Nomads' access to the current healthcare system is impaired by their perception of its cost, quality, and accessibility and by gender segregation in Timbuktu, Mali: A cross-sectional study

Abstract Background Access to community-based healthcare services is one of the key characteristics in successful public health policy. In Mali, community-based interventions do not reach nomadic communities, remote and hard-to-reach areas. Methods: In order to determine a better healthcare strategy for these nomadic populations, we conducted a cross-sectional survey in the administrative region of Timbuktu in Mali using the administration of questionnaires to community members. Results: A total of 520 individuals from two nomadic communities, Gossi and Ber, were included in the questionnaire survey. Inhabitants of the two nomadic communities were livestock breeders (27%), housekeepers (26.4%), local traders (11%), farmers (6 %) and artisans (5.5%). The median age of the study participants was 38 years (18-86 years). The participants from Gossi and Ber lived at a mean distance of 40.94 km and 23.19 km from the closest health center, respectively. The major complaints with respect to accessing healthcare were cost (35.7%), distance to the health center (46.2%), quality of the provided services (39.2 %) and means of transportation (79.4%). More than 25% of the participants from the community stated that they will never accept to being examined by a health care provider of the opposite gender. Conclusion It appears from the interviews results that these nomadic populations have health needs not presently covered by the current health delivery system. Tackling the method and organization of health care delivery by adapting them to the local lifestyle, culture and values could lead to significant improvements health outcomes.