MOPTI, 18 December 2009 (IRIN) - Even the most altruistic, engaged community health worker is likely to quit when he or she finds a paid job, according to the Malian federation of community health associations.

The government is considering ways to retain, support and train health volunteers to fill gaps in a system where there is one doctor for every 15,000 residents, according to the Health Ministry.

"Community health workers cannot be ignored in our health system," said Ahmed Diallo, a community health association director in the capital Bamako. "They are the vehicles to carry out our country's public health campaigns. They are even more accepted by communities than some professionals in passing along certain information."

While there were 838 doctors to serve 12 million people in Mali as of May, there are more than 950 health volunteers, according to the national community health association.

Though not on the state payroll, some volunteers and their families receive free health care, Diallo told IRIN. "The only job criteria are: they contribute on a voluntary basis, have the confidence of the population and are available," said the health director.

Health volunteer Sekou Touré told IRIN he has always been passionate about health. "I volunteer as a lab technician analysing tuberculosis tests. I have attended trainings and probably work harder than some paid staff in this country," he told IRIN.

He said selling tie-dyed fabric allows him to put in long unpaid hours at the lab. Immediately following his volunteer training in 2005 at the regional hospital of Mopti in central Mali, he said he was given a bicycle and assigned 35 homes to visit regularly in Sevaré, a town 13km from Mopti. But in 2009 he has visited only one home. Of the 23 volunteers in his training group, he said at most 10 are active.

"We were given bicycles, but most of them no longer work. We used to submit reports to the regional hospital with our home visits, but no one is motivated. We are tired. We cannot feed our families doing this." Touré said he did not receive any stipend other than 2,000 CFA francs [US$4.37] during vaccination campaigns.

"We also do not have tools to do our work." He said salt iodization testing kits provided by UN Children's Fund (UNICEF) in 2005 had expired as of 2007, and that the volunteers no longer receive notebooks to record health information from their house visits.

The UNICEF office in Mali confirmed they had not distributed notebooks for health workers since 2008 and that the agency expects to resume distribution of salt iodization kits in 2010 in response to a recent government request.

In March 2009 the Health Ministry convened a forum to discuss ways to encourage, train and support health volunteers. One suggestion was to incorporate volunteers into the state health force and pay them. When asked whether paying volunteers risked doing away with health volunteerism, the Health Ministry's Mountaga told IRIN: "We are considering all options and nothing has been decided."

He said the government is doing health trainings in villages. "We have no firm deadline but will progress little by little to fulfill this initiative after 2015 [Millennium Development Goal achievement deadline]. This is not sudden."

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