Even if you build it, they may not come. That is what medical staff in Koulogo, 800 km northeast of Mali’s capital Bamako, discovered when a new health centre opened in 2004. Maternal mortality remained high after the centre’s opening – with up to half of women dying in childbirth, according to health workers. They decided that if patients did not come to the centre until their lives were in danger, it was time to bring the centre to the patients.

Health centre director Ousmane Fomba told IRIN that the trip to the centre can be a painful trek for area women. “The villages are far away, the women came wheeled in on carts. Now, we go to the pregnant women.” Since May 2006, a doctor, traditional birthing attendant or nurse travel every other day to check on pregnant women in 16 villages with more than 14,000 residents.

The house visits cost the centre about US$100 a year, which covers the health workers and gasoline for two motorbikes donated by the UN Children’s Fund (UNICEF), Fomba said. Each of the 16 villages contributes for these expenses, plus $35 per year per village for an ambulance that comes from a hospital in Bankass, 37 km away, for cases that cannot be treated in Koulogo.

For Dramane Tesougué – chief of Aljadiné village, 3km from the health centre – the cost is worth it. “[The cost] is nothing compared to the services provided by the doctor.” He said the doctors weigh the pregnant women, vaccinate children and give out medication. “It spares us having to transport the women on carts or bikes. Since the doctor started coming, we have had less infant and maternal deaths,” he told IRIN.

In the same village, Fatoumata Guindo told IRIN she is receiving regular pre-natal care. “From the beginning of my pregnancy, the doctor took care of me. He sees me each time he comes to the village. I have not had any problems so far in my eight months of pregnancy.” She said that for her other four children, she “suffered greatly” because she never went to the health centre.

In 2006 almost half of all births in Mali were unattended; 119 babies of every 1,000 births died, and more than 900 women out of 100,000 died in childbirth in 2005, according to the government. In 2006, maternal deaths nationwide decreased to 464 per 100,000.

Fomba told IRIN there was one maternal death in 2008 in the villages covered by the Koulogo centre. In the first three months of 2009 there have been two stillbirths in the same area – when mothers arrived to the health centre too late, he said.

This story, entitled MALI: Medical house visits cut maternal mortality, datelined Koulogo April 15, 2009, was written and distributed by IRIN News, the humanitarian news agency.

For more stories about womens health, see:

A thousand people walk to save womens' lives in western Georgia

Inexpensive tracking of maternal deaths can help protect maternal health – Indian study

Hundreds run in Tanzania to increase breast cancer awareness, action

Community grants raise breast cancer awareness in Mexico

Motorbike ambulances save lives of mothers, babies, in remote areas of Africa

Fistula operation ends shame, allows women to rejoin society

Five Congo nurses create organization to aid Congo women raped by rebel fighters

Cervical cancer control 'achievable for the first time'

Vinegar provides simple cervical cancer screening test where Pap smears not available

Trained birth attendants save mothers' lives in Ethiopia

Respect for Bolivia’s indigenous mothers may help reduce high maternal mortality rates

Affordable menstrual pads keep girls in school, create jobs