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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.
The study was conducted in the Timbuktu region, in the commune of Ber, in the health district of Timbuktu and the commune of Gossi in the health district of Gourma Rharous, both of which are located at about 900 km from Bamako, the capital city of Mali [4]. The study was performed among Kel Tamasheq, Songhai, Arab, Fulani and Bozo people. The main lifestyle of these populations is pastoralism that requires a nomadic lifestyle for a significant part of the community. Nomadic populations settle in small groups of 25–35 people in a campsite for a relatively long period of time (20–30 days) and then move from one seasonal grazing area to another without specific directions. Movement is driven by the grazing. Each campsite is composed of around 3–5 families with 5 to 7 households each living in 4–6 tents around a leader who is usually the eldest family member. They settle with their animals around an oasis in transhumance between the northern and southern parts of the country depending on the season and availability of pasture for their animals. With these conditions and cultural values, nomads prefer not to stay in these communities due to the constant search for new pastures for livestock. They spend most of their time and effort caring for their animals. Therefore, it seems as if the welfare and the health of their animals is as important as their own wellbeing [14]. We conducted a cross-sectional study from January to March 2011 in the communes of Ber and Gossi by administrating a questionnaire to community members. In each commune, we went to the different villages and nomadic camps to interview people. When we arrived in a camp we explained the study and among the volunteers, 3 or 4 people were randomly selected. In the villages, from the list of families, 4 or 5 families were selected and 3 or 4 people from these families were selected as volunteers. It should be noted that in the study sites the size of the villages did not exceed 15–20 families. Only volunteers of 18 years of age and above who were able to give informed consent were included in the study. The sample size has been estimated by using Epi Info software; assuming 95% confidence level, power of 80 and 20% of no access in healthcare among the nomadic population. The level of significance was set at 0.05 (two-tailed). Data were analyzed using the statistical package for social sciences (SPSS) version 20.0 (https://www.ibm.com/analytics/spss-statistics-software) and chi-square tests performed to compare proportion as appropriate. The graphs were generated by using GraphPad Prism 8 (https://www.graphpad.com). Missing data were not included in the analysis. The missing data that were not considered in the analysis because they were very few. Only four (4) subjects who did not complete the questionnaire so we decided not to consider the incomplete information of these subjects in the analysis. A questionnaire was administrated to community members by well-trained investigators. The content of the questionnaire was related to health problems specific to the context of nomadic communities, such as the lack of medicines or the inadequacy of modern means of transport such as vehicles and ambulances. For example, pregnant women with complications during maternal labor and delivery are transported in carts pulled by donkeys. For the questionnaire development (Additional file 1), we mainly focused on the study objectives to generate questions that could provide with accurate and complete information specific to the nomadic context of northern Mali. After the questionnaire development, it was reviewed by the senior researchers and then tested in Bamako during the simulation sessions. The shortcomings were considered before the actual field survey phase. The questionnaire development was done to get insight about nomads’ access to and use of available health care based on health belief model theory [15]. It was entirely made up by the study investigators for the purpose of this study.
