Muso

Twenty years ago, a small group of Malians and Americans, some of whom were medical students, were brought together by common mentors in Mali’s capital city. They shared a commitment to alleviating the inequity and poverty that was directly impacting health and longevity, but stood on the outside of the problem, looking in. They like to say that Muso wasn’t really founded until they were taken in by community leaders, in a peri-urban neighbourhood in the shadows of the capital, to live and work within the community they sought to serve.

This inside view revealed the true challenges. One key community leader (and eventual cofounder), Nana Niare, was a retired nurse. Neighbours came to her with their sick children, and she in turn invited the fledgling Muso team to sit in on the consultations. One of the first was a year-old child with respiratory distress. Despite taking him to a hospital, he died. The pattern repeated itself at least once a week, translating into hundreds of the children and young mothers of their neighborhood dying from treatable conditions that had not been caught in time – malaria, meningitis, intestinal issues, even an infected cavity.

Working within the community this way, the team researched life medical histories and came to realize that the timing of receiving medical care was at the heart of almost every death or life outcome. Delayed care because of fees patients couldn’t pay or distances they couldn’t travel, or providers who didn’t have the necessary skills or equipment, was costing many lives, especially among children.

The core question therefore became how to build a different kind of rapid health care system that could be provided to everyone who needed it. The community helped design a system from the inside out, with Community Healthcare Workers (CHWs) at its core and upgraded clinics to provide immediate, accessible next-level care. All without fees. An initial model of care was deployed in partnership with community-based Primary Health Centres (PHCs) and the Ministry of Health.

Within the first seven years of Muso’s new system, removing those barriers to care allowed them to deliver results unprecedented in history. Child mortality rates in their longest-running intervention area in urban Mali, on the edge of Bamako, plummeted from 15% to less than 1% in that short period. It’s the most extreme change on record, globally.

Even more astounding, shortly after Muso expanded its rapid care approach to the Mopti region of rural Mali, armed conflict spread to the area but child mortality rates dropped by 63% compared to peacetime - in just three years. Muso has continued its commitment and has provided continuous service with partner communities during seven years of armed conflict. 

Says Co-Founder Ari Johnson, “Muso began with a shared commitment: that everyone, no matter how much money they have or where they’re born, deserves care with the kind of speed and urgency we want for our own families. Speed is love in action. When we build healthcare that delivers the right care at the right time, we make it into an instrument of love and justice.”

That model was further refined and rolled out to eight other areas, testing its efficacy in a variety of situations. Research – a key part of Muso’s work - is conducted using randomized cluster trials to ensure goals are being met. On the strength of the model’s continued success, in 2019 the Minister of Health for Côte d’Ivoire approached Muso for a technical partnership. Côte d’Ivoire is a conflict-free country, yielding yet another circumstance for testing their approach. They are now active and researching in 29 sites there.

A critical pillar of this care system is the professionalization of CHWs. Whether they’re operating out of a clinic or providing services door-to-door, Muso’s process includes open recruitment of community-based workers, training, an exam, and a final selection. CHWs are then paid and gain further skills development on the job, through Muso’s 360 Supervision model. As a co-founding member of the Community Health Impact Coalition (CHIC), Muso works with member organizations across more than 30 countries worldwide to make professionalized CHWs a global norm.

One of the many benefits of CHWs in the system is the patient trust generated by their understanding of the cultural norms of their communities, and their connection with the population. They also significantly reduce the time needed for patients to access care, intervening well before a situation becomes life-threatening. If more significant medical care is needed, they organize getting the patient swiftly to a local clinic.

Muso is committed to continuous adaptation and innovation. Their Learning and Innovation team, along with rigorous impact research, ensure the model is not static. There are always new adaptations in training, manuals and approaches so the quality of care is prioritized at all levels and adapted to every individual place and its customs.

The latest country working with Muso is Zambia. The Ministry of Health had already set up a well aligned system of healthcare, with no fees, a trained CHW force and upgraded clinics. Muso’s experience therefore supports Zambia’s vision, while gaining another opportunity to adapt and test the model. In addition, they provide technical assistance in Senegal and Sudan, creating increasingly global impact.

It’s been almost twenty years of dedication to finessing and studying the model so it can make a difference across this broader geography, with more planned for the future. Says Co-Founder Moïse Samaké, “As human beings, few things hurt more than witnessing someone suffer - especially from a health issue - and feeling powerless to help. Through Muso, I’m empowered to do more than just care; I can act. I can help open the door to life-saving care for those in need within my community and beyond.”

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