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. 2021 Feb 28;21(1):421.
doi: 10.1186/s12889-021-10481-w.

Factors hindering health care delivery in nomadic communities: a cross-sectional study in Timbuktu, Mali

Moussa Sangare  1   2 , Yaya Ibrahim Coulibaly  3 , Siaka Yamoussa Coulibaly  3 , Housseini Dolo  3 , Abdoul Fatao Diabate  3 , Kueshivi Midodji Atsou  3 , Abdoul Ag Souleymane  3 , Youssouf Ag Rissa  3 , Dada Wallet Moussa  3 , Fadimata Wallet Abdallah  3 , Massitan Dembele  4 , Mahamadou Traore  4 , Tieman Diarra  5 , William R Brieger  6 , Sekou Fantamady Traore  3 , Seydou Doumbia  3 , Samba Diop  3
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Factors hindering health care delivery in nomadic communities: a cross-sectional study in Timbuktu, Mali

Moussa Sangare et al. BMC Public Health. .

Abstract

Background: In Mali, nomadic populations are spread over one third of the territory. Their lifestyle, characterized by constant mobility, excludes them from, or at best places them at the edge of, health delivery services. This study aimed to describe nomadic populations' characteristics, determine their perception on the current health services, and identify issues associated with community-based health interventions.

Methods: To develop a better health policy and strategic approaches adapted to nomadic populations, we conducted a cross-sectional study in the region of Timbuktu to describe the difficulties in accessing health services. The study consisted in administering questionnaires to community members in the communes of Ber and Gossi, in the Timbuktu region, to understand their perceptions of health services delivery in their settings.

Results: We interviewed 520 individuals, all members of the nomadic communities of the two study communes. Their median age was 38 years old with extremes ranging from 18 to 86 years old. Their main activities were livestock breeding (27%), housekeeping (26.4%), local trading (11%), farming (6%) and artisans (5.5%). The average distance to the local health center was 40.94 km and 23.19 km respectively in Gossi and Ber. In terms of barriers to access to health care, participants complained mainly about the transportation options (79.4%), the quality of provided services (39.2%) and the high cost of available health services (35.7%). Additionally, more than a quarter of our participants stated that they would not allow themselves to be examined by a health care worker of the opposite gender.

Conclusion: This study shows that nomadic populations do not have access to community-based health interventions. A number of factors were revealed to be important barriers per these communities' perception including the quality of services, poverty, lifestyle, gender and current health policy strategies in the region. To be successful, future interventions should take these factors into account by adapting policies and methods.

Keywords: Access; Delivery; Healthcare; Mali; Nomadic; Timbuktu.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Frequency of the most common barriers to nomads’ access to health services mentioned by the respondents
Fig. 2
Fig. 2
Variation of the median distance between respondents’ location and the closest health center per study site
Fig. 3
Fig. 3
Perception of respondents about the lack of financial resources and the unwillingness of opposite gender examination
See this image and copyright information in PMC

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