the ASACOs in management, advocacy and as community 
representatives:
3) ensure health services are financially sustained through a cost-recovery system in 
which the community participates through the use of the services.
 As noted above, there has been a tremendous increase in the ASACO management skills. 
They are keeping organized accounting books and bank books, they are able to mobilize 
the communities for health and they manage the CSCom funds. They have a good 
understanding of their roles and responsibilities and have their internal statutes and 
regulations. Other evidence of their effectiveness is that the in all the CSComs visited, the 
staff are fully supported through the funds brought in for services. This had not been the 
case before the CS project. Obviously this increased use of services can be attributed to 
improved quality of care helped by the CS project supported training, and by the 
increased community mobilization activities that are encouraged by the ASACOs, VHCs 
and relays. Also the clinics all have functioning essential drug supply systems. None of 
the pharmacies had had stockouts during the past year. 
28
To date, the project has phased out of 5 CSComs and is planning to phase out of more 
during the next year. There is concern that the VHCs and relays are not yet ready to take 
over health promotion and mobilization activities without the support of the animators. 
As evidence of this, the animators noted that when the NGO contract was not renewed on 
time and the animators were laid off, the relays stopped working. To address this, the CS 
project is planning to conduct an OR study in the communities that have been phased out 
to see the status of planned health activities. The mid-term evaluation team believes that 
in order for activities to be sustained after phase out, the Chefs du Post at the CSComs 
need to take over supervision of the village relays. This has been a problem in the past 
because the animators, who supervise the relays, work for the CS project and the CDP 
works for the MOH. These two do not participate nor are they supervised through the 
same health system. In some instances the animators have a good working relationship 
with the CDP but that is not always the case and because the two work with different 
systems, there has been no pressure for them to work together. The DHO would like the 
animators to be part of the district health team and have them attend quarterly district 
health meetings. These issues were discussed during the team evaluation and it was 
decided that the project and the district health office (CSRef) will sign a memorandum of 
understanding in which the CDP will be designated as the CSCom supervisor for the 
village relays. The animators will still provide technical supervision as long as the project 
is in the area but the long term supervisor will be the CDP. The DHO would like to see 
quarterly supervision sessions at the CSComs wherein the CSRef and CS project staff 
from Kita would also attend. He thought that if there were enough agencies involved 
then they could also invite the mayor and try to get his involvement in the work of the 
VHCs and relays. Since the mayors also have funds for community activities this was 
seen as a strategy to garner more support for the relays.
Despite the concerns about the sustainability of activities after phasing out, the ASACOs 
interviewed all stated that they felt confident in their abilities to maintain social 
mobilization activities and continue managing the CSComs successfully. There is also an 
issue in that the fees that are supposed to be paid by the area community members are not 
being paid regularly.
Another problem that has affected project viability is that when the project was originally 
planned, it was assumed that PIDRIK would cover the cost of building and equipping 10 
CSComs in Kita district. As discussed in section B.1. of this report, so far this has not 
happened. Plan and the CSRef have had to work around this problem and it has reduced 
their resources that were meant for other activities. Fortunately Plan has been able to 
meet some of the requirements with private funds. 
2.C. Program Management
C.1 Planning
Project planning occurs at quarterly Coordinating Committee meetings in which all 
partners participate, the ASACO, CSRef, Plan, NGOs, and the VHCs. The project has 
29
generally followed the DIP workplan, of which all partners have copies. The work plan 
is reviewed each trimester by the partners and used as part of the quarterly planning 
activities. Some items in the workplan have not been completed such as the development 
of IEC materials. Also after the first year, the HFAs have not been done at all the 
CSComs because the project realizes that the health staffs at these facilities all need IMCI 
training and other assessments are used to project equipment needs. But generally the 
work plan is used as a guide for project planning.
Given that all partners have copies of the DIP including the monitoring and evaluation 
plan, and discuss the activities at regular planning meetings, it is clear that they have a 
good understanding of project goals and objectives. It was clear from the LQAS that most 
of the year 3 objectives have been reached or surpassed. Likewise from interviews 
conducted with field staff, headquarters staff, and the communities it is clear that they 
also understand the purpose of the project and appreciate the benefits they are receiving 
from it.
Each month there is a regular meeting of project staff to evaluate progress and plan 
activities for the next month. Whatever planned activities have not been completed 
during the month are then programmed for the next month. 
The project makes regular use of monitoring data. The LQAS is conducted twice a year 
and allows the project to determine the level of attainment of objectives. It also permits 
the project to see if work is reaching its objectives in the different zones. The results are 
compared with the SIS data collected at the CSComs in order to get a complete picture 
and validate findings. If they find, for example, that vaccination rates are low in a 
particular zone, then the staff visit the communities and talk about it at village meetings.
C.2. Staff Training
The project staff participated in two types of training. When the project began, the project 
director asked each staff member to identify what weaknesses they had that needed to be 
strengthened in order to perform their jobs. For example the data manager came to the 
project from an environmental health background. In order to strengthen his data 
management skills, the project sent him to the MOH for a month to receive training from 
the HIS department. Likewise the monitoring and evaluation coordinator did not have 
experience with the LQAS methodology. So the project director arranged for him to 
attend a regional LQAS training program in Rwanda. The training coordinator has a 
general medicine background and does not have public health training. So the project 
arranged for him to attend a four month epidemiology course offered at the university in 
Bamako during the rainy season. 
The staff’s work is monitored by the project director. Because the project director is a 
physician who completed an MPH with a specialty in monitoring and evaluation, he has 
been able to follow-up with the training and assist with the required activities. For 
example, the monitoring and evaluation coordinator leads the bi-annual LQAS surveys 
but the project coordinator assists him with the analysis by using SPSS (a tool that the 
30
M&E coordinator is still learning). In addition, each staff member writes a report of any 
training they receive. 
It seems that the staff training has been a worthwhile investment as it has allowed the 
staff to acquire pertinent skills for their jobs. In addition, the training was done locally or 
regionally and was not overly expensive.
C.3. Supervision of Program Staff
The staff activities and performance are monitored by the coordinator during their regular 
project planning meetings which occur weekly, monthly and quarterly. Because the staff 
is small it is easy to keep track of personnel and activities. Supervision of the animators is 
the responsibility of the NGO staff but the NGO sends the monthly plan of activities to 
the CS project. The CS staff then coordinates their field visits with those of the 
animators and are able to provide additional supervision of relays or ASACO members as 
required. 
C.4. Human Resources and Staff Management
The Project Coordinator works closely with two Assistant Program Coordinators and the 
HIS Manager to provide direction to the CS team. He also receives input from Plan’s 
National Child Survival Coordinator and the Plan/Mali country office. The project team 
is composed of the Project Coordinator, the Assistant Program Coordinator for Training, 
who oversees the CSCom health personnel and partner NGO staff; the Assistant Program 
Coordinator for Monitoring and Evaluation, who oversees M&E for the project; and the 
Health Information Systems Manager, who is responsible for the design and 
implementation of the HIS (SIS) and basic surveillance. The Project Coordinator 
oversees all field staff. The two assistant project coordinators and the HIS manager 
report to the project coordinator. In addition the project has administrative support staff 
and a driver. All the positions are filled and there have not been changes in the personnel 
plan since the DIP was written. The coordinator was the only staff who was hired from 
outside Plan.
All positions have Plan job descriptions and are managed as core Plan staff members. 
Each staff member is evaluated at the end of the year in accordance with the requirements 
of their job descriptions. The NGO animators are hired for specific community 
mobilization tasks and also have specific job descriptions by which they are evaluated. 
In general the morale among the Plan staff is high. It is a small group of staff who work 
together with good coordination on a regular basis. There has been more of a problem 
with the NGO staff morale. This is because the Ngo has been given yearly contracts by 
Plan that need to be re negotiated every year and there have been delays in re-contracting 
of staff. There were also budgetary issues for funding of NGO activities that had to be 
resolved. This also took several months and resulted in laying off the animators for 4 
months. The lack of animator continuity has created problems in the stability of village 
relays and community mobilization activities. The Plan PU manager stated that this 
31
problem is being resolved. The project is going to sign a two year contract with the two 
NGO partners so the animators will have stability. Also the animators will be paid for 
time worked without a contract. 
In general, among the Plan staff there has been no staff turnover. However because of 
the budget problems and animator lay-offs, there has been turnover among the animators. 
Though they have been able to hire some of them back for the new contracts.
Except for the project coordinator all the Plan staff are permanent Plan staff who were 
brought into the project from other Plan projects. Therefore they are guaranteed other 
jobs after the project ends either in the Kita area or in another PU in Mali. The PU 
manager stated that even though the Project Coordinator was not permanent Plan staff 
that there would be a place for him at Kita if he wanted to stay. Since the CS project has 
started Plan has installed Health Coordinator positions in each of the country PUs. Kita 
does not have one so when the project ends, he would be in a position to assume this role.
C.5. Financial Management
The project coordinator and the accountant reviewed the financial reports and then 
submitted monthly financial reports to the Operations Support Manager in the national 
office via the Program Unit Manager. The program tracked costs incurred using the 
already established financial system of Plan/Mali. Expenditures were broken down using 
specific codes for labor, equipment, supplies, and facilities. Project expenditure reports 
were sent directly from Plan/Mali to the US office of Plan where they were reviewed for 
USAID compliance and submitted to USAID. Plan’s corporate general ledger system 
assigns a project ID number to enable accurate tracking of project expenditures related to 
each project. Plan’s organizational finance system also enables Plan/USA to separately 
track donations from USAID and non-USAID sources. After the US office submitted 
reports to USAID, and received the re-imbursement, funding transfers were made on a 
monthly basis from the US office to the Child Survival project to reimburse project 
expenditures. 
C. 6 Logistics
There is one project vehicle but if necessary the project makes use of other vehicles in the 
PU. The project has not had problems with supplies and equipment. The project 
prepared their budgets for purchase of major equipment items. These have been delivered 
to the existing CSComs. The MOH and ASACOs are supplying the smaller supply items 
and instruments. 
The biggest logistics challenges will be supplying equipment for the new CSComs. It will 
require a budget modification and funds in order to cover the costs. Originally PIDRIK 
and Plan were going to construct and equip 10 CSComs but now the money that Plan had 
was spent to construct and equip the project’s original 8 CSComs and funding is no 
longer available to equip more CSComs. Another issue concerns whether there will be 
32
sufficient vehicles for the work in the 5 new CSComs which are located in the northern 
part of the region and will require extensive travel. Because the existing vehicle will still 
be needed for project work in the southern part of the district, there may be a need for 
another vehicle to handle all the supervisory and other project demands in the north.
C.7. Information Management
The program’s community-based information management system (SIS) has been in 
place since February 2003. The data is recorded by the village relays in 7 record books 
including family census, vaccinations, prenatal care, childhood illnesses, deaths and 
epidemics. This information is collected by the animators on a monthly basis and given 
to the project Information Systems manager. There have been some gaps in the 
information due to the laying off of the animators. Also the animators for the new 
CSComs have been recruited but are being trained and are not yet functioning at their 
new posts. At the time of the mid-term evaluation the animators were busy updating 
records from the period when they had been laid off. 
Once the Information Manager receives these reports, he checks the information with the 
data collected by the CSRef (district) from their health centers. If there is a discrepancy in 
the figures, he then visits the particular CSCom or village to check the relay reports and 
registries and make appropriate changes. The project data is also validated against 
regional data which is reported every quarter. 
This community-based data has been very useful for informing communities about their 
own health issues. The project staff review health indicators on a village-by-village 
basis. If there are problems, such as a drop in vaccination rates, the project then brings it 
to the VHC’s attention and works with them to discover what the problem is and correct 
it. For example in the Sanjangbougu CScom which includes 13 villages, the information 
manager noted that there were 7 child deaths in May/ June 2004. So they visited the area 
to see if vaccinations were up to date or what the cause was. However when they visited, 
the parents told them that the children had died from malaria. The children had been 
vaccinated and the parents said they died of fever. The staff wondered about this because 
this time period is early for malaria but since the children were not taken to the health 
center, they could not verify the cause. However, the staff used this example as an 
opportunity to educate the villagers about the need to keep the area clean and free of 
standing water even if it is not malaria season. They also instructed them to use bed nets. 
In another area, Kassaro, the project staff found that the TT vaccination rate of WRA 
dropped from 60% to 40%. When the staff followed up to find out what had happened, it 
turned out that rumors had been spread that TT caused sterility. Fortunately, the staff 
were able to call a village meeting before the problem became more pronounced and 
correct the misunderstandings.
The information manager also works with the LQAS surveys, which are done twice a 
year and he compares these results with the SIS findings. He felt confident about the 
project data. He indicated that the LQAS is 90 percent accurate and the SIS is cross 
33
checked with the district data. Also the LQAS is compared with the monthly SIS data. 
The project did conduct a KPC survey at the beginning of the project and they did a 
Rapid Catch in November 2004. 
C.8. Technical and Administrative Support
The project has received regular assistance from the Plan headquarters staff. The Child 
Survival Program Coordinator has worked with them during the proposal process, the 
launch of the project, the DIP process and the mid-term evaluation. He also reviews and 
backstops the KPC and LQAS survey process. The previous HQ Health Assistant visited 
in 2003 to help iron out some of the programming and budget issues. The new CS Health 
Assistant has been coordinating with the project regarding mid-term evaluation and 
LQAS results. The HQ contracts specialist also visited in 2003 and 2004 in order to help 
the project figure out budget modifications to cover the NGO partner expenses and 
address other unanticipated expenses. In addition Plan Mali has exhibited a lot of interest 
in the project. The Country Director has visited twice a year along with the National CS 
Advisor. In addition the Plan Executive Director visited the project in 2003.
To date the project has not received other outside technical assistance. However, the 
evaluation interviews indicated that the project might benefit from technical assistance in 
the development of a project wide BCC strategy and follow-up as well as appropriate use 
of IEC materials. The Plan Mali Director also advocated technical assistance for 
participatory IEC materials development. Also, although breastfeeding techniques and 
counseling are not a specific project intervention area, it is included as part of the 
diarrhea control activities and IMCI. Given the low exclusive breastfeeding rates and in 
consideration of the CDD objectives, the project may want to consider some additional 
technical assistance and community training in this area.
As mentioned, the project is also planning an evaluation of the CSComs that the project 
has phased out of, in order to see how sustainable the interventions have been and if the 
phase out is as premature as many of the staff and community actors have indicated. The 
project coordinator indicated that technical assistance would be helpful for the design of 
this study.
E. Conclusions and Recommendations
Conclusions
Successes
· As noted in the LQAS results, the project is making good progress in achieving its 
projected results. It has already either met or surpassed most of its year 3 
objectives. Perhaps the biggest success is the achievement of almost 70 percent of 
children who are fully vaccinated. The recognition of this achievement on the 
part of the MOH is a huge indication of the project’s success. Prior to project 
initiation, the MOH had targeted Kita District as having the worst immunization 
levels in the country. Now they are sending a team to verify the results and are 
using it as a model for other districts.
34
· The project has also achieved tremendous success in mobilizing communities to 
use health services. The relays, animators and VHCs have been very effective in 
mobilizing their communities to seek care and preventive services, especially 
immunizations and prenatal care. The number of referrals by village relays 
increased from 27 in 2003 to 118 in 2004. The project staff have also been 
innovative in helping health center staff bring services to the villages. This has 
been by supporting the work of the CSCom vaccination staff and by encouraging 
the matrons to accompany them and offer prenatal consultations in the villages at 
the same time.
· Another contribution has been the strengthening of the management skills of the 
ASACOs. Every ASACO visited had its accounting and bank books in order. 
Also, every ASACO was able to meet its financial obligations of supporting the 
salaries of the CSCom staffs. Given the poverty of the region, this is a 
commendable achievement and may be the only country/ region where local 
government health services are completely supported by community constituents.
· The project has done a good job of developing a community-based health 
information system. There is good evidence that the information is being used by 
the communities and CSComs for planning and for making health care decisions.
· The IMCI training that was instigated by the project, has greatly improved the 
quality of care at the CScoms. The health staff are now able to perform broad 
diagnosis of child illness and provide counseling for caregivers. This improved 
quality of care seems to be partially responsible for the increase in visits for 
services. 
· Plan has done a good job of strengthening local partner technical capacities. The 
local NGO staff now possess health and mobilization skills that they are able to 
use in other areas. 
· Despite the unavailability of the originally planned support, the project has been 
able to meet all the designated equipment needs for the project CSComs and 
provide material support for outreach activities. 
Challenges
· One of the biggest issues is the sustainability of program inputs and whether the 
phase in/phase out timeline is too short. The project has achieved tremendous 
success in getting people to use preventive and curative services. All the project 
inputs such as IMCI training of providers, formation of relays and VHCs and 
corresponding community mobilization activities, and strengthening of the 
ASACOs so they can fulfill their management mandate, have contributed to the 
increase use of services and the self-sufficiency of the CSComs. The question is 
whether the ASACOs, VHCs and relays are sufficiently capable at this point to 
continue CSCom support activities on their own. There is concern that the 
organizational support structures are not in place yet for them to do this.
35
· It is clear that the relays need a lot of motivation to continue their activities. They 
are asked to maintain 7 registries, organize meetings, follow-up on referrals, 
mobilize villages for immunizations, and generally address health issues in the 
villages. The project animators who live in the area are doing a good job of 
training and motivating them but once the project phases out, they will no longer 
do this. 
· The project has had to work around the fact that PIDRIK has not come through 
with the promised constructing and equipping of 10 CSComs for the district 
health system. Plan and the CSRef have been able to come up with some extra 
resources but it is unclear whether they will be able to fully equip and construct 
all 26 CSComs as planned.
· The project has done a good job of working with community HC and relays and 
training them in areas of community mobilization and in the health intervention 
areas. However, there is still work to be done in the area of IEC/ BCC. Many 
villagers are still unaware of proper care related to CDD, such as exclusive 
breastfeeding and handwashing. Likewise some villages are very aware of malaria 
prevention and use of bednets while others are not as attuned. The project lacks an 
overarching BCC strategy that targets specific behaviors and includes specific 
communication interventions. The project is also lacking in IEC materials that 
the relays and animators could use to reinforce health messages. In the DIP the 
project had planned to develop materials but was unable to with the budget 
adjustments.
· Given the difficult roads and the large distances to be traveled, particularly with 
the 5 new CSComs that are located at the other end of the district, the project staff 
will need significant travel time and vehicle support for supervision and support 
activities. This will infringe on the vehicle support already required for on-going 
monitoring activities in the current project areas. In addition, the motorbikes that 
the animators use are almost worn out and require significant repairs.
Recommendations
· The project should conduct an evaluation of the CSCom areas that it has phased 
out of to see how well the health agents, ASACOs, VHCs and relays are doing in 
managing the health activities without project support. If there are problems then 
the project should take steps to address them in a timely manner.
· In order to strengthen the sustainability of the relays, the evaluation team 
recommended that the Chef du Post become the supervisor of the relays and their 
activities. This could be done at the time of regular outreach visits to the villages 
and/or through monthly meetings of all the relays at the CSCom. There are some 
administrative arrangements that need to be made in order for the CDP to 
supervise the village relays but once this is done there would be a system in place 
36
for on-going supervision of village health activities. This could start by having the 
CSCom team and the animators conduct joint team supervisions in the 
surrounding villages. Then after the animators leave, the supervision system 
would be in place. This would strengthen the sustainability of relay and village 
health committee activities. The on-going supervision of the relays would also 
strengthen their motivation, particularly if they were seen as working with the 
chef du Post who is very respected in the area. The evaluation team also 
recommended that the project staff and district health staff attend quarterly 
supervision meetings done at the CSComs. Their presence would encourage the 
other actors (ASACOs, CSCom staff, VHCs and relays) to attend and get 
involved in the process. They also pointed out that if the district staff were there, 
there would be more likelihood that the mayors would participate in the relay 
supervision meetings. This is important given that the mayors have access to their 
own source of funds and would be more likely to spend them on relay activities if 
they were involved in their management.
· If PIDRIK comes through with funding this year for the construction of the 10 
CSComs that they are promising, then the project needs to work with them and 
the MOH to see how to equip the facilities and carry out the corresponding 
community activities with the limited project resources. If PIDRIK does not come 
through with the anticipated funding, then the project needs to decide how many 
more CSComs it can realistically work with by the end of the project. Once the 
CS project has the results of the CSCom phase-out evaluation discussed above, it 
will be able to decide whether it should put more resources into new CSCom 
areas or if it should devote them to strengthening the sustainability of the old 
ones.
· Recommend that the project contract a short term BCC consultant to help them 
design a strategy that includes behavior change targets and strategies as well as 
awareness raising communications activities. It would be useful to employ more 
entertaining cultural formats that could be used to create interest in the villages 
such as stories, songs, street theater, and other methods. 
· The CS project needs to follow through on its original plan to acquire and/or 
develop IEC materials that are appropriate for the target audiences. The health 
messages need to be reinforced through support materials. Also the materials 
would help the relays with their educational tasks.
· If resources permit, the project should consider acquiring another vehicle for the 
work in the new CSComs in the far northern section of the district. It should also 
consider replacing some of the worn out motorbikes being used by the animators.
· In order to strengthen some of the intervention activities, the project should 
consider providing breastfeeding technical assistance to improve technique and 
promote exclusive breastfeeding in the communities.
37
F. Results Highlight
Perhaps the biggest achievement of the project to date has been its high level of 
vaccination coverage. With almost 70 percent of the children in the district completely 
immunized, the project is close to achieving its overall objective of 80 percent. The Kita 
district was selected for this project because it had the lowest immunization levels in Mali 
and was of great concern to the MOH. If they do achieve 80 percent coverage, Kita will 
be the only district in Mali to do so. To achieve this record level, the project has gone 
beyond working in the designated 13 CSComs (health center areas). Because the District 
Health System does not have CSComs in 30 areas, the project agreed to support 
additional vaccination posts and support for mobile teams and CBOs in these 30 areas. 
The project covered all costs related to continuous operation of the cold-chain system and 
supported maintenance and repair of cold-chain logistics. The MOH is sending a team to 
validate the LQAS findings in early 2005. If their results concur with the LQAS findings, 
Kita will be the district with the highest immunization rates in Mali and the MOH will be 
using it as a model.
I ndicators Project 
Year 3 
% 
Ob jective 
LQAS 
Resu lts
March 
2003
LQAS 
Resu lts 
November 
2003
LQAS 
Resu lts 
June 
2004
LQAS 
Resu lts 
Novembe r 
2004
Fu ll I mmun ization 
Coverage (F I C)
65 33 . 55 50. 00 69.54 70.00
According to the DIP, the MOH rate for fully vaccinated children in the Kayes region in 
2001 was 13.5 percent. Also only 40 percent of women had received two doses of anti￾tetanus vaccine during their last pregnancy. As we can see, the rate is now 78 percent in 
the Kita district. Issues also revolved around availability of vaccination cards, now close 
to 91 percent of children have them.
The project followed the strategies planned in the DIP in order to improve immunization 
coverage. Working with the MOH and ASACOS, they established the monthly outreach 
services with associated communities, supported bi-annual measles campaigns, ensured 
that quality vaccines were administered and provided training to CSCom health workers, 
particularly the vaccination staff.
This support given to District MOH to achieve greater immunization coverage 
contributes directly to CSHGP Intermediate Result 1 and more indirectly to Intermediate 
Results 2 and 3. 
38
III. Action Plan
Recommendation Steps that need to be 
taken to effectively 
address recommendation
Actor who 
will be 
responsible 
for each step
Timeline. By 
when each 
step shall 
have been 
accomplished
The project should conduct an 
evaluation of the CSCom areas that it 
has phased out of to see how well the 
health agents, ASACOs, VHCs and 
relays are doing in managing the 
health activities without project 
support. If there are problems then the 
project should take steps to address 
them in a timely manner.
1) Develop TOR of the 
survey
 2) Identify the 
institution, which will 
carry out the survey and 
negotiate a contract for 
carrying out the survey
3) Organize a workshop 
for the validation of the 
protocol before the 
starting of the survey. 
1) Dr 
Bagayoko 
PSE 
Coordinator
 2) Dr 
Aguibou 
Coulibaly
3) Dr 
Bagayoko
January 05
March 05
April 05
2. In order to strengthen the 
sustainability of the relays, the 
evaluation team recommended that the 
Chef du Post become the supervisor of 
the relays and their activities. This 
could be done at the time of regular 
outreach visits to the villages and/or 
through monthly meetings of all the 
relays at the CSCom. There are some 
administrative arrangements that need 
to be made in order for the CDP to 
supervise the village relays but once 
this is done there would be a system in 
place for on-going supervision of 
village health activities. This could 
start by having the CSCom team and 
the animators conduct joint team 
1) Make administrative 
arrangements (making 
memorandum of 
understanding, entering 
of the supervision 
responsibility in the job 
description of heads of 
post)
2)Define and negotiate 
the implementation of a 
mechanism of joint 
supervision of health 
activities in villages 
with a schedule of 
implementation and 
budget
1) Head of 
district health 
center
 2) Elie 
Coulibaly 
Responsible 
for SE 
Monitoring 
and 
Evaluation
January 05
January 05
February 05
39
supervisions in the surrounding 
villages. Then after the animators 
leave, the supervision system would be 
in place. This would strengthen the 
sustainability of relay and village 
health committee activities. The on￾going supervision of the relays would 
also strengthen their motivation, 
particularly if they were seen as 
working with the chef du Post who is 
very respected in the area. The 
evaluation team also recommended 
that the project staff and district health 
staff attend quarterly supervision 
meetings done at the CSComs. Their 
presence would encourage the other 
actors (ASACOs, CSCom staff, VHCs 
and relays) to attend and get involved 
in the process. They also pointed out 
that if the district staff were there, 
there would be more likelihood that 
the mayors would participate in the 
relay supervision meetings. This is 
important given that the mayors have 
access to their own source of funds 
and would be more likely to spend
them on relay activities if they were 
involved in their management.
3) Develop and 
negotiate the 
implementation of a 
plan of organization of 
meetings with actors 
(mayor, CSREF, PSE 
team)
3) Dr 
Souleymane 
Bagayoko
3. If PIDRIK comes through with 
funding this year for the construction
of the 10 CSComs that they are 
promising, then the project needs to 
work with them and the MOH to see 
how to equip the facilities and carry 
out the corresponding community 
activities with the limited project 
resources. If PIDRIK does not come 
through with the anticipated funding, 
then the project needs to decide how 
many more CSComs it can 
realistically work with by the end of 
the project. Once the CS project has 
the results of the CSCom phase-out 
evaluation discussed above, it will be 
See Action plan
Recommendation 1
40
able to decide whether it should put 
more resources into new CSCom areas 
or if it should devote them to 
strengthening the sustainability of the 
old zones.
(We purpose to reformulate this 
recommendation as below due to the 
fact that the extension of the project is 
no longer linked to PDRIK)
 
On the basis of the results of the 
CSCom Phase out study as 
recommended above, determine with 
the ministry of health and the other 
partners if more resources must be put 
into new health zones or if these must 
be devoted to reinforce the 
sustainability of the old zones.
4. Recommend that the project 
contract a short term BCC consultant 
to help them design a strategy that 
includes behavior change targets and 
strategies as well as awareness raising 
communications activities. It would 
be useful to employ more entertaining 
cultural formats that could be used to 
create interest in the villages such as 
stories, songs, street theater, and other 
methods.
1) Develop terms of 
reference of the 
consultation and plan 
financial resources for 
that purpose
2) Identify the 
consultant and get the 
protocol of agreement 
signed
3) Designing strategy 
and train actors of the 
implementation 
Dr Bagayoko
Dr Bagayoko
Consultant 
(under the 
supervision of 
Dr Bagayoko
March 05
March 05
May 05
5) The CS project needs to follow 
through on its original plan to acquire 
and/or develop IEC materials that are 
appropriate for the target audiences. 
The health messages need to be 
reinforced through support materials. 
Also the materials would help the 
relays with their educational tasks.
1) Plan financial 
resources for the 
acquisition of adequate 
supports
2) Make census of 
existing IEC materials at 
the level of CNIECS 
and ensure the obtaining 
Dr Bagayoko
Dr Sita Sidibe
May 05
Jun 05
41
of more. 
3) Put IEC materials at 
the disposal of actors 
(animators and Relays) 
Dr Sita Sidibe Jun 05
6) If resources permit, the project 
should consider acquiring another 
vehicle for the work in the new 
CSComs in the far northern section of 
the district. It should also consider 
replacing some of the worn out 
motorbikes being used by the 
animators
1) Plan for the 
purchasing of a vehicle 
and motorbikes for the 
project
PUM Kita
February 05
7) In order to strengthen some of the 
intervention activities, the project 
should consider providing 
breastfeeding technical assistance to 
improve technique and promote 
exclusive breastfeeding in the 
communities.
1) On the basis of the 
results of LQAS survey, 
identify communities 
where there is less 
breast-feeding and work 
with partners (NGOs) to 
develop a special action 
plan to promote 
exclusive breast-feeding 
in these communities 
2) Conduct a 
communication 
campaign targeting 
behavior change on 
breast-feeding in these 
communities 
3) Evaluate action of 
the campaign
Dr Bagayoko
NGOs (under 
the 
supervision of 
Dr Bagayoko)
Elie Coulibaly
January 05
February 05
August 05
42
IV. ATTACHMENTS
A. Baseline Assessment from the DIP 43
B. Evaluation Team Members and Titles 47
C. Evaluation Assessment Methodology 48
D. List of Contacts 49
F. 3
rd LQAS Report 50
G. Project Data Sheet Form- Updated Version 71
43
Attachment A. Baseline Information from DIP
 SUMMARY OF BASELINE ASSESSMENTS
Two baseline studies were undertaken prior to the development of the DIP. The 
researchers were staff members of the local NGO (ACD) that will be doing the training 
for the project. Two district health officers and two Plan Kita staff members supervised 
them. Dr. Pierre-Marie Metangmo, Plan International Health Program Coordinator 
trained the whole team in the use of the Rapid CATCH (Core Assessment Tool on Child 
Health) questions. Complete report in French can be found as Annex II and I. It is being 
translated into English.
E.1 Evaluation of CSComs in Kita District
The objective of this study was to have baseline information about the availability of and 
access to maternal and child health services in the district, as well as the quality of those 
services, with emphasis on the following: 
o Initial and continuing training on health protocols, IMCI and nutrition
o Availability of ten essential medicines
o Capacity of health workers to communicate health messages to users
o Degree of user satisfaction with services received at the health centers.
The study was carried out during the period from January 18 to 28, 2002. Eight CSComs 
were visited and information was collected through observations, interviews and 
inventories. Each of these CSComs is considered “functional” according the MOH’s 
definition. In each center, the sample constituted a minimum of ten children who 
presented with diarrhea (15), ARI or cough (16), fever/malaria (22), or malnutrition (5), 
and their mothers. All staff present were observed or interviewed. These included one 
doctor, 8 nurses, 7 midwives, one obstetric nurse and three nurses aides. Forty-two 
mothers were interviewed as they left the center.
The following services were available CSComs: examination of sick children, CPN, 
family planning, birthing/deliveries, and vaccination. Centers were officially open from 
7:30 am to 4:00 pm. Travel time to reach the center averaged more than one hour, and 
women had arrived by foot, bicycle, motor scooter or donkey cart.
Of the 19 staff interviewed, nine had training in treatment procedures and protocols, one 
had IMCI training, six had nutrition training, and 10 in midwifery. 
A center is considered to be adequately equipped if it has the following: medical 
stethoscope, thermometer, blood pressure, otoscope, tongue depressors, scales (regular 
and for babies), refrigerator and tools for measuring and mixing. Using this standard, 
four centers ere not adequately equipped. The centers had anywhere from 30% to 90% of 
the ten essential medicines. No center had all ten essential medicines.
44
Staff were observed during examinations of sick children in order to determine their 
training needs, with the following results:
o Diarrhea cases correctly diagnosed: 60%
o Dehydration as a result of diarrhea correctly diagnosed: 40%
o Diarrhea cases appropriately treated: 25%
o Dysentery cases appropriately treated: 67%
o Cough/breathing difficulties correctly diagnosed: 6.7%
o Cough/breathing difficulties appropriately treated: 27.3%
o Fever/malaria cases correctly diagnosed: 27.3%
o Fever/malaria cases appropriately treated: 75%
o No cases of malnutrition were diagnosed and therefore none was treated.
o Verification of possession of vaccination cards took place for 10 of 42 children or 
23.8%.
o None of the mothers was asked whether she had a vaccination card or health 
book.
o 70% of staff did not know the vaccination schedule.
o 65% of staff did not know at least three signs of serious illness that would indicate
the need for referral.
o In 34.9% of cases observed, at least three messages about child health care were 
transmitted.
Exit interviews with mothers:
o 54.8% of mothers said they had learned at least two types of home care for their 
sick children after the examination.
o 59.5% said the health care provider had told them about signs that would indicate 
the need to bring the child to the health center. 
o 84% were able to tell the interviewer at least two of the signs they had learned 
during the examination.
Supervision:
o 89.5% of staff said they got supervision once a trimester.
o Only 17.6% reported getting any feedback from their supervision.
User satisfaction:
55% of mother said they had difficulties in using the CSCom health services, including 
the long distance which takes a long time (54.5%), child care (9.1%) and the hours during 
which the CSCom is open.
While 40 mothers interviewed (95.5%) said they were satisfied with the medical attention 
their children had received, what is interesting is the reasons they gave for being 
satisfied:
o The health care provider really looked at the child carefully. 
o The health care provider really welcomed me/the health care provider was 
friendly 
o The health care provider reassured me/told me it was nothing serious. 
o The health care provider told me what was wrong with my child. 
o The health care provider gave me a lot of explanation. 
45
The researchers’ general impression was that women were timid about questioning the 
health workers.
Recurring costs:
· There was a lack of ledger books for keeping accounts.
· Supporting records, such as the treasurer’s records, were badly filled out or not filled 
out at all.
· Absence of justifying document for expenses declared.
· At Kassaro CSCom salaries hadn’t been paid for a year, and in Sandjanbougou there 
was no financial information at all.
E.2 Baseline Evaluation of Knowledge, Attitudes and Practices
This study was undertaken by the same researchers from January 20 to February 5, 2002. 
The objective was to determine knowledge, beliefs and behaviors regarding malaria, 
diarrhea, immunization, ARI and nutrition. Women between the ages of 15-49 and their 
children ages 0-23 months were randomly chosen. The total number of mother/child 
pairs was 430. 
Findings:
o 18.4% of children were two standard deviations below average in weight for age.
o 68.6% of infants had an assisted birth (from a health worker).
o 24.1% of mothers had received two TT during their last pregnancy.
o 51.0% of children ages 12-23 months had completed their vaccines before their 
first birthday.
o 61.5% of children ages 12-23 months had been vaccinated against measles.
o 11.6% of infants ages 0-5 months had been exclusively breastfed during the 24 
hours preceding the interview.
o 79.7% of children ages 0-23 months were breastfed immediately within the first 
hour after birth.
o 9.8% of infants ages 6-9 months had received breast milk and complementary 
food during the 24 hours preceding the interview.
o 3.9% of children ages 0-23 months had slept under an insecticide treated bed net 
the night before the interview.
o 39.5% of mothers of children ages 0-23 months could cite at least two methods of 
preventing HIV/AIDS, including abstinence, having only one partner or using 
condoms.
o 27.9% of mothers said they washed their hands with soap before preparing food 
or giving food to their children.
Health care behaviors:
ß 26.6% of children ages 0-23 months had received increased amounts of liquid and 
continued eating while sick during the preceding two weeks.
ß 25.2% of children with diarrhea during the preceding two weeks had received 
ORT or liquid foods made at home.
46
ß 35.3% of mothers of children ages 0-23 months knew at least two signs of serious 
illnesses that would necessitate taking their children for treatment, including high 
fever, not eating, listlessness and vomiting everything that had been eaten.
47
Attachment B. Evaluation Team Members and their Titles
Names Titles
Elie Coulibaly CSP M&E Assistant
Alassane Cissé Program Unit Manager Plan Kita
Issa Traoré District Chief Medical Officer, Kita
Souleymane Bagayoko Coordinator of CSP
Abdoulaye Diakité Chief of the Social Development Ministry for Kita
Soriba Diarra FELASCOM President
Sita Sidibé CSP Training Assistant
Aguibou Coulibaly National Coordinator for Child Survival in Plan Mali
Mamadou Seck Assistant Information Systems manager for CSP
Dian Namory Sidibé Medical Coordinator, Plan Banamba
Bourema Yanogué Zone Chief, Plan Kita
Bemba Doumbia Zone Chief, Plan Kita
Seydou Diabaté Medical Coordinator, Plan Kangaba
Ibrahima Diakité Coordinator of ARAFD/C Kita
Mamadou Keita Kayes Regional Health Officer for Child Survival
Pierre Marie Metangmo Health Programs Coordinator Plan (IH) USA
Sandra Wilcox Child Survival Project Evaluation Consultant
Ibrahim Simaga Assistant Chief Medical officer, Kita
48
Attachment C. Evaluation Assessment Methodology and Preliminary Results
The mid-term field evaluation took place between December 12th and 22nd 2004. The 
consultant and Plan Child Survival Coordinator met with the Plan Director of Programs 
and the national Coordinator for Child Survival in Bamako on the 13th. They also met 
with the USAID health officer very briefly and traveled to Kita that day. The field 
evaluation took place between the 14th
– 21st of December at the project sites in the Kita 
district. 
On December 14th the consultant and CS Coordinator met with the rest of the evaluation 
team. The team, as noted in Attachment B, was composed of a broad array of 
stakeholders including individuals from the project team (Plan and local NGO 
(ARAFD/C) staff, Plan regional, national and international offices, the Kayes Regional 
and Kita District MOH, the FELASCOM (ASACO national organization), and the Kita 
Ministry of Social Development. The team met between December 14th
 – 20th at Plan’s 
regional Program Unit office in Kita. The first two days were spent listening to a briefing 
by project staff of the project’s achievements and issues, discussing key project questions 
and concerns, small group preparation of field visit questionnaires, organizing the group 
into teams and selecting sites to be visited. On the third day, the team finalized the 
questionnaires and field tested them at a non-project site.
On December 16th, 17th and 18th, the evaluation team was split into three groups and each 
visited one CSCom and at least one associated village each day. A total of 6 health Areas 
were visited. The teams met with and interviewed: the staff of the CSCom, the ASACO 
members, the village Health Committee members, women’s groups, the Relays and 
Animators. Afterwards the visiting teams conducted home visits and interviewed some of 
the village members. After each visit the individual teams met and outlined strengths, 
weaknesses and preliminary recommendations regarding the sites they had visited.
On December 19th the evaluation team met and reviewed the preliminary findings from 
each group. These were discussed and then compiled into a summary of results 
document. During this period and on December 18th and 19th the Consultant conducted 
individual interviews with project staff, partners, the animators, the MOH representatives, 
Felascom director and Chief of the Social Development Ministry.
The consultant conducted a preliminary debriefing with the CS Project staff on the 
morning of the 20th and then traveled to Bamako in the afternoon. She met with and 
debriefed the Plan Country Director on December 21st and returned to the US on the 22nd
.
49
Attachment D. List of Contacts
Kasimir Youmbi Plan Program Support Manager
Aguibou Coulibaly Plan national Child Survival Coordinator
Joachim Segurado Plan Country Director
Alassane Cisse Plan Program Unit Manager, Kita
Elie Coulibaly CSP M&E Assistant
Issa Traore District Chief Medical Officer, Kita
Soulemane Bagayoko Coordinator of CSP
Abdoulaya Diakite Chief of Ministry of Social Development
Soriba Diarra President of the FELASCOM
Sita Sidibe CSP Training Assistant
Mamadou Seck Information Systems manager
Dian Namory Sidibe Health Coordinator, Plan Banamba
Bourema Yanogue Zone Chief, Plan Kita
Bemba Doumbia Zone Chief, Plan Kita
Seydou Diabate Health Coordinator, Plan Kangaba
Ibrahima Diakite NGO Coordinator ARAFD-C Kita
Mamadou Keita Kayes Regional Health Officer for Child Survival
Ibrahim Simaga Assistant Chief Medical officer, Kita
50
Attachm ent F Resu lts of the third LQAS su rvey (JUNE 2004)
 
E li e COUL I BALY, CSP Mon itoring and Eva l uat i on Ass istant CSP
D r Sita SIDIBE, CSP Training Assistant 
MON I TOR I NG THE KI TA CH I LD SURVI VAL 
PROJECT.
JUNE 25 – 30 , 2004
51
 
 
Septembe r 2004
 
SUMMARY
Page
I - I NTRODUCTION 2
II - RESULTS 4
A. Current level of indicators
4
B. Evol ution of indicators
6
C. Graphs 7
 D. I dentifi cati on of pr i orities by health area
11
III - DI SCUSSION 14
IV- CONCLUS ION and RECOMMENDATIONS
16
APPENDI CES 18
52
I - I NTRODUCTIO N
The third Pl an Kita-Koura Ch ild Survi val Project LQAS survey was
conducted from June 20 through 25 2004, and health and soci al services 
personnel and ASACOs we re closely involved in this survey technique. 
Through this exercise, the project staff begins to undertake the process 
of transferring competenc i es with the active participation of the first 
benef i ci aries and stakehol ders of the project. 
The survey was carr i ed out i n five (5) days.
Resu lts obtained from this survey provi ded us with quite revealing 
i ndi cati ons that we will now ill ustrate in this report. The results will 
certainly be useful for us as indicators mon itoring the project for this 
year, and they will also enabl e us to draw up an acti on pl an taki ng i nto 
account the areas that are consi dered to show weaknesses . 
The survey showed us that mo thers’ behavi or in the management of 
ch il dhood ill ness had changed s i gn ifi cantl y. 
Resu lts for this survey have proved that the rate of coverage of
i mmun i zati on has cl early progressed (69.54% o f fully vaccinated children 
as oppose d to 50% i n the Novembe r 2003 su rvey.)
Concerni ng care for mo thers, there has been quite interesting progress 
(during the last pregnancy, 79.61 % of women had taken iron and foli c 
aci d i n June 2004, as agai nst 76. 32% i n Novembe r 2003)
Women ’s behavi our relating to ANC (Ante -Natal Consu ltation) i mp roved, 
showi ng a rate of 55.92 % i n June 2004, as compa red with a yearly 
objecti ve of 40%.
The rate of women’s i mmun i zati on coverage has i mp roved by 8. 90 %
between Novembe r 2003 and June 2004, 
With relation to wom en taki ng vitami n A i n the 40 days i mmedi atel y 
following childbirth, the result of 40.13% has exceeded the annual 
objecti ve of 35%.
53
The results of this June 2004 LQAS survey enabl ed us to i dentify the 
zones with problems, or the priority zones for wh i ch we are mak i ng 
suggesti ons and recommendati ons.
- Ma i ntai n and rei nforce vacci nati on at a month l y rate in advanced 
strategy i n all health areas and outreach posts, with i mp li cati on of 
traditional birth attendants in this outreach strategy for ANC and 
PNC and /or mon itoring healthy children. 
- Decentrali ze the strategy for distri buti ng vitami n A i n all health area 
vill ages with close involvement of commun ity health relay wo rkers 
i n the process. 
- Enter all the ti mes vitami n A is taken in a CSCom register, and i n 
the notebooks of the commun ity level relay wo rkers. 
- Emphas i ze commun i cati on for behavi or change, targeti ng mo thers 
so that they will adopt behavi ors favorabl e to their health and that 
of their children. 
- Foll ow up i mp l ementati on of mi cro -p l ans and HI S i n the chil d 
survival project zones. 
- Emphas i ze support for vill age hea lth committees and commun ity 
health relay wo rkers in analysis and interpretation of data collected 
each month . 
A. OBJECTI VES OF THE SURVEY
1. Compa re the level of evolution of indic ators to the results of the 
Novembe r 2003 su rvey and to the project’s third year objectives. 
2. List the priority zones by health area in order to undertake necessary 
corrective action. 
B - METHODOLOGY
1. Sa mp li ng : 
The survey target concerned mo thers with ch il dren aged from 0 through 
23 months , who li ved i n the project i nterventi on zones for at l east 6 
months . Th is survey popul ation was sel ected through two parall el 
samp l es: mo thers with children aged from 12 through 23 months , and 
those with children aged 0 through 11 months
We put var i ous questi ons to the mo thers concerni ng the mai n areas of 
the chil d survi val project. 
54
For each of the groups of women, a samp l e of a maxi mum o f 19 subjects 
was sel ected at random i n each of the 8 health areas in the zone covered
by the project, giving a total of 303 women. 
The numbe r of subjects for the survey i n each vill age was chosen as 
follows: 
- Ca l cu l ate the accumu l ated popu l ation of the vill ages i n the supervised 
area (health zone) 
- A list of all the househol ds was drawn up by the project team. 
- The f irst househol d to be surveyed was sel ected at random, using a 
tabl e of random numbe rs, from the list of househol ds. 
- From this househol d , women to be quest i oned were sought out i n the 
househol ds at a rate of one woman per househol d , and sel ecti ng the 
nearest house. 
- If there is mo re than one woman i n the househol d who fits the target 
criteria, a draw is made among the names of all of those i n the househol d , 
and the sel ected name is retained for the samp l e.
The s i ze of the samp l e var i es accordi ng to the numbe r of avail abl e 
responses from 303 to 143 and accordi ng to whether or not the two 
groups of women are part of the denomi nator. 
2. Ana l ys is (or tabulation) of data
The tabl e of anal ysis for each health area was used by the survey team to 
make anal ysis of the data: the who l e operati on was conducted manuall y. 
 3 . Data ana l ys is.
We conducted data anal ysis from the summary tabl e and the tabl e of the 
« rule of decisions ».
II - RESULTS OF THE SURVEY 
- The current l eve l o f i nd i cators m easured. 
: Average cover of indicators in Kita project intervent i on zones, June 04. 
55
Level of the indicator in each 
group of women
Size of samp le Average Cover , by 
Perc entage
0-11 12 -23 Together 0-
11
12 -
23
Total 0-11 12 -23 Total
Ch ildren having a vaccination card. - 137 137 - 151 151 - 90.72 90.7
2
Fully vaccinated children - 
105 
105 - 151 151 69.53 69.5
3
Women having a consultation card/booklet 129 
-
 
129
15
2
0 152 84.86 
-
84.8
6
Women having comp leted at least three 
ante - natal visits. 
 85 - 
85
15
2
0 152 55.92 55.9
2
 
-
Women having taken iron folic acid during 
the last pregnancy 
121 - 121 15
2
0 152 79.60 - 79.6
0
Women having taken chloroquine during the 
last pregnancy 
125 0 125 15
2
0 152 82.23 - 82.2
3
Women having received two doses of more 
of ATV
120 0 120 15
2
0 152 78.94 - 78.9
4
Women having given birth i n a health center 80 0 80 15
2
0 152 52.63 - 52.6
3
Women having been assisted by a trained 
health worker in childbirth 
99 0 99 15
2
0 152 65.13 - 65.1
3
Women having taken Vitam in A in the 40 
days following childbirth
61 0 61 15
2
0 152 40.13 - 40.1
3
Wom en possessing a bednet 34 58 92 15
2
151 303 22.36 38.41 30.3
6
Ch ild having slept under an i mpregnated 
bednet. 
30 38 68 15
2
151 303 19.73 25.16 22.4
4
Women knowing 2 signs indicating that the 
child needs care 
45 138 183 50 152 202 90 90.78 90.5
9
Sick children having received at least the 
same quant ity or more than usual to drink
98 98 143 143 68,53 - 68,5
3
Sick children having received at least the 
same quant ity or more than usual to eat
- 72 72 - 143 143 50.34 - 50.3
4
Women knowing how to describ e the 
preparation of ORS. 
- 54 54 - 70 70 77.14 - 77,1
4
Tabl e no. 1 denotes the current situation of indicators in the two target 
group sel ected for the survey: ( Women with children aged 0 -11 months 
and women with children aged 12-23 months) 
Ana l ysis o f this table provides interesting infor mation on:
- i mmun i zati on coverage of chil dren under the age of 24 months 
- use of health services by mo thers to preserve their health status 
and that of their children. 
- the i mpact of commun i cati on acti vities for behavi or change (BCC ) 
on mo thers’ attitudes and behavi or. 
56
- Use of i mp regnated bednets i n our commun ities, particularly for 
ch il dren under the age of 5 years and for pregnant women. 
Resu lts in this table lead to the followi ng deduct i ons: 
- use by ch il dre n of i mp regnated bednets appears to be the i ndi cator 
with the weakest response l evel i n this survey (22,45% o f children slept 
under an i nsecti ci de-treated bednet the previ ous n i ght). 
- Women ’s conservati on of i mmun i zati on cards and their knowledge of 
ch il dhood ill nesses seem to be the i ndi cators with the highest scores: 
90. 72 % for the first, and 90.59% for the second
B - Evo l ution o f the i nd i cators i n rel ati on to the baseli ne study
and the Nove m be r 2003 LQAS survey
Tab l e N°2 : Level of evol ution of the i nd i cators i n the e i ght (8) f irst 
project i ntervent i on zones i n Kita, June 2004
I ndi cators Baseli ne 
l evel -
%
3 year 
l evel - %
3 year l evel 
- %
Novembe r 
2003
3 year l evel -
%
June 2004
Ch il dren havi ng a i mmun i zati on 
card
49 65 86 . 84 90.73
Fu ll y v acci nated chil dren 51 65 50. 00 69.54
Women with an ANC 
card/book l et 
14 40 83 . 55 84.87
Women havi ng comp l eted at 
l east 3 ANC visits
14 40 53 . 02 55.92
Women havi ng taken iron+foli c 
aci d dur i ng the l ast pregnancy 
65 75 76 . 32 79.61
Women havi ng taken 55 70 83 . 78 82.23
 
1
 Basic KPC %age is fixed at 51% of fully vaccinated children from 12 through 23 months (53 children 
vaccinated out of 104 holding a card, as compared with a total of 212 surveyed children). This calculation 
excluded children not holding a vaccination card from the sample. We have therefore adjusted the 
indicator by relating it to the overall number of surveyed children (53/212 =25%) in accordance with 
general practice and methodology applied in the LQAS framework).
57
ch l oroqu i ne dur i ng the l ast 
pregnancy 
Women havi ng recei ved at 
l east 2 doses of ATV
24.1 40 71 . 05 78.95
Women havi ng been ass isted 
by a trai ned hea lth wo rker in 
ch il dbirth 
68 .6 75 68 . 24 65.13
Women havi ng taken Vitami n A
i n the 40 days following
ch il dbirth
- 35 40. 56 40.13
Ch il d havi ng s l ept under an 
i nsecti ci de-treated bednet. 
3 .9 30 17 . 67 22.45
Women knowi ng 2 s i gns 
i ndi cati ng that the chil d needs 
care
35 .3 50 87 . 75 90. 59
Si ck ch il dren havi ng recei ved at 
l east the same quantity or 
mo re than usual to dr i nk
26 .6 50 66 . 52 68 . 53
Si ck ch il dren havi ng recei ved at 
l east the same quantity or 
mo re than usual to eat
21 50 44. 04 50. 34
Women knowi ng how to
descr i be the preparati on of 
ORS.
49 50 58 . 75 77 . 14
C. G raphs ill ustrati ng the re su lts in com par i son with the 
m on ito ri ng i nd i cators 
58
0
10
20
30
40
50
60
70
80
90
100
Existence child. vacc
card
Fully vaccinated
children
Women with
consultation card
Women 3 ANCs
objective Yr3
result Nov 03
result June 04
59
0
10
20
30
40
50
60
70
80
90
3 ANC visits Iron + folic acid
taken 
Chloroquine taken Two doses of
ATV
Objective Yr 3
Result Nov 03
Result June 04
60
0
10
20
30
40
50
60
70
80
90
100
Vit A 40 days after
giving birth
Children having slept
under ITM bednet.
 Women knowing 2
signs of illness
requiring treatment
Objective YR 3
Result Nov 03
Result June 04
0
10
20
30
40
50
60
70
80
Sick child +drink Sick Child + eat Women knowing
SRO description
Objective Yr 3
Result Nov 03
Result June 04
61
Tabl e no. 2 h i gh li ghts the extent of evol ution of i ndi cators between the 
surveys of Novembe r 2003 , June 2004 and the baseli ne study, and these 
results are compa red to the objecti ve set for the third year of the 
project.
We note a s i gn ifi cant i mp rovement i n the l evel of indicators compa red 
with the result s of the Novembe r 2003 LQAS su rvey. 
- The evol ution is very significant for indicators of behavior and 
practi ces ( Women havi ng had at l east three postnatal 
consu ltations, women havi ng recei ved at l east two doses of ATV, 
and women havi ng taken vitami n A) 
- The rate of possessi on of vacci nati on cards by chil dren aged from 
12 through 23 months is an indicator with a good score. The 
objecti ve set for year three of the project has been decisively 
exceeded. 
- For the i ndi cator measur i ng the behavi or of a mo ther faced with a 
ch il d suffering from d i arrhea, the objecti ve set for year III of the 
project has been cl early attained. 
- The objecti ve set has been attai ned or exceeded i n 11 cases out of 
14
- For three sentry i ndi cators, the objecti ves set have not been 
attained; results of these indicators are characterized by pockets 
where they have become a pr i ority and they call for particular 
attention: ( Women havi ng been ass isted during childbirth, children 
havi ng s l ept under i mp regnated bednets and s i ck ch il dren havi ng 
been gi ven at l east as much as usual to eat.) 
- For five (5) indicators ( women havi ng taken chl oroqu i ne dur i ng 
their l ast pregnancy, women havi ng been ass isted in childbirth by a 
health wo rker, women havi ng taken vitami n A i n the 40 days 
following childbirt h, sick children having received at least as much 
as usual to eat, sick children having received at least as much as 
usual to dr i nk) the l evel of indicators has fallen between Novembe r 
2003 and June 2004. 
C- I dent ification of priorities
- 1 -Pr i or iti es not ed for women with children aged from 0 
through 11 m onths
62
Tab l e N°3 : I dent ifi cat i on of pr i orities accordi ng to results of the LQAS3 
survey i n the i ntervent i on zones of the P l an Ma li, K ita PU CSP i n June
2004
 
Indicators 
BEND BOUG DIDJAN FLD MAK KAS SEB SAND
Women, having a consultation 
card/booklet 
No N N N N N N N
Women having received two or 
more doses of ATV 
N N N N N N N N
Women, having completed at least 
three ante-natal consultations 
N N N N N N N N
Women having taken iron + folic 
acid during the last pregnancy 
N N N N N N N N
Women having taken chloroquine 
during the last pregnancy
N N N N N N N N
Women having given birth in a 
health center
NNN Yes Y N N N N N
Women having been assisted by a 
trained health worker during 
childbirth 
Y Y N N N N N N
Women having taken vitamin A in 
the 40 days after childbirth
N N Y N N N N N
Women possessing a bednet N N N N N N N N
Children 0-11 months, having slept 
under an impregnated bednet 
N N N N N N N N
Women knowing two signs that the 
child needs care at home or 
elsewhere 
N N N N N N N N
Children having presented 
symptoms of illness during the 
previous two weeks 
N N N N N N N N
Sick children having received at 
least the same amount as usual, or 
more, to drink. 
N N N N/A N N N N
Sick children, having received at 
least the same amount as usual, or 
more to eat. 
N N N/A Y N N N N
Women, having heard of ORS N N N N N N N N
Women, knowing how to describe 
ORS preparation 
Y
Key: no priority N/A : 
Not App li cable
63
priority
Tabl eau No. 3 be l ow p resents the success registered in each health area 
i n the project i nterventi on zone. 
We note here that there has been cl ear progress at the l evel of indicators 
i n each health area.
All the areas surveyed have made real progress, the pockets showi ng 
priority needs or the areas of concern have been consi derabl y reduced i n 
the i ntervals between the three surveys: i n Ma rch 2003 , there we re 29
priority pockets, in Novembe r 2003 : 12 pockets , and the current survey 
i n June 2004 shows 6 pockets . 
We note that every health area has made a great l eap forward between 
the Novembe r 2003 su rvey and the June 2004 one (for examp l e the 
Dji d i an area had 4 p ri ority zones i n Novembe r 2004, agai nst onl y 1 i n the 
June 2004 survey, and Sandi anbougou registered 4 priorities compa red 
with 0 th is ti me.)
The areas of Makandi anbougou , Sébékoro, Sandi anbougou , mai ntai ned 
their l evel of perfor mance (no red square either in the Novembe r 2003 
survey or that of June 2004).
Out of a total of sixteen (16) sentry i ndi cators targeted by the survey, 
four (4) present pr i ority areas.
2 Priorities noted among women with children aged from 12
through 23 months
Table N°4: Identification of priorities in accordance with results of the Plan Mali, Kita PU 
third LQAS survey, in June 2004 
I nd icators BEND BOUG D I DJAN FLD MAK KAS SEB SAND
Ch il dren havi ng a immun ization 
card 
N N N N N N N N
Fu lly vaccinated children N N N N N N N Y
Women possess i ng a bednet N N N N N N N N
Ch il dren from 12 through 23
months hav i ng s lept under an
i mp regnated bednet 
N N N N N N N N
Women knowi ng two s i gns that 
a ch il d needs treat m ent at 
home or e lsewhere. 
N N N N N N N N
64
Ch il dren of 12 - 23 months , 
havi ng presented symptoms of 
ill ness dur i ng the previ ous two
weeks 
N N N N N N N N
S ick children from 12 - 23 
months hav ing received at least 
the sa m e a mount as usua l, or 
mo re, to drink. 
N N N N N N N N
S ick children from 12 - 23 
mon ths having received at least 
the sa m e a mount as usua l, or 
mo re, to eat
N N N N Y N N N
Women hav i ng heard of ORS N N N N N N N/ A N
Women , knowi ng how to 
describe ORS preparation 
N/ A N/ A N N/ A N N N/ A N/A
Key: Good Bad N/A: Not App li cable
From the contents of this table we note that there has been a cl ear 
evol ution of the targeted sentry i ndi cators between the LQAS survey of 
Novembe r 2003 and that of June 2004 (on l y I pocket of pr i ority need i n 
June 2004 as compa red with 12 i n the November 2003 su rvey). 
I n additi on , the table shows that onl y the Sandi anbougou hea lth area 
presents a pr i ority zone and for onl y one i ndi cator « fully vaccinated 
ch il dren » wh il e the areas of Bougar i baya , Bendougouba , Sebekoro , 
Dji d i an, Sandi anbougou , all have at l east one i ndi vi dua l priority during the 
Novembe r 2003 LQAS su rvey. 
Concerni ng the possess i on of chil dren’s vacci nati on cards, whil e just one 
(1) area, Bougar i baya , presented a pr i ority need i n Novembe r 2003 , 
dur i ng the present survey, no health area has presented a pr i ority pocket 
for this indicator.
We note that all the areas have made a real effort. However, we still 
have to note that there are differences between the l evels of 
perfor mance of the areas (see the summary tabl e i n appendix): different 
l evels of priority for the various efforts to be made are observed i n the 
health areas. 
The Sandi anbougou hea lth area stands out among the other hea lth areas 
because of its weak l evel of perfor mance and its score is in comp l ete 
contrast with the tendency elsewhere. 
65
Th is fact calls for an effort on our part and should make us parti cu l arly 
attentive: we must gi ve it our supervisory attention to bring this zone to
the same l evel of perfor mance as the others. 
To sustai n the success we have noted previ ous l y, we must be vi g il ant and
put forth the maxi mum effort not onl y to mai ntai n this perfor mance, but 
also to i mp rove them. 
III. DISCUSSION
I n this chapter, we will attemp t to gi ve el ements of answers to some of 
our preoccupati ons, whi ch we cons i der pertinent in order to attain the 
objecti ves that will l ead the chil d survi val to full success. 
1 . i mm un i zat i on :
The percentage of full y vacci nated chil dren is of 69.54 % compa red with 
an objecti ve of 65%, i n our opi n i on represents a strong perfor mance. The 
results for this indicator are striking: (33.55% i n Ma rch 2003 , 50 % i n 
Novembe r 2003 , and 69. 54% i n June 2004) . 
Th is success is certainly remarkabl e, but there are certain difficulties that 
shou l d be poi nted out – among others the distance of the popu l ation 
from vacci nati on centers, the proliferation of agricultural haml ets, 
irregular conduct of vacci nati on i n outreach strategy, del ays i n payment 
of vacci nators’ salaries: the examp l e bei ng that of the vacci nator for 
Sandi anbougou , l ack of foll ow-up of i mp l ementati on of the ASACO
membe rs’ mi cro -p l ans i n the var i ous health areas surveyed – all of these 
are major constrai nts wh i ch must be countered and wh i ch call for remova l 
as they represent real obstacl es to the Chil d Survi val Project. 
2 . The use of i mp regnated bednets 
The i ndi cator concerni ng usage of i mp regnated bednets has made c l ear 
progress. It has gone from 17 . 6% i n Novembe r 2003 to 22 . 45% i n June 
2004. Th is can be expl ai ned i n part by Pl an’s support for free suppl y of 
i nsecti ci de tre ated nets to the ASACOs (March 2003) and a lso by the 
promo ti ona l sales of i mp regnated bednets by the M i n istry of Health (June 
2003) . 
The l evel of progressi on rel ating to this indicator is acceptable and
encouragi ng with a success rate of 22.45% towards an objecti ve of 30%. 
66
I n additi on to the comb i ned efforts concerni ng these two acti ons, the 
recent arrival of UNICEF in the circle ( Ap ril 2004) p l aci ng at the 
d isposition of the Health referral Center a stock of 30 000 i mp regnated 
bednets to be provi ded fr ee of charge to women havi ng attended a 
postnatal consu ltation and to chil dren who have comp l eted i mmun i zati on 
before their first birthday, will certainly contribute to i mp rove responses 
to this indicator in the comi ng months. 
I n coll aborati on with its partners, the Chil d Survi val project will p l ace 
particular emphas is on treating bednets and other supports i n the next 
months to i mp rove this activity, wh i ch until now has remai ned a weak li nk 
i n the poli cy of preventi ve mal aria control. 
1 - Commun i cat i on a ctivities to change mo thers’ behavi or:
With regard to mo thers’ attitudes to giving mo re food than usual to a s i ck 
ch il d , the indicator has shown a z i gzag devel opment : (43 . 72% i n 
Ma rch 2003 ; 44. 04% Novembe r 2003 , and 42. 17% i n June 2004),
Th is indicator s hou l d attract our attenti on most of a ll, because not on l y 
the object i ve for the th ird year (50%) has not been attai ned, but also, 
and i n part i cu l ar, the level of perfor m ance for th is indicator has fallen
between Nove mbe r 2003 and June 2004. 
We are encouragi ng the organi zers and chi efs of medi cal posts to pl ace a 
particular emphas is on commun i cati on acti vities for Behavior Change in 
this respect, and also call on greater ASACO i nvol vement i n soci al 
mob ili zati on acti vities in their respective health areas.
4 . Concern i ng ad m i n istration of Vitam i n A: 
From Novembe r 2003 to June 2004, the level of indicator relating to 
admi n istration of Vitami n A to women i n the 40 days foll owi ng ch il dbirth 
has fall en – the l evel pass i ng from 40 . 56% i n Novembe r 2003 to 40. 13% 
i n June 2004. 
To i mp rove the tendency, we must have the unwaver i ng support of the 
ch i efs of medi cal centers and all the CSCom staff on one hand, and on the 
other hand that of the Chil d Survi val project through the organi zers 
representi ng it for this a ctivity at commun ity level. 
I mp li cati on of the commun ity health relay wo rkers is very i mpo rtant in the 
strategy for Vitami n A d istri buti on to post-partum women and to ch il dren 
aged from 6 through 59 months
67
We are not l oos i ng s i ght of the efforts made by those i n charge of the 
Referral Health Center in bringing the rate of average coverage for this 
i ndi cator from 8 . 55% i n Ma rch 2003 to 40. 56% i n Novembe r 2003
I n additi on , although the l evel of perfor mance certai n l y fell between 
Novembe r 2003 and June 2004, it has to be recogni zed that the 
objecti ve for year three (35%) has cl early been attai ned.
I V. CONCLUS I ON AND RECOMMENDATI ONS 
On p resenting the results of this third LQAS su rvey, we note c l ear 
i mp rovement i n the mon itoring indictors, each health area havi ng shown 
real i mp rovement. 
The objecti ves set for year three (3) have been met for 12 i ndi cators out 
of 14 with significant increases in maternal protecti on (ante -natal 
consu ltations, admi n istration of iron and folic acid) and for the protection 
of i nfants (vacci nati on , usage of i nsecti ci de treated bednets).
The results of this survey give essential infor mation.
The questi onna ire admi n istered to mo thers of chil dren aged from 12 
through 23 months shows that out of the ei ght areas surveyed, onl y the 
health area of Sandi anbougou has a pr i ority need pocket and that is for 
on l y one i ndi cator “fully vaccinated children wh il e five (5) areas presented
at least one pr i ority pocket: Sandi anbougou , Dji d i an, Bougar i baya , 
Sebekoro, Bendougouba i n Novembe r 2003
I n additi on , it appears from anal ysis of the questionnaire addressed to 
mo thers with children aged from 0 through 11 months that the areas of 
Sandi anbougou , Sebekoro, Makandi anbougou mai ntai ned the same 
perfor mance, from the Novembe r 2003 su rvey through that of June 
2004 and that they have presented no def i cit for the 16 i ndi cators. 
Dur i ng the same per i od , priority zones have been i ndi cated i n the other: 
F l adougou-Ma réna 1, Dji d i an 1 , Kassaro 1 as compa red with 3 i n 
Novembe r 2003 , Bendougouba 1 compa red with 3 , Bougar i baya 2 
compa red with 4 
With regard to chil d i mmun i zati on , a clear i mp rovement is noted i n the 
situation, and the numbe r of fully vaccinated children has passed from 
50% to 69. 54% from Novembe r 2003 through June 2004
We have obtai ned this result thanks to the joint efforts of the CSREF and 
Pl an, wh i ch have set up outreach vacci nati on posts i n zones whose access 
68
poses a probl em, and throughout the circle. There too, it is i mpo rtant to 
recogni ze the efforts of the decentralised organizations ( mayors’ offices, 
ASACOs) , wh i ch have supported this initiative on a voluntary basis. 
There has obvi ous l y been cons i derabl e progress, but we must not forget 
the mai n ai m o f the project, namel y:
Sustai nabl e i mp rovement i n the health status of children and wom en of 
ch il dbear i ng age; this is why we must take i nto account the pr i orities 
i dentifi ed i n anal ysis of the results of this third survey to ensure nor mal 
conti nuati on of project acti vities. 
We make the foll owi ng recommendati ons:
1 - Add ressed to the ASACOs
- Greater involvement by ASACOS i n drawi ng up, i mp l ementi ng, 
mon itoring and eval uati ng CSCom acti vities (taken into account by 
the mi cro -p l an for i mp l ementati on of i ndi cators recognised during 
this survey as bei ng pr i orities) 
- Support the rel ay workers’ acti vities in certain areas (such as 
d istri buti on of vitami n A and soc i al mob ilisati on .) 
2 - Add ressed to the ch i efs of hea lth centers 
- Ma i ntai n month l y vacci nati ons as an outreach strategy i n all the 
health areas and outreach posts, and addi ng ANC, PNC and 
mon itoring healthy children 
- Devel op a strategy for distri buti on of Vitami n A (to ch il dren and 
post partum women ) in CSComs and i n outreach strategy, i nvol vi ng 
relay wo rkers at the commun ity level 
- Undertake routi ne registration of Vitami n A d istrib ution in CSCom 
support for ms and those at the disposal of commun ity relay 
wo rkers. 
3 -Add ressed to the comm un ity organizers 
- Rei nforce commun i cati on acti vities for behavior change by mo thers 
and by men for the care of si ck ch il dren. 
- Support the CSV and rel ay workers i n anal ysis and interpretation of 
the health data coll ected on a month l y bas is. 
- Gi ve strong support to vill age hea lth committees in setting up a 
vill age hea lth devel opment pl an. 
69
4 - Add ressed to the supervisory te ams (Plan, ARAFD/C, CSREF , SDSES) : 
- Undertake regul ar integrated supervisi on i n the chil d survi val 
project and vacci nati on zones and outreach posts. 
- Mon itor i mp l ementati on of mi cro -p l ans and the HI S (Hea lth 
I nfor mation System) in Child Survi val Project zones. 
We beli eve that LQAS shou l d be mo re wi del y used by hea lth and soci al 
devel opment servi ces because it is not only quick and easy but also 
i nexpens i ve i n compa rison with other survey techni ques such as KPC 
(knowl edge, practi ce, coverage.)
It also allows for identification of zones with strong perfor mance and 
those with weak perfor mance, whi ch enabl es us to be mo re effective and 
efficient in i mp l ementi ng our acti ons. 
We have therefore taken the decisi on to transfer the next LQAS surveys 
(the project’s fourth year surveys) to the Health Referral Center in order 
to prepare it for conti nu ity of this activity after withdrawa l of the project. 
The results obtained during this survey coul d be used to ass ist the mid -
ter m eval uati on , wh i ch i s programmed for Decembe r 2004. 
70
Append ix 1
 :
 TABLE SUMMARIZING INDICATORS BY HEALTH AREA IN KITA (LQAS 12-23 MONTHS)
LQAS 3 JUNE 04
ES
71
N
0
Indicators 
BEND BOUG DIDJAN FLD MAK KAS SEB SAND Total Average 
coverage
Objectives 
Yr 3
13 Children, having a 
vaccination card 
Number of correct replies 18 19 19 14 11 18 19 19 137
Size 19 19 19 18 19 19 19 19 151
Decision rule 16 16 16 16 16 16 16 16
90.73 95.00
13*
*
Fully vaccinated children 
Number of correct replies 16 17 16 13 9 12 18 4 105
Size 19 19 19 18 19 19 19 19 151
Decision rule 9 9 9 9 9 9 9 9
69.54 60.00
15Women possessing a bednet
Number of correct replies 5 11 10 12 9 3 4 4 58
Size 19 19 19 18 19 19 19 19 151
Decision rule 2 2 2 2 2 2 2 2
38.41 25.00
15* Child aged 12-23 months, 
having slept under an 
impregnated bednet 
Number of correct replies 4 6 9 10 2 3 2 2 38
Size 19 19 19 18 19 19 19 19 151
Decision rule 1 1 1 1 1 1 1 1
25.17 20.00
18Women knowing at least two 
signs that child needs care at 
home or elsewhere
Number of correct replies 15 19 18 13 19 19 19 16 138
Size 19 19 19 18 19 19 19 19 151
Decision rule 6 6 6 6 6 6 6 6
91.39 45.00
19 Children 12-23 having 
presented symptoms of illness 
during previous two weeks 
72
Number of correct replies 17 13 10 13 18 15 15 13 114
Size 19 19 19 18 19 19 19 19 151
Decision rule
75.50 -
73
TABLE SUMMARIZING INDICATORS BY HEALTH AREA IN KITA (LQAS 12-23 MONTHS) Continued
LQAS June 2004
N
0
Indicators 
BEND BOUG DIDJAN FLD MAK KAS SEB SAND Total Average
Coverage
Project 
Objectives
Yr 3
20 Sick children from 12-23 
months having received at 
least the same amount as 
usual, or more, to drink
Number of correct replies 15 13 11 14 6 14 14 11 98
Size 17 13 19 18 19 19 19 19 143
Decision rule 4 3 5 5 5 5 5 5
68.53 40.00
21 Sick children from 12-23 
months having received at 
least the same amount as 
usual, or more, to eat 
Number of correct replies 10 7 11 12 3 8 15 6 72
Size 17 13 19 18 19 19 19 19 143
Decision rule 5 4 6 6 6 6 6 6
50.35 45.00
22Women having heard of ORS
Number of correct replies 19 19 15 18 15 19 15 N/A 120
Size 19 19 19 18 17 19 15 126
Decision rule 5 5 5 5 4 5 4
95.24 40.00
23Women knowing how to 
describe ORS preparation 
Number of correct replies N/A N/A 15 N/A 14 11 14 N/A 54
Size 19 N/A 17 19 15 70
Decision rule 5 4 5 4
77.14 40.00
24Well-nourished children 
Number of correct replies N/A N/A N/A N/A N/A N/A
Size
Decision rule
85.00
74
Attachment G CSHGP Project Data Sheet- updated version
Child Survival Grants Program Project Summary
Mid Term Submission: Jan-31-2005 
PLAN Mali 
Field Contact Information:
First Name:
Last Name:
Address:
City:
State/Province:
Zip/Postal Code:
Country Mali 
Telephone:
Fax: (223) 2228143 
E-mail: @plan-international.org 
Project Web Site:
Project Information:
Project 
Description:
Plan International is implementing a new five-year Child Survival project 
in partnership with the Mali Ministry of Health, PDRIK (Projet de 
Développement Rural Intégré de Kita), Action Couverture 
Développement (ACD), and local municipalities in Kita District, located 
in the southeastern part of Kayes Region, in the republic of Mali. Kita’s 
total population in 2001 was estimated at 315,520 people of whom the 
project will cover 260,458 people by its fifth year. Estimated 
beneficiaries include: 52,091 women of childbearing age, 10,418 infants 
ages 0-11 months, and 36,464 children ages 1-4 years. Plan has been 
working in Kita District since October 1994, carrying out integrated 
health and hygiene, reproductive health, education, water and sanitation, 
environment, and micro-credit activities. It has been working with the 
local NGO partner, which has extensive experience in training and 
delivery of health messages. Health indicators for Kayes Region and Kita 
District lag behind those of Mali as a whole. According to the 1996 DHS, 
infant mortality in Kayes was 135/1000 and under-five mortality was 
259/1000. The major causes of death of children in Kayes region are 
75
malaria, ARI, diarrhea, malnutrition and measles. Challenges to health of 
women and children include: poor road conditions and long distances to 
health centers, the insufficient number of first level health centers (only 
ten of the currently proposed 46 health centers are functional), inadequate 
quality of health services provided due to insufficient training of 
personnel, and low income and purchasing power of the population, 
combined with high user fees of health centers. Utilization of health 
centers is very low (around 8% of the eligible population) and traditional 
healers are often sought for medical advice before health care providers. 
The program approach is to help strengthen the existing health care 
system. This approach comprises two strategies: (1) Training and 
building the capacity of health personnel and supporting community 
health committees (ASACOs) in order to increase utilization of health 
care services, and (2) Supporting IMCI implementation in CSComs. The 
four interventions are: i) Malaria (35%): Reduction of mortality and 
morbidity associated with malaria in children and pregnant women, 
through prevention education, promotion of use of impregnated bed nets, 
improved treatment of malaria, and prenatal chemo-prophylaxis. ii) 
Diarrhea (20%): Reduction of diarrhea-associated mortality and 
morbidity through a) teaching and promoting prevention measures in the 
home, b) strengthening mothers’ capacity to recognize and provide home 
treatment for mild diarrhea with fluid and dietary management, and c) 
strengthening mother’s capacity to identify signs of moderate and severe 
diarrhea, know sources of care, take the child for care, and comply with 
health provider recommendations. iii) Immunizations (35%): Increased 
immunization coverage in the program area for all infants by the end of 
the first year of life, and tetanus toxoid (second dose) immunization for 
pregnant women, increased measles vaccination (including twice yearly 
vitamin A) and prevention of measles-caused diarrhea and death. And iv) 
Pneumonia (10%): Reduction of pneumonia-associated mortality through 
prompt, appropriate and standardized pneumonia case management, a 
sustainable supply of antibiotics at the health centers (CSComs), prompt 
recognition by relays of pneumonia signs (fever, fast breathing) and 
referral of suspected cases to the nearest health center, and appropriate 
mothers’ care-seeking behavior. 
Partners: Mali Ministry of Health and Action Couverture Developpement (ACD) 
Project 
Location: Kita District, in Kayes Region, Mali 
Grant Funding Information:
USAID Funding:(US $) $1,300,000 PVO match:(US $) $433,333
Target Beneficiaries:
Type Number
76
infants (0-11 months): 10,418 
12-23 month old children: 10,157
0-59 month old children: 46,882
Women 15-49: 52,091
Estimated Number of Births: 63,105
Beneficiary Residence:
Urban/Peri-Urban % Rural %
10% 90% 
General Strategies Planned:
Advocacy on Health Policy
Strengthen Decentralized Health System
Information System Technologies 
M&E Assessment Strategies:
KPC Survey
Health Facility Assessment
Organizational Capacity Assessment with Local Partners
Participatory Rapid Appraisal
Lot Quality Assurance Sampling
Community-based Monitoring Techniques
Participatory Evaluation Techniques (for mid-term or final evaluation) 
Behavior Change & Communication (BCC) Strategies:
Mass Media
Interpersonal Communication
Support Groups 
Capacity Building Targets Planned:
PVO Non-Govt 
Partners
Other Private 
Sector Govt Community
US HQ (CS 
unit)
CS Project 
Team 
Local NGO
Networked Group 
Traditional Healers Dist. Health 
System
Health Facility 
Staff
Health 
CBOs
Other CBOs
CHWs 
Interventions:
Immunizations 35 %
** IMCI Integration
** CHW Training
** HF Training
*** Polio
*** Vitamin A
*** Surveillance
*** Cold Chain Strengthening
77
*** Mobilization
Acute Respiratory Infection 10 %
** IMCI Integration
** CHW Training
** HF Training
*** Pneum. Case Mngmnt.
*** Recognition of ARI Danger Signs
Control of Diarrheal Diseases 20 %
** IMCI Integration
** CHW Training
** HF Training
*** Hand Washing
*** ORS/Home Fluids
*** Feeding/Breastfeeding
*** Care Seeking
Malaria 35 %
** IMCI Integration
** CHW Training
** HF Training
*** Training in Malaria CM
*** Antenatal Prevention Treatment
*** ITN (Bednets)
*** IPT
*** Community Treatment of Malaria
78
Indicator Numerator Denominator Estimated 
Percentage
Confidence 
line
Percentage of children age 0-23 
months who are underweight (-2 SD 
from the median weight-for-age, 
according to the WHO/NCHS 
reference population)
79 430 18.4 5.5
Percentage of children age 0-23 
months who were born at least 24 
months after the previous surviving 
child
0 0 0.0 0.0
Percentage of children age 0-23 
months whose births were attended by 
skilled health personnel
99 152 65.1 11.0
Percentage of mothers of children age 
0-23 months who received at least two 
tetanus toxoid injections before the 
birth of their youngest child
120 152 78.9 9.5
Percentage of infants age 0-5 months 
who were exclusively breastfed in the 
last 24 hours
10 86 11.6 9.9
Percentage of infants age 6-9 months 
receiving breastmilk and 
complementary foods
4 41 9.8 13.1
Percentage of children age 12-23 
months who are fully vaccinated 
(against the five vaccine-preventable 
diseases) before the first birthday
105 151 69.5 10.7
Percentage of children age 12-23 
months who received a measles 
vaccine
64 104 61.5 13.5
Percentage of children age 0-23 
months who slept under an 
insecticide-treated bednet the previous 
night (in malaria-risk areas only)
68 303 22.4 6.9
Percentage of mothers who know at 
least two signs of childhood illness 
that indicate the need for treatment
183 202 90.6 6.0
Percentage of sick children age 0-23 
months who received increased fluids 
and continued feeding during an 
illness in the past two weeks
72 143 50.4 11.9
Percentage of mothers of children age 170 430 39.5 6.8
79
0-23 months who cite at least two 
known ways of reducing the risk of 
HIV infection
Percentage of mothers of children age 
0-23 months who wash their hands 
with soap/ash before food preparation, 
before feeding children, after 
defecation, and after attending to a 
child who has defecated
120 430 27.9 6.3
Comments
TB Indicator
Indicator Numerator Denominator Estimated 
Percentage
% of new smear positive cases who were 
successfully treated 0 0 0.0