Strengthening Health Systems in Sahel’s Fragile Communities: Impact and Progress in Mali and Mauritania

Nouakchott: Between 2018 and 2024, World Bank-supported programs have significantly strengthened health systems and improved nutrition services in the Sahelian countries of Mali and Mauritania, with a particular focus on women and children in fragile and conflict-affected areas.According to World Bank, these initiatives have expanded and improved health services, exceeding the original goals by providing essential health care to over 5 million people in both nations. Health centers in targeted regions have seen marked improvements through better equipment, staff training, and enhanced patient care.In conflict-affected areas of Mali, the percentage of pregnant women completing prenatal checkups has tripled, while in Mauritania, 160,000 safe births were attended by trained staff, surpassing the target by 20 percent. Pediatrics services have also seen a boost, with Mali delivering 1.17 million curative consultations for children under five, tackling common illnesses such as malaria and respiratory infection s. In Mauritania, over 200,000 children were vaccinated, while nearly 5 million curative services were offered, achieving three times the initial goal.Nutrition services were bolstered by providing support to 750,000 women and children in Mauritania. The project also ensured that 460,000 vulnerable people in Mali accessed essential health services free of charge, and over 1 million free health services were provided to vulnerable populations in Mauritania, including refugees. Furthermore, contraceptive use among teenage girls in Mali significantly increased, while the number of women using modern contraception in Mauritania surged from about 9,000 to over 240,000.The World Bank's approach involved performance-based financing, allowing local clinics to hire staff, stock medicines, and repair equipment. The removal of fees and the provision of small cash incentives encouraged checkups, safe deliveries, and vaccinations. Community health workers played a vital role in extending services to remote areas, whil e partnerships with organizations like UNICEF and UNHCR amplified the impact.The initiatives also contributed to the World Bank's Healthier Lives Scorecard outcome by expanding health services and supported the WBG Strategy for Fragility, Conflict, and Violence by enhancing basic services in insecure regions. The success of these programs highlights the importance of focusing on measurable results, removing barriers to care, and investing in community engagement to drive meaningful progress in fragile settings.Moving forward, Mali's ARISE-Keneya Yiriwali project aims to expand the pay-for-results model nationwide, while Mauritania's successor to INAYA continues to scale the approach across underserved regions. Both countries remain committed to delivering better care, bringing services closer to communities, and sustaining gains through national financing reforms and local capacity building.