The humanitarian-development nexus and its operationalization for health interventions in Mali

Mali’s complex political landscape has been marked by instability, including multiple coups, frequent shocks and stresses, and the presence of designated terrorist non-state actors. Mali has some of the highest maternal, infant, and child mortality, and fertility rates globally. Due to the dynamic nature of the Malian context, a combination of humanitarian, development, and peace programming has been funded and implemented. The convergence of multiple mandates has prompted publications on the intersection of different forms of assistance. The objective of this research was to document the challenges, barriers, facilitators, and drivers of humanitarian development nexus (HDN) implementation in Mali and highlight examples of HDN operationalization for health. A qualitative case study using key informant interviews and a document review was conducted to chart examples, challenges and facilitators of HDN implementation for health interventions in Mali. Interviews were conducted in Bamako and Gao region with individuals from the Ministry of Health and Social Development, donors, United Nations agencies, local and international non-governmental organizations, health providers, and the private sector. Thematic content analysis was conducted and findings synthesized into the thematic areas presented. Thirty-eight interviews were conducted in Mali with 73 participants between February and March 2023 and 31 documents were analyzed. Since 2020, the government has worked to align humanitarian intervention packages with national health development plans. Attempts to shift from a reliance on humanitarian assistance have occurred, including the implementation of different health financing models for cost recovery. Sustainability and financial autonomy were two critical themes of nexus operationalization for the health system. Financial coverage of services has moved from one external source (humanitarian donors) to another (development donors) without a longer-term plan for subsidization. Beyond financing, building health system resilience and enhancing preparedness at the community level was a nexus focus for some agencies. Investment in human resources for health was critical due to the fragility and fluidity of the operational landscape. Implementation of health interventions in the HDN in Mali is complex, and the feasibility of its operationalization varied given fragility is not uniform. Recent efforts to align humanitarian and development plans and targeted health coverage have created a more conducive nexus policy environment, but it is too early to document how these commitments will manifest in the long-term. Different health financing models have begun to carve out a promising, but precarious, path to sustaining health services in the long-term, including for human resources.