Mali: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

There is there is evidence That Mali has an AMR plan, that covers surveillance, detection, and reporting.
A National Action Plan (NAP) to Combat Antimicrobial Resistance (Plan d’Action National (PAN) de lutte contre la Résistance aux Antimicrobiens (RAM) au Mali) was developed in 2018 for the period 2019-2023 for the surveillance, detection, and reporting of priority AMR pathogens¹. In an address at a high level meeting on AMR on the margins of the 2024 United Nations General Assembly, Mali's Minister of Health and Social Development, Colonel Assa Badiallo Toure, stated that a second National Action Plan had been put in place covering the period 2024-2028 ². Reference to the process of updating the plan is also made in the WHO Tracking AMR Country Self Assessment Survey (TrACSS) 2022 Country Report. ³ However, no documentary evidence could be found of the updated plan on the Ministry of Health and Development website at the time of the research ⁴. According to the "Mali national action plan on antimicrobial resistance – Review of progress in the human health sector" published by the WHO in 2022, the 2019-2023 NAP included surveillance and reporting, through raising awareness of AMR and surveillance in five sites. Surveillance sites are required to send results to the national coordination structure (NCCS) for AMR surveillance monthly and report unusual resistance immediately. However, routine data collection and reporting across the facilities has been weak. The NCCS develops and disseminates national surveillance reports to national partners every 6 months. ⁵

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

Mali has a national laboratory system which tests for priority AMR pathogens, but not all of them. According to the 2022 World Health Organization (WHO) document "Mali national action plan on antimicrobial resistance – Review of progress in the human health sector", most "bacteriology laboratories in the public health sector are part of a national laboratory network" (p.6) and the national reference laboratory supports the network in identifying pathogens (the name of the national reference laboratory is not provided). According to the WHO review of the antimicrobial resistance (AMR) action plan progress, as part of the surveillance on AMR, Antimicrobial susceptibility testing (AST) is required for the following 11 pathogens by the five surveillance sites (p.6): S. pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus aureus, E. coli, Klebsiella pneumoniae, Acinetobacter baumannii, P. aeruginosa, Salmonella spp., Shigella spp. and Neisseria gonorrhoeae ⁶. The WHO Joint External Evaluation for Mali from June 2017 notes that the country has seven laboratories capable of detecting AMR pathogens. These include the Bacteriology Laboratory of the National Institute for Research in Public Health (INRSP) and the National Reference Laboratory for Priority AMR Pathogens. There is no mention of ongoing, regular testing for AMR pathogens or of a sentinel surveillance system. ⁷ A national Research Centre on Emergent Pathogens (Centre de Recherche sur les Pathogènes Emergents (CRPE)), part of the National Institute for Public Health (Institut National de Sante Publique) was inaugurated in July 2025, however, no specific reference is made to which pathogens are tested in the article introducing the laboratory, nor on the Ministry of Health and National Institute for Public Health websites generally. ⁸⁹¹⁰

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

No evidence could be found that the government of Mali conducts environmental detection or surveillance activities for antimicrobial residues or AMR organisms. The national action plan focuses on surveillance in health centres but does not reference environmental surveillance ¹¹¹². The National Water Laboratory (Laboratoire National des Eaux) conducts biological testing at water sites for the following: E. colis, total coliforms, fecal coliforms, salmonella, streptococci. ¹³ No regulations regarding soil testing could be found on the website of the Ministry of Health nor in the repository of the Food and Agriculture Organization of the United Nations (FAO) ¹⁴. At the time of the research a number of relevant government websites were inaccessible, including the Ministry of Livestock and Fisheries (Ministere de l'Elevage et la Peche), the Ministry of Agriculture (Ministere de l'Agriculture). ¹⁵¹⁶

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 0

There is no evidence that Mali requires prescriptions for antibiotic use for humans.

No clear evidence could be found that Mali requires prescriptions for antibiotic use for humans on the website of the Ministry of Health. ¹⁷ In its National Action Plan to Combat Antimicrobial Resistance 2019-2023 (Plan d’Action National (PAN) de lutte contre la Résistance aux Antimicrobiens (RAM) au Mali), the government recognizes the legislative or regulatory weaknesses on the Regulation of the sale of antimicrobials by professionals, including regarding precriptions, which suggests that there is weak legislation on this requirement, while under Objective 4 of the plan, there is reference to the need to regulate prescription and delivery of antimicrobials. ¹⁸

The Ministry of Health's Socio-Health Development Programme – 2014-2018, refers to prescribers of antibiotics not respecting the directives on the rational prescription of antibiotics, without mentioning what these directives are. ¹⁹ There is reference to good practices on the prescription of antibiotics for humans, for example in the undated Directive on the Treatment of Infectious Pathologies (Directives de Traitement de Pathologies Infectieuses), but these do not reference a specific law on the requirement to provide a prescription for antibiotic use, only how to determine the right antibiotic. The Directive refers to an Action Plan of Antimicrobial Stewardship in Animal and Human Health for the period 2021-2025 (Gestion des Antimicrobiens dans le domaine de la santé animale et humaine pour la période 2021 – 2025), however the document could not be located. ²⁰

According to the World Health Organization, Mali has laws or regulations in place on the prescription and sale of antimicrobials for human use (p.10), however, no documentary evidence or reference was provided, thus not allowing for confirmation of this. The same document recognizes that there is weak oversight of the prescription of antibiotics and widespread self-medication (p.10). ²¹ The World Health Organization (WHO) data on prescription requirements is provided based on Mali's self-assessment of progress – the wider data on self-assessment is available on the Global Database for Tracking Antimicrobial Resistance (AMR) Country Self- Assessment Survey (TrACSS). Under this data set, Mali claimed that it "has laws or regulations on prescription and sale of antimicrobials, for human use" in 2019, 2021, 2022 and 2024, however, in 2023 they stated that there were no such laws. ²²

Decree No. 04-557/P-RM of 1 December 2004, which regulates the commercialization of both human and veterinary medicines, does not require a prescription for antibiotics for humans. The approval process for medicines for human is overseen by the Ministry of Health. ²³ The WHO Joint External Evaluation (JEE) for Mali from June 2017 indicates that there is no national multisectoral plan for the detection of priority pathogens resistant to antimicrobials, antimicrobial stewardship plan, or national guidelines on the proper use of antibiotics. ²⁴

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 100

There is evidence of national legislation requiring prescriptions for antibiotic use for animals. Decree No. 2022-0334/PT-RM of 06 June 2022 on the application of Law No.2016-004 of 12 February 2016 governing veterinary pharmacy outlines that "Prescription and labeling rules for the retail sale of veterinary drugs are mandatory" for "veterinary drugs containing one or more active ingredients that may be toxic to animals or pose a risk to users of the drug or consumers of animal products through harmful residues", including "virulent substances and products of microbial origin intended for the diagnosis, prevention, and treatment of animal diseases" (Article 23). ²⁵ Under the Global Database for Tracking Antimicrobial Resistance (AMR) Country Self- Assessment Survey (TrACSS), Mali claimed that it "has laws or regulations on prescription and sale of antimicrobials, for terrestrial animal use" in 2022 and 2024, however, in 2023 the country stated that there were no such laws. For aquatic animals, they claimed a prescription was required in 2022, but not in 2023 and 2024. ²⁶ Under Objective 4 of the National Action Plan to Combat Antimicrobial Resistance (Plan d’Action National (PAN) de lutte contre la Résistance aux Antimicrobiens (RAM) au Mali), published prior to the above decree, there is reference to the need to regulate prescription and delivery of antimicrobials, including to animals, demonstrating a commitment to the need to strengthen the legislation around prescription of antibiotics for animal use. ²⁷ No evidence could be found regarding studies on antibiotic dispensation and the Ministry of Livestock and Fisheries website was not accessible at the time of the research. ²⁸

1.2.1a Laws/plans on zoonotic disease

Score: 100

There is evidence of a variety of plans and guides for zoonotic disease prioritization, detection and reporting.

In 2017, the government of Mali published a Practical Guide to Multisectoral Integrated Surveillance of Zoonoses and Response in Mali (Guide Pratique de la Surveillance Integree Multisectorielle des Zoonoses et la Reponse au Mali), as part of its "One Health" approach. The guide's objective is to strenghten capacities of officials for surveillance and response to zoonotic diseases. The One Health approach itself is defined as a multisectoral and coordinated approach to build bridges between sectors and disciplines to promote the development of an integrated strategy to combat endemic and zoonotic threats. The Practical guide describes the role of different stakeholders in the detection and reporting of zoonotic diseases, including of community health workers. The guide was due to be updated every two years, however, no more recent guide could be identified. ²⁹ As committed to in the Practical Guide, a prioritization workshop was organised in 2021 by to identify Mali's priority zoonotic diseases. During this workshop, attended by One Health stakeholders and representativs (such as the ministries of Health, Livestock and Fisheries, Agriculture, etc.), five groups of priority zoonotic diseases were agreed upon: Anthrax; Bovine Tuberculosis; Rabies; Viral hemorrhagic fevers (including Crimean–Congo hemorrhagic fever, Ebola, Lassa, Marburg, Rift Valley fever, yellow fever); Zoonotic Influenza. ³⁰

The government has published a guide on integrated monitoring and response to diseases in Mali. The Technical Guide for Integrated Disease Surveillance and Response (Guide Technique pour la Surveillance Integree de la Maladie et la Riposte au Mali) includes surveillance, with guidance on examples of symptoms (p.88), and immediate reporting of zoonotic diseases (such as rabies, anthrax, yellow fever, zika, etc., p.30). It provides information regarding detection, assessment and reporting of zoonotic (and other) diseases. For example, information is available on Anthrax (p.457), Dengue (p.498), Rift Valley Fever (p.528). ³¹ The Integrated Strategic Plan For The Control Of Neglected Tropical Diseases 2022-2026 (Plan Strategique Integre De Lutte Contre Les Maladies Tropicales Negligees (MTN) 2022-2026) refers to monitoring and reporting on zoonotic diseases as the main epidemiological surveillance priority in Mali. ³²

A number of documents which might provide additional information regarding surveillance and reporting were not safe to access; a document titled Terms of Reference for the Setting up of Regional Platform for the One Health Initiative, for example, is inaccessible as of September 2025, and no archived version was found. ³³

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 0

There is insufficient publicly available evidence that Mali has national legislation or strategy documents explicitly detailing systematic risk identification and reduction measures for zoonotic spillover events from animals to humans, although multisectoral coordination mechanisms and specific zoonotic disease control initiatives exist in Mali supported by One Health principles. No details of legislation or strategy documents could be found on the website of the Ministry of Health, while the Ministry of Livestock and Fisheries website was not accessible at the time of the research, and was last archived in October 2021. ³⁴³⁵ Mali has individual projects aimed at limiting the spillover of zoonotic diseases under the National One Health Platform. For example, a campaign against rabies exists, with the vaccination of dogs, under a project entitled BlockRabies. ³⁶ In December 2024, the government launched a livestock vaccination campaign for 2024-2025, which aimed at vaccinating against a variety of zoonotic diseases, including anthrax, foot and mouth disease and rabies. ³⁷ The World Health Organization Joint External Evaluation (JEE) for the Republic of Mali conducted in June 2017 references several official relevant documents, but the full text of the orders and plans are not available online: Decree No. 97-3150 / MDRE-SG of 1997 relating to Brucellosis; Contingency plan to fight against avian influenza (2015-2019); and Integrated Emergency Plan for Rift Valley Fever 2016. ³⁸ The Order No. 05 -2703 MEP-SG of November 16, 2005 on the fight against avian influenza (avian influenza) and Order No. 02-0982 /MDR-SG of May 15, 2002 on bovine tuberculosis do not include information about zoonotic disease spillover events, focusing only on the livestock. ³⁹

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

There are guidelines on the surveillance and control of multiple zoonotic pathogens of public health concern. The government has published a guide on integrated monitoring and response to diseases in Mali. The Technical Guide for Integrated Disease Surveillance and Response 2021 (Guide Technique pour la Surveillance Integree de la Maladie et la Riposte au Mali) includes surveillance, with guidance on examples of symptoms (p.88), and immediate reporting of zoonotic diseases (such as rabies, anthrax, yellow fever, zika, etc., p.30). It provides information regarding detection, assessment and reporting of zoonotic (and other) diseases. For example, information is available on Anthrax (p.457), Dengue (p.498), Rift Valley Fever (p.528). ⁴⁰ The Integrated Strategic Plan For The Control Of Neglected Tropical Diseases 2022-2026 (Plan Strategique Integre De Lutte Contre Les Maladies Tropicales Negligees (MTN) 2022-2026) refers to monitoring and reporting on zoonotic diseases as the main epidemiological surveillance priority in Mali among the neglected tropical diseases, stating that the main interventions remain those relating to integrated surveillance of zoonotic diseases and support from veterinary services for the management of certain NTDs such as Guinea worm (p.60). ⁴¹

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 100

There is evidence that Mali has a multi-ministry unit dedicated to zoonotic diseases. In the WHO's Joint External Evaluation (JEE) in Mali in 2017, it was recommended that the country should have a functional and sustainable multisectoral coordination mechanism involving stakeholders from the human, animal and environmental health sectors to control health threats. In response, the Prime Minister signed an April 2018 decree establishing the creation, responsibilities and functioning of the National One Health Platform in Mali. ⁴²⁴³ One Health is a cross-ministerial approach to managing health issues, particularly zoonotic diseases. The platform includes 12 government departments, and is headed by a Secretariat composed of the departments of health, environment, livestock and agriculture; the national platform meets on a monthly basis to share information on epidemiological surveillance data. ⁴⁴⁴⁵⁴⁶ There is evidence that the One Health platform has recently been operational across its various levels, holding a review meeting on the implementation of the Regional platforms, a meeting of the sub-committee on risk communication to approve the workplan, and a workshop on data collection for health events in 2024. ⁴⁷⁴⁸

1.2.1e Presence of One Health strategic plan

Score: 0

While there is no evidence of a standalone One Health strategy for Mali, the country formalized its national One Health Platform and taken concrete steps (priority disease listing, coordination structures) toward One Health.⁴⁹ Moreover, Mali completed a formal zoonotic-disease prioritisation workshop under the Centers for Disease Control and Prevention (CDC) “One Health Zoonotic Disease Prioritization (OHZDP)” process. The workshop identified five priority zoonotic disease clusters (anthrax; bovine tuberculosis; rabies; viral haemorrhagic fevers; zoonotic influenza). ⁵⁰

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 0

There is insufficient evidence that Mali has a national mechanism (either voluntary or mandatory) for owners of livestock to conduct and report on disease surveillance to a central government agency. There is no mention in the World Health Organization (WHO) Joint External Evaluation (JEE) for Mali conducted in June 2017 of any mechanism for livestock owners to conduct and report on disease surveillance. ⁵¹

Information provided by the governmnent's National Center for Health Information, Education, and Communication (Centre national d’information, d’éducation et de communication pour la santé, CNIECS) around zoonotic diseases emphasizes that owners of livestock should not sell their diseased livestock to butchers, nor eat it. The messages on anthrax, bovine tuberculosis and avian flu do not promote reporting of the matters to a national mechanism and refer only to the need for personal care of herders around animals, contacting veterinaries when livestock is diseased and promoting the sharing of information between veterinaries and doctors. ⁵²

At the time of the research, the Ministry of Livestock and Fisheries website was inaccessible, and the National Veterinary Services Directorate does not have a website. ⁵³

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is insufficient evidence of legislation and/or regulations that safeguard the confidentiality of information generated through surveillance activities for animals (for owners). There is no evidence that Mali has a national mechanism (either voluntary or mandatory) for owners of livestock to conduct and report on disease surveillance to a central government agency. There is no mention in the Joint External Evaluation (JEE) for Mali conducted in June 2017 of any mechanism for livestock owners to conduct and report on disease surveillance. ⁵⁴

In terms of citizen health data, the 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali states that: "In order to ensure the protection of patient data confidentiality and privacy during reporting, unique identifiers such as numbers or alphanumeric combinations should be used instead of names, thereby preventing any inadvertent disclosure of identities" (p.143). ⁵⁵ It does not discuss confidentiality of information generated through surveillance activities for animals.

The website of the Ministry of Livestock and Fisheries (Ministere de l'Elevage et la Peche) was not accessible at the time of the research and the National Veterinary Services Directorate does not have a website. ⁵⁶

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is no evidence that Mali systematically conducts surveillance of zoonotic disease in wildlife, poultry or livestock.

Animal surveillance is overseen by the EPIVET MALI epidemiological surveillance network, a permanent system within the Ministry of Livestock and Fisheries. However, according to EcoHealth 2022 Alliance's One Health and Veterinary Systems in Africa report, the EPIVET MALI network is weak or ineffective at meeting its objectives, due to lack of resources and personnel. Surveillance at slaughterhouses and at the points of entry is conducted by the Regional Directorate of Veterinary Services (DRSV) officers, who are assigned to slaughterhouses and veterinary stations. While Mali has well-established zoonotic disease surveillance systems, a lack of staff and resources prevents them from being fully implemented. ⁵⁷

As part of the One Health initiative started in 2018, the Ministry of Health's December 2022 Bulletin on One Health implementation states that Mali has strengthened the capacities of guards and agents of the forestry and water services to identify and report cases of illness among wildlife. In addition, to ensure a wider capacity of surveillance, training was provided to forest stakeholders such as hunters and traditional healers to identify and notify authorities of cases of illness in wildife, ensuring a bottom-up approach to reporting on zoonotic diseases. ⁵⁸ There is a focal point for Wildlife based in the National Directorate of Veterinary Services (DNSV) who contributes to wildlife surveillance reporting.

A workshop was held in 2024 on the configuration of data collection to report health events, including those of the DNSV, however, it did not specify details on data collection in wildlife, poultry or livestock. ⁵⁹

At the time of the research, the Ministry of Livestock and Fisheries website was inaccessible, while the Directorate of Veterinary Services does not have a website. ⁶⁰

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence of a mechanism for reporting notifiable diseases to The World Organisation for Animal Health (WOAH). Mali reports diseases to the WOAH on their World Animal Health Information System (WAHIS). In this database, a case of Contagious bovine pleuropneumonia was reported on 01.09.2025 and was stable, having begun in April 2025, and a case of African Swine Fever was reported on 29.08.2025 and was resolved, having started in June 2025. There are records for 10 events in Mali for 2005 to 2025. ⁶¹ WAHIS also holds data for outbreaks of diseases in Mali, showing 44 deaths in 111 cases in the period January-June 2025. ⁶² In addition, outbreaks are reported to the WOAH in the "Six-monthly report on the notification of listed diseases, infections and infestations". ⁶³ The WOAH website lists the focal point for Mali for Animal Disease Notification; it is a member of the National Veterinary Services Directorate. ⁶⁴

1.2.4a Number of veterinarians per 100,000 people

Score: 1.26

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 7.94

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 100

There is evidence that Mali's national plan on zoonotic disease or other legislation, regulations, or plans include mechanisms for working with the private sector in controlling or responding to zoonoses.

The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in December 2021, and the Integrated Strategic Plan For The Control Of Neglected Tropical Diseases 2022-2026 both cover zoonotic diseases, though not exclusively. ⁶⁵⁶⁶ They are based on One Health approaches, which includes multi-sector approaches to surveillance and response. They outline roles of the private sector in the monitoring and response to diseases, including the important role that private laboratories and healthcare facilities play in this process (for sharing information with the health authorities, as well as publishing information regarding responses by the government), building capacity of health sector actors on collecting and analysing data, as well as working with private sector communication/telecommunication companies to help in diffusing messages. ⁶⁷⁶⁸

The 2017 Practical Guide to Multisectoral Integrated Surveillance of Zoonoses and Response in Mali (Guide Pratique de la Surveillance Integree Multisectorielle des Zoonoses et la Reponse au Mali) highlights that the One Health approach can also apply to collaboration between the public and private sectors for the health of domestic animals and wildife. ⁶⁹

There is evidence of the collaboration between the state and private veterinarians for animal health, although not necessarily focused on zoonotic disease control. For example, according to the World Organization for Animal Health's One Health and Veterinary Systems in Africa: "The government, through the DNSV [National Directorate of Veterinary Services], coordinates annual livestock vaccination campaigns (PPR, CBPP and Pasteurellosis); the vaccine is subsidized by the state, but vaccination is carried out by private veterinarians. The country has a national immunization program and plan (EPI), aligned with the WHO Global Plan of Action for Vaccines, covering 11 vaccine preventable diseases. To date, this program does not include zoonotic diseases, although veterinarians provide vaccination against rabies and anthrax in parallel under their mandates." (p.86) ⁷⁰

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no evidence that Mali has a record, updated within the last five years, of the facilities in which especially dangerous pathogens and toxins are stored or processed.

Information in this regard could not be found on the website of the Ministry of Health or of the National Institue for Public Health. Mali has P-3 level laboratories capable of testing and investigating dangerous pathogens and toxins, including a newly inaugurated research center on emergent pathogens under the National Institute for Public Health. ⁷¹ There is insufficient public information regarding Mali's record of storage and processing of these pathogens.

According to the World Health Organization Joint External Evaluation (JEE) for Mali, conducted June 2017, the country does not maintain a registry or inventory of pathogens to monitor. There is no national structure for storing or handling pathogens, toxins, and other dangerous substances; nor is there a mechanism in place to ensure the safety of staff and the control of sensitive information. ⁷²

There is, however, a government list outlining which laboratories are responsible for testing for specific diseases included in the 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali (p.134). ⁷³

No further relevant evidence could be found on the website of the Ministry of Health. ⁷⁴

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 100

Mali has in place legislation related to biosecurity which addresses requirements such as physical containment, operation practices, and failure reporting systems of facilities in which especially dangerous pathogens and toxins are stored or processed. It does not cover cybersecurity requirements.

A legal framework for biological safety and security in Mali is established under Law No. 2024-035 of 24 December 2024 on Biological Safety and Security (Loi N°2024-035 du 24 decembre 2024 relative a la securite et a la surete biologiques). It covers, for example, communication with the national authorities regarding the intention of handling of pathogens, and providing related details on the their storage, use and containment (Articles 5, 6), and ensuring proportionate risk management measures are implemented, including for handling and confinement of the pathogens and/or toxins (Article 21). Intervention and emergency plans are required to be put in place between the handler, the national authority and the civil protection agency to preempt emergency responses (Article 22); in cases of failures, the entity is required to inform the national authority responsible for biosafety and biosecurity immediately, and the authorities manage the response at the cost of the entity (Article 23); for damage and liability purposes, the entity must pay an insurance, as well as pay an annual bond to the national authorities (Article 29). The law does not cover cybersecurity requirements. ⁷⁵

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 100

There is evidence of of an established agency responsible for the enforcement of biosecurity legislation and regulations. According to its website, the National Institute for Public Health (Institut National de Sante Publique, INSP) is responsible for the enforcement of biosecurity legislation and regulations. This is undertaken through the Institute's Quality, Health, Safety, Security, and Pharmacovigilance Department. Among other activites related to biosecurity, it refers to the following tasks: develop and implement policy and the national strategic plan for biological security and safety. ⁷⁶ The INSP's role is confirmed by the United Nations Institute for Disarmament Research Biological Weapons Convention National Implementation Measures Database. ⁷⁷

However, Law No. 2024-035 of 24 December 2024 on Biological Safety and Security (Loi N°2024-035 du 24 decembre 2024 relative a la securite et a la surete biologiques), establishing the legal framework for biological safety and security, states (p. 1203) that "The implementation of biological safety and security is ensured by a public body created for this purpose." (La mise en œuvre de la Sécurité et de la Sûreté biologiques est assurée par un organisme public créé à cet effet.). It does not specify that this role will fall to the National Institute for Public Health, despite the Institute predating the law. ⁷⁸ No specific details on the creation of a new agency to enforce biosecurity legislation and regulations after the law was introduced could be found on the Ministry of Health's website. ⁷⁹ The website of the Ministry of Livestock and Fisheries (Ministere de l'Elevage et la Peche) was not accessible at the time of the research and the National Veterinary Services Directorate does not have a website. ⁸⁰

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is insufficient public evidence that shows Mali has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities. Despite the National Institute for Public Health (Institut National de Sante Publique) being responsible for biosecurity regulation and having an emergent pathogen laboratory, their website shows no evidence of measures taken to limit the number of facilities or consolidate inventories. ⁸¹ According to the World Health Organization Joint External Evaluation (JEE) report for Mali, conducted June 2017, the country does not maintain a registry or inventory of pathogens to monitor. ⁸²

There is no information about inventory consolidation of dangerous pathogens on the website of the Ministry of Health. ⁸³ The website of the Ministry of Livestock and Fisheries (Ministere de l'Elevage et la Peche) was not accessible at the time of the research and the National Veterinary Services Directorate does not have a website. ⁸⁴

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 100

There is public evidence of in-country capacity to conduct Polymerase Chain Reaction (PCR)-based diagnostic testing for Ebola that precludes culturing a live pathogen. Academic publications indicate that the Serefo Laboratory (also referred to as UCRC or UCRC-Serefo), part of the University of Sciences, Techniques and Technologies of Bamako (USTTB), has the capacity to conduct PCR-based diagnostic testing that precludes culturing a live pathogen. ⁸⁵ The University Clinical Research Center (UCRC, also referred to as Serefo or UCRC-Serefo), a joint initiative between the Ministry of Health, the Ministry of Higher Education and Scientific Research, USTTB, and the United States National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH), has PCR equipment in its Molecular biology and Genominc Sequencing lab and played a key role during the 2014 Ebola outbreak. ⁸⁶
No information could be found regarding capacity for PCR-based diagnostic testing for anthrax on the website of the Ministry of Health or the National Institute for Public Health. ⁸⁷⁸⁸

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no publicly available evidence that Mali requires biosecurity training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

Law No. 2024-035 of 24 December 2024 on Biological Safety and Security (Loi N°2024-035 du 24 decembre 2024 relative a la securite et a la surete biologiques) does not refer to training needs for handlers of pathogens and toxins. ⁸⁹ The National Institute for Public Health states that it is responsible for developing and implementing a national training and assessment program in biological safety and security, however, it does not provide details of existing modules nor any details on requirements (such as refresher courses) for training. ⁹⁰ No evidence could be found of such requirements on the website of the Ministry of Health. ⁹¹

The World Health Organization's Joint External Evaluation of IHR Core Capacities of the Republic of Mali, conducted June 2017, notes that the country's laboratory staff are poorly trained with respect to biosafety and biosecurity best practices. The JEE also notes that the country has not yet set up a permanent training curriculum for personnel working with pathogens, toxins, and other dangerous substances, though eight basic training modules on biosafety and biosecurity developed by the Djomi Consortium/GHSA (Global Health Security Agenda) have taken place. ⁹²

A 2022 study provides evidence of ad-hoc trainings having taken place in Mali for laboratory workers: "Malian lab workers from human, veterinary, and agricultural National Reference Laboratories also attended training courses offered by SNL, the International Federation of Biosafety Associations, and the Middlebury Institute of International Studies at Monterey’s James Martin Center for Nonproliferation Studies. The training courses focused on the development of biosafety and biosecurity frameworks and regulatory documents. Upon completion of these courses, many of the graduates served later as trainers for others in their organization." (p.4) The same article surveyed lab workers who suggested that they lacked basic training to detect biosafety and biosecurity threats (p.9) and recommends that Malian stakeholders may wish to develop a training plan at the national and regional levels across multiple sectors, including agriculture, the environment, human health, and animal health. (p.11) ⁹³

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no evidence that there are regulations in Mali specifying that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to drug testing, background checks, or psychological/mental fitness checks. Law No. 2024-035 of 24 December 2024 on Biological Safety and Security does not cover personnel management and control aspects. ⁹⁴ There is no mention that personnel are subject to any of these checks in the completed WHO Joint External Evaluation for Mali from June 2017. ⁹⁵ There also is no mention of this issue on the websites of the Ministry of Health, the National Institute for Public Health or the Rodolphe Mérieux Laboratory in Bamako. ⁹⁶⁹⁷⁹⁸.

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

There is no evidence that Mali has publicly available information on national regulations on the safe and secure transport of infectious substances. Law No. 2024-035 of 24 December 2024 on Biological Safety and Security (Loi N°2024-035 du 24 decembre 2024 relative a la securite et a la surete biologiques) states that national and international transport of pathogens and toxins can only be undertaken by persons and entities holding a permit, license, authorization, or prior agreement. It further states that guidelines on technical and security requirements for transport and handling will be developed based on the law at a later time (Chapter III). ⁹⁹ At the time of research no evidence could be found regarding the publication of guidelines on technical and security requirements for transport and handling referred to in the 2024 law. These were not publicly available on the website of the Ministry of Health nor of the National Institue for Public Health. ¹⁰⁰¹⁰¹

The WHO Joint External Evaluation for Mali from June 2017 mentions the existence of national directives on the sampling, packaging, preservation, and transportation of samples. ¹⁰² However, the text of these directives are not available on the websites of the Ministry of Health, the National Institue for Public Health, Rodolphe Mérieux Laboratory in Bamako. ^103104105

In its list of diseases, the 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali has guidance on "How to prepare, store, and transport collected samples", according to the specific disease (for example, details on anthrax can be found from p.457), but this does not amount to information on national regulations. ¹⁰⁶

The website of the Ministry of Livestock and Fisheries (Ministere de l'Elevage et la Peche) was not accessible at the time of the research and the National Veterinary Services Directorate does not have a website. ¹⁰⁷

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 100

Mali has legislation in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential. Law No. 2024-035 of 24 December 2024 on Biological Safety and Security (Loi N°2024-035 du 24 decembre 2024 relative a la securite et a la surete biologiques) states that national and international transport and exchange of pathogens and toxins can only be undertaken by persons and entities holding a permit, license, authorization, or prior agreement. It further states that guidelines technical and security requirements for transport and handling will be developed based on the law at a later time. In addition, per Chapter III of the law, the recipient must hold end-use certification. According to the law, the end-use certification is a document requested in connection with the export of goods to confirm their end use for authorised purposes, without which the transfer cannot take place. ¹⁰⁸

1.4.1a Biosafety laws/regulations

Score: 100

Mali has legislation in place on national biosafety. Law No. 2024-035 of 24 December 2024 on Biological Safety and Security (Loi N°2024-035 du 24 decembre 2024 relative a la securite et a la surete biologiques) establishes the legal framework for biological safety and security. The scope of this law covers the manufacture, cultivation, reproduction, possession, storage, transport, transit, transfer, release, abandonment, destruction, use, handling, release into the environment, import, export, removal of pathogens and/or toxins, biological weapons, equipment, vectors, and dual-use goods and technologies. ¹⁰⁹

Per the United Nations Institute for Disarmament Research (UNIDIR)'s Biological Weapons Convention National Implementation Measures Database, in Mali, "Biosafety measures are incorporated in Law No. 02-013 of 3 June 2002 on Phytosanitary Control in Mali; and Law No. 08-042 of 1 December 2008 on Biotechnology Safety in the Republic of Mali. Mali has a specific legal framework governing the licensing of individuals working with GMOs as per Articles 8 and 9 of Law No. 08-042. Biosafety measures for facilities are included in Article 43 and 44 of the same law." ¹¹⁰

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 100

There is evidence of of an established agency responsible for the enforcement of biosafety legislation and regulations. According to its website, the National Institute for Public Health (Institut National de Sante Publique, INSP) is responsible for the enforcement of biosafety legislation and regulations. This is undertaken through by the Institute's Quality, Health, Safety, Security, and Pharmacovigilance Department. Among other activites related to biosecurity, it refers to the following tasks: develop and implement policy and the national strategic plan for biological security and safety. ¹¹¹ The INSP's role is confirmed by the United Nations Institute for Disarmament Research Biological Weapons Convention National Implementation Measures Database. ¹¹²

However, Law No. 2024-035 of 24 December 2024 on Biological Safety and Security (Loi N°2024-035 du 24 decembre 2024 relative a la securite et a la surete biologiques) establishing the legal framework for biological safety and security states (p. 1203) that "The implementation of biological safety and security is ensured by a public body created for this purpose." (La mise en œuvre de la Sécurité et de la Sûreté biologiques est assurée par un organisme public créé à cet effet.). It does not specify that this role will fall to the National Institute for Public Health, despite the Institute predating the law. ¹¹³ No specific details on the creation of a new agency to enforce biosafety legislation and regulations after the law was introduced could be found on the Ministry of Health's website. ¹¹⁴

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no publicly available evidence that Mali requires biosafety training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

Law No. 2024-035 of 24 December 2024 on Biological Safety and Security (Loi N°2024-035 du 24 decembre 2024 relative a la securite et a la surete biologiques) does not refer to training needs for handlers of pathogens and toxins. ¹¹⁵ The National Institute for Public Health states that it is responsible for developing and implementing a national training and assessment program in biological safety and security, however, it does not provide details of existing modules nor any details on requirements (such as refresher courses) for training. ¹¹⁶ No evidence could be found of such requirements on the website of the Ministry of Health. ¹¹⁷

The World Health Organization's Joint External Evaluation of IHR Core Capacities of the Republic of Mali, conducted June 2017, notes that the country's laboratory staff are poorly trained with respect to biosafety and biosecurity best practices. The JEE also notes that the country has not yet set up a permanent training curriculum for personnel working with pathogens, toxins, and other dangerous substances, though eight basic training modules on biosafety and biosecurity developed by the Djomi Consortium/GHSA (Global Health Security Agenda) have taken place. ¹¹⁸

There is evidence of ad-hoc trainings having taken place in Mali for laboratory workers: "Malian lab workers from human, veterinary, and agricultural National Reference Laboratories also attended training courses offered by SNL, the International Federation of Biosafety Associations, and the Middlebury Institute of International Studies at Monterey’s James Martin Center for Nonproliferation Studies. The training courses focused on the development of biosafety and biosecurity frameworks and regulatory documents. Upon completion of these courses, many of the graduates served later as trainers for others in their organization." (p.4) The same article surveyed lab workers who suggested that they lacked basic to detect biosafety and biosecurity threats (p.9) and recommends that Malian stakeholders may wish to develop a training plan at the national and regional levels across multiple sectors, including agriculture, the environment, human health, and animal health". (p.11) ¹¹⁹

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Mali has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential, and/or other dual use research. No information on this topic was found on the websites of the Ministry of Health, Ministry of Security and Civil Protection, National Insitute for Public Health (INSP) and Rodolphe Mérieux Laboratory in Bamako. ^120121122123

The United Nations Institute for Disarmament Research Biological Weapons Convention National Implementation Measures Database refers to research undertaken by the INSP and international experts, however, this is focused on the culture of biosafety and biosecurity amon laboratory workers in Mali. It did not assess the kind of research that is currently being undertaken in the country on especially dangerous pathogens, toxins, pathogens with pandemic potential, and/or other dual use research. ¹²⁴¹²⁵

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no evidence of a national policy in Mali requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. While Law No. 2024-035 of 24 December 2024 on Biological Safety and Security (Loi N°2024-035 du 24 decembre 2024 relative a la securite et a la surete biologiques) establishes the legal framework for biological safety and security, it does not explicitly regulate specific types of research or experiments and does not explicitly define or ban categories of scientific experiments.Instead, for research, it establishes rules for the issuance of permits, licenses, authorizations, and prior approvals for activities involving the development, acquisition, manufacture, possession, storage, transport, transfer, release, abandonment, destruction, handling, or use of pathogens and/or toxins that may have adverse effects on human, animal, plant, or environmental health animal, plant, and environmental health. ¹²⁶

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 100

There is evidence of an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

According to its website, the National Institute for Public Health (Institut National de Sante Publique, INSP) is responsible for the enforcement of biosafety and biosecurity legislation and regulations. In the Malian context, particularly with reference to Law No. 2024-035 of 24 December 2024 on Biological Safety and Security (Loi N°2024-035 du 24 decembre 2024 relative a la securite et a la surete biologiques), research is included within the biosafety and biosecuirty legislation. ¹²⁷ This is undertaken by the Institute's Quality, Health, Safety, Security, and Pharmacovigilance Department. Among other activites related to biosafety and biosecurity, it refers to the following tasks: develop and implement policy and the national strategic plan for biological security and safety, as well as promote research into biological security and safety. ¹²⁸ The INSP's role is confirmed by the United Nations Institute for Disarmament Research Biological Weapons Convention National Implementation Measures Database. The latter further states that in the context of dual-use research, the INSP carried out a first assessment of the culture of biosafety, biosecurity and responsible conduct in the life sciences, suggesting that the entity is concerned with research aspects. ¹²⁹

However, Law No. 2024-035 of 24 December 2024 on Biological Safety and Security establishing the legal framework for biological safety and security, and includes research, states (p. 1203) that "The implementation of biological safety and security is ensured by a public body created for this purpose." (La mise en œuvre de la Sécurité et de la Sûreté biologiques est assurée par un organisme public créé à cet effet.). It does not specify that this role will fall to the National Institute for Public Health, despite the Institute predating the law. ¹³⁰ No specific details on the creation of a new agency to enforce biosafety legislation and regulations after the law was introduced could be found on the Ministry of Health's website. ¹³¹

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

Although Mali has guidance regarding the screening of synthesized DNA, there is no evidence that the required screening involves a code reader. Mali's Law No. 08-042 of 1 December 2008 on Biotechnology Safety in the Republic of Mali regulates recombinant DNA in the context of agricultural biotechnology and pharmaceutical products; it is inclusive of DNA, not just crops/products. Approval decisions regarding the dissemination and commercialization of genetically modified organisms, which include recombinant DNA, are made by Mali's Ministry of Environment in consultation with a National Biosafety Committee. The application process requires risk assessment studies equivalent to at least one life cycle of the species and results showing
that the genetically modified organism (GMO) or GMO product does not pose a significant risk to human health, biological diversity, or the environment. There is no mention of screening involving a code reader. ¹³² There is no further information available on this topic to be found on the websites of the Ministry of Health, the National Institue for Public Health or the Rodolphe Mérieux Laboratory in Bamako. ^133134135 At the time of the research, the websites of the Ministry of the Environment and of Agriculture were inaccessible. ¹³⁶¹³⁷

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 100

Mali's official foot-and-mouth disease vaccination figures for livestock are publicly available on the WAHIS (formerly OIE) website for livestock vaccinated in response to outbreaks. The details can be found in the semestrial analytical reports for the country and are listed on the WAHIS dashboard. In the first semester of 2025, 700 livestock were vaccinated in response to outbreaks. ¹³⁸¹³⁹

1.6.1c Equitablenature of national immunization strategy/plan

Score: 0

There is evidence that a national immunization plan exists in Mali, although the plan itself is not available online.

According to the World Health Organization (WHO), as of 2024, Mali had a "national immunization plan such as National Immunization Strategy (NIS) or other multi-year plan (MYP)" in place. ¹⁴⁰ Mali implements an Expanded Program on Immunization (PEV) currently covering the period 2023-2027, however, no plan or strategy document regarding the program could be found online for the current period on the website of the Ministry of Health or WHO. ^141142143

According to a September 2023 publication of public-private partnership Gavi, titled The Zero-dose Landscape in Mali, Mali's immunization schedule includes 10 different vaccines and targets approximately 900,000 children each year. Mali administers the pentavalent vaccine, which prevents diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b (Hib) (p.8). ¹⁴⁴

There is no evidence available on whether the national immunization plan includes a plan for equitable distribution or overcoming other inequalities, geography etc. due to a lack of access to the plan. However, the PEV is mainly implemented through Community Health Centres (Centres de santé communautaire, CSCOM) and involves the mobilization of community health workers to raise awareness on vaccinations and remind people about upcoming vaccinations, in rural areas, vaccinations are carried out in community spaces or my mobile clinics, suggesting that efforts are made to ensure geographical coverage, according to Gavi (p.24).¹⁴⁵ Efforts are made to ensure that vaccines are transported to the most remote parts of the country, according to the United Nations Children's Fund (UNICEF). ¹⁴⁶ Mali is affected by conflict, which has undermined the health system's capacity to access all areas of the country to implement the immunization programme, according to Gavi (p.25).¹⁴⁷

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 0

There is insufficient evidence that Mali has a national immunization strategy/plan include measures to address vaccine hesitancy and build public trust in vaccines.

The Ministry of Health has issued guidance on how to build trust in vaccines. The approach is based on the use of traditional figures in Malian culture/communities to support the process of awareness raising of the benefits of immunization with regards to the government's Expanded Programme on Immunization. These figures are also empowered to mediate between communities and the vaccination teams, in cases where communities are particularly reticent to accept vaccinations for their children. It also provides guidance on organizing educational talks ("causeries educatives") with groups of between 20-25 people interested in receiving more information about vaccinations.¹⁴⁸

According to relevant World Health Organization (WHO) indicators for 2023, Mali undertook an "assessment of the demand-related reasons for under-vaccination", which also included Behavioural and Social Drivers (BeSD) of Vaccination. It implemented strategies for addressing under-vaccination; it undertook community engagement, digital and social listening strategies and implemented communication strategies, among other actions, to address under-vaccination. ¹⁴⁹

The National Center for Information, Education and Communication (Centre national pour l'information, l'éducation et la communication, CNIECS) is responsible for coordinating and putting in place strategies and plans for the promotion of vaccine uptake. ¹⁵⁰¹⁵¹

According to the WHO, as of 2024, Mali had a "national immunization plan such as National Immunization Strategy (NIS) or other multi-year plan (MYP)" in place. ¹⁵² Mali implements an Expanded Program on Immunization (PEV) currently covering the period 2023-2027, however, no plan or strategy document regarding the program could be found online for the current period on the website of the Ministry of Health or WHO, therefore it cannot be determined whether this multi-year plan includes measures to address vaccine hesitancy. ^153154155

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Mali has a national advisory group that provides technical guidance on the immunization strategy/plan to the government. The Technical Advisory Group on Immunization in Mali (Groupe Technique Consultatif pour la Vaccination au Mali, GTCV-MALI) was created in December 2014, and is a group of experts responsible for advising the Ministry of Health on vaccination strategies and policies to combat vaccine-preventable diseases ("Créé en décembre 2014, le GTCV-MALI est un groupe d’experts chargé de conseiller le Ministère de la Santé sur les stratégies vaccinales et les politiques de lutte contre les maladies évitables par la vaccination."). ¹⁵⁶
In addition, Mali has self reported having a standing national immunization technical advisory group (NITAG) to the WHO. ¹⁵⁷

1.6.1f Presence of an immunization programme for influenza

Score: 0

Mali does not have an immunization programme for influenza.

As of 2024, Mali did not have an immunization programme for influenza, according to the World Health Organization's (WHO) Influenza Vaccination Policy webpage. ¹⁵⁸

According to the WHO, as of 2024, Mali had a "national immunization plan such as National Immunization Strategy (NIS) or other multi-year plan (MYP)" in place. ¹⁵⁹ Mali implements an Expanded Program on Immunization (PEV) currently covering the period 2023-2027, however, no plan or strategy document regarding the program could be found online for the current period on the website of the Ministry of Health or WHO, allowing no confirmation of whether it includes measures for influenza. ^160161162

1.7.1a Strategy/plan for resilience of health system

Score: 0

There is no publicly available evidence that the country has a strategy or plan to develop a health system that is resilient to the challenges that climate change and changing seasonal weather patterns pose, that includes the threat of infectious diseases. However, there is evidence that action is being taken by Mali to address these issues.

The country's Ten-Year Health and Social Development Plan (PDDSS) 2014-2023 states that Mali will prioritize the following actions on climate impact on health "Integrated monitoring of the impact of climate change on health; Promotion of research and monitoring on the adverse effects of climate change on health; Capacity building for adaptation to the adverse effects of climate change on health." (p.57). ¹⁶³ No evidence of a government specific plan having been developed in this regard could be found on the Ministry of Health website ¹⁶⁴, however, the World Health Organization Mali Cooperation Plan for 2024-2027 states that one of its activities will be "Support for the implementation of the Joint Health and Environment Plan through the updating of the Health and Environment and Climate Change plans, the development of guidelines and protocols on air quality, and training for stakeholders on environmental health" (p.53). This suggests that the plan may be currently under development. ¹⁶⁵

There is evidence of a programme being implemented by the Ministry of Health with development partners such as the World Bank that includes climate considerations in healthcare. The programme is entitled Advancing Resilience And Inclusive Health Systems For Everyone (arise – Keneya Yiriwali), running from 2024 to 2029. Sub-component 3.4 of Arise – Keneya Yiriwali focuses on "Optimizing Surveillance, Preparedness, and Response to Epidemics and climate-sensitive diseases." Its objective is to "To prevent, detect, and respond to potential health threats" and its activities include "Strengthening disease surveillance, enhancing diagnostic capabilities, conducting capacity-building activities, promoting public health education, supporting digital health technologies, and facilitating multi-sector coordination" (pp.3-4) ¹⁶⁶ in response to climate sensitive diseases and climate shocks. ¹⁶⁷. The new programme is an expansion of a previous programme that ran between 2020-2024 and the new funding expands the scope of the original one to "climate-vulnerable areas and communities…with a particular focus on climate emergencies." ¹⁶⁸

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 50

The national laboratory system has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests although the specific tests are not specified.

Mali has four P-3 level laboritories capable of testing and investigating dangerous pathogens and toxins including tuberculous, HIV, malaria, Hepititus B and C, pneumonia, COVID-19, Ebola, Lassa Fever, Yellow Fever, Rift Valley Fever, Zika virus disease, Diphtheria, Dengue and Crimean-Congo Haemorrhagic Fever. ^169170171

The WHO Joint External Evaluation (JEE) for Mali, conducted in June 2017, indicates that there is a national network of laboratories for integrated disease surveillance and rapid confirmation of epidemics. The JEE gives Mali a score of 4 on indicator D.1.1 (Laboratory analysis for the detection of priority diseases), which means that the national laboratory system is capable of conducting five or more of the ten core tests, however, only three WHO-defined core tests are named, namely HIV, tuberculosis, and malaria. The types of tests are not explicitly mentioned. ¹⁷²

The National Institute for Public Health does not list the diagnostic tests the institute's laboratories can carry out, however, it has machinery to carry out bacteriological, biochemcial, polymerase chain reaction (PCR), serology and tuberculosis testing. ¹⁷³ There is no additional information on the Ministry of Health website. ¹⁷⁴

2.1.1b Plan to conduct testing during a public health emergency

Score: 50

Mali has a guide that outlines the needs for testing and role of laboratories at different levels (district and national) during public health emergencies, including their role in confirming the diseases and in providing ongoing data during pandemics, and provides considerations for scaling capacity and defining goals for testing, but not for testing for novel pathogens.

The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in 2021 and based on World Health Organization guidelines, provides guidance on assessment of presence of diseases, as well as the ongoing approach and role of laboratories in testing the diseases throughout the public health emergency. ¹⁷⁵ During pandemics, laboratories are required to provide weekly reports on the type of samples taken and their results to be added to the descriptive analysis of the emergency (p.137). The guide also outlines the need for laboratories to share and coordinate their results with veterinary laboratories especially in cases where animal health can affect humans (p.142). The guide provides guidance on the required diagnostic test and sample to be taken in cases where diseases can be confirmed by laboratory tests, providing clarity on what to look for and what tests to use according to the specific disease (section 11 from p.449).

The guide recognizes the importance of testing in cases of emergencies and defines the goal of testing as to confirm the diagnosis in a patient with precision; and to verify the cause (or aetiology) of a suspected outbreak (p.82). It also has guidance on the kind of support to provide to scale up capacity; for example, it suggests the setting up of mobile or field laboratories to meet the routine and outbreak laboratory testing needs of crisis-affected populations; strengthening of national and sub-national level laboratories to meet the additional needs of populations affected by a crisis; cold chain shipping arrangements to transport samples (p.442).

There is insufficient evidence that the guide covers considerations for testing for novel pathogens. ¹⁷⁶

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 100

Mali has a national laboratory that is accredited. The Rodolphe Mérieux Laboratory at the Charles Mérieux Center for Infectious Disease in Mali is International Organization for Standardization (ISO) 15189:2012 accredited. It received its accreditation in 2020 and the accreditation has been renewed for the period 2025-2027 for biochemistry, heamatology, immunology and microbiology. ¹⁷⁷¹⁷⁸

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

There is evidence that the national reference laboratory is subject to external quality assurance review.

According to a 2022 World Health Organization review, Mali's national reference laboratory runs "the national external quality assessment and standard panels are sent annually to the laboratory of the five [AMR] surveillance sites". ¹⁷⁹ The Rodolphe Mérieux Laboratory of Bamako is a national reference laboratory for the government for Ebola, the Zika virus, Lassa fever, and tuberculus. ¹⁸⁰ It is a member of the West African Network of Medical Biology Laboratories (RESAOLAB network), which conducts external quality control evaluations on its members. ¹⁸¹¹⁸² The Mérieux Fondation also has external experts that conduct quality controls on the Rodolphe Mérieux Laboratory of Bamako. ¹⁸³¹⁸⁴ Specifically, the Mérieux Fondation through the RESAOLAB network has conducted external quality assurance reviews in all RESAOLAB countries including Mali since 2009. This external quality assurance review consists of comparing test results from a laboratory to an external reference to provide objective evidence of test quality. The laboratories receive test samples to be analyzed and the level of compliance of the results provided is sent to the participating laboratories in order to put in place any corrective actions aimed at continuous improvement of the quality of the analyzes. ¹⁸⁵

There is also evidence that the Center for Vaccine Development's (Centre Pour les Vaccins en Developpement, Mali) microbiology and molecular biology laboratories are subject to external quality assurance, under the World Health Organization's (WHO) quality assurance programme. ¹⁸⁶

Under Decree N°2021-0738/PT-RM of 18 October 2021, activities undertaken by research laboratories require quality assurance by the Malian Agency for Quality Assurance (Agence Malienne d’Assurance Qualité (AMAQ-Sup)) in public institutions; the evaluation includes the work programme and all scientific activities undertaken. ¹⁸⁷

The Joint External Evaluation (JEE) for Mali from June 2017 notes the involvement of domestic laboratories in international external quality control for meningitis, measles, HIV, tuberculosis, malaria, and viral haemorrhagic fevers. However, the laboratories are not named. ¹⁸⁸

2.2.1a Nationwide specimen transport system

Score: 0

No evidence could be found that Mali has a nationwide specimen transport system. The Rodolphe-Merieux Laboratory-Bamako has a manual for its staff on sample collection which explains that samples from outside the laboratory must be transported according to regulations on the transport of dangerous materials by road (p.8), however, no details are given of these regulations. ¹⁸⁹

According to the WHO's Joint External Evaluation (JEE) for Mali, conducted in June 2017, Malian laboratories have sample transport material available but there is no coordination mechanism available between the various sectors that would be involved in specimen transport. The JEE also indicates that guidelines exist for the transport of samples of diseases with epidemic potential and tuberculosis, but it does not provide the name of these guidelines or what these guidelines consist of. The JEE states that current methods did not ensure the safety of the samples during transport, including sending samples via public transportation. ¹⁹⁰

According to an academic study from 2020, "The current ad hoc system that relies on untrained public transport companies carries risks of spoilage, accidental release of pathogens, and delays, which compromise specimen quality" and a system using the national postal system was trialled. ¹⁹¹

There is evidence of regional efforts to strengthen regulation on the transport of specimens, under the leadership of the Economic Community of West African States (ECOWAS) with a workshop having taken place in 2023. ¹⁹² The Centers for Disease Control and Prevention (CDC) has also been supporting Mali to reinforce specimen transport. ¹⁹³

No evidence could be found on the wesbite of the Ministry of Health, the National Institute for Public Health, Rodolphe-Merieux Laboratory-Bamako or the University Clinical Research Center. ^194195196197 At the time of the research, the Ministry of Livestock and Fisheries website was inaccessible and the National Veterinary Services Directorate does not have a website. ¹⁹⁸

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no evidence of a plan in place in Mali to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak.

For the COVID-19 pandemic, the Malian government created a new national plan in March 2020 called the COVID-19 Disease (COVID-19) Prevention and Response Action Plan, which indicated that Mali had a weak testing capacity. ¹⁹⁹ This document does not include a strategy or plan for rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing.

Mali's 2010 National Multi-Risk Preparation and Disaster-Response Plan does not mention a plan to rapidly authorize laboratories to supplement testing capacity. ²⁰⁰ According to the WHO's Joint External Evaluation (JEE) for Mali, conducted in June 2017, Mali updated its National Risk and Disaster Management Plan in February 2017, although this plan in not publically available. ²⁰¹ The JEE indicated that Mali does not have a national multi-risk preparedness and action plan in the event of a public health emergency.

The National Institute for Public Health (INSP) oversees the Department of Public Health Emergency Operations (Departement des Operations d'Urgences de Sante Publique, DOUSP), but no documents could be found in relation to their actions with regards rapid authorization or licensing of laboratories during an outbreak. Only documents regarding the workings of the Department could be found, such as a Manual of Operations and a Concept of Operations. ²⁰²²⁰³ The Department is responsible for contributing to the design and actioning emergency response plans and promoting national and international cooperation in research to combat the disease, among other things. ²⁰⁴ The INSP's Department of Laboratory is responsible for the development of a rapid response center in the event of an epidemic threat to provide solutions. ²⁰⁵

There is no further information available on the websites of the Ministry of Health, the INSP or Rodolphe Mérieux Laboratory in Bamako. ^206207208

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

There is evidence that Mali is conducting event-based and indicator-based surveillance and analysis for notifiable and novel infectious diseases, however, there is no clear evidence that it is being performed daily.

The West African Health Organization (WAHO) outbreaks dashboard shows that Mali is providing surveillance and analysis for infectious diseases. The dashboard covers a number of diseases, including dengue, measles, zika, cholera, etc. with data provided on a weekly basis, numbers of suspected cases, confirmed cases and deaths; as well as details of the geographic distribution of cases. ²⁰⁹

Since 2015, Mali uses District Heath Information Software (DHIS2) as the electronic system for aggregating routine facility and community service data and DHIS2 indicator data has been made public via quarterly reports available on the Ministry of Health website. The data is extracted by the Ministry of Health and presented in bulletins on diverse diseases or for general information. ^210211212

The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in December 2021 and based on World Health Organization guidelines, outlines how this should be undertaken. The Guide has, for example, an annex entitled: "Guide for Implementing Event-based Surveillance at the National, Regional, District, Health Area, and Community Levels" (p.113). While investigating epidemics, daily analysis of data is to be shared between the national, regional and district levels, with information such as deaths, hospitalised patients, affected areas, etc.) as part of the strengthened surveillance system (p.198). The guide also outlines the need for updating digital and paper (as relevant) records with "Daily notification of aggregated or case-based data on priority diseases, conditions, and events during the acute phase of the crisis and after confirmation of a new epidemic" (p.443). Data is expected to be analysed at all levels (district, regional and national) and guidance is given on how to ensure relevant analysis (p.195-212). ²¹³

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

There is publicly available evidence of a mechanism for reporting notifiable diseases to the World Health Organization (WHO) within the set timeline. The Technical Guide for Integrated Monitoring of Diseases and Response, published by the Ministry of Health in 2021 and based on World Health Organization guidelines, refers to the immediate notification of the WHO in cases of notifiable events, by the intermediary of the IHR Focal Point (p.58). The document demonstrates the mechanism for reporting of events upwards until they are reported to the IHR focal point and, subsequently to the WHO (p.146). ²¹⁴ No public evidence could be found of who is considered the IHR focal point for Mali on the website of the Ministry of Health or the National Institute for Public Health, allowing no confirmation of capacity to report notifiable diseases to the WHO within the set timeline. ²¹⁵²¹⁶

The WHO Joint External Evaluation for Mali conducted in June 2017 (JEE) stated that Mali had nominated IHR focal points in the various required ministries, however, the focal point overseeing coordination had not been nominated. The need to nominate a national focal point was highlighted as a priority of the JEE. ²¹⁷

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

There is evidence that the government of Mali operates an electronic reporting surveillance system at both the national and sub-national levels. Since 2015, Mali uses District Heath Information Software (DHIS2) as the electronic system for aggregating routine facility and community service data and DHIS2 indicator data has been made public via quarterly reports available on the Ministry of Health website. The data is extracted by the Ministry of Health and presented in bulletins on diverse diseases or for general information. ^218219220 According to a 2020 evaluation, since 2017, the DHIS2 is available in 100% of regional health offices and hospitals and 100% of districts. ²²¹

According to the WHO Joint External Evaluation for Mali from June 2017, the country collects indicator-based surveillance data at both the national and sub-national levels via multiple methods, i.e. paper, mobile phone, and electronically. ²²² The Integrated Strategic Plan for the Control of Neglected Tropical Diseases 2022-2026 shows an ongoing commitment to the DHIS2 data platform with annual trainings in each health district (p.125). ²²³ The Mali National Digital Health Strategy Plan 2024-2028 refers to ongoing efforts to work with DHIS2 as a tool for analysis and archiving of health indicators and data in the country (p.72). ²²⁴

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 0

There is no evidence that Mali's electronic reporting system collects ongoing/real time laboratory data and that the data can be disaggregated and analysed by age, ethnicity, etc.

Mali uses District Heath Information Software (DHIS2) as the electronic system for aggregating routine facility and community service data, however, there is no indication that there is real time laboratory data collection. ²²⁵²²⁶ The WHO Joint External Evaluation for Mali conducted in June 2017 does not mention real-time data collection within laboratories. ²²⁷ There is no information about real-time laboratory data collection on the websites of the Ministry of Health, or Rodolphe Mérieux Laboratory in Bamako. ²²⁸²²⁹ Information regarding the use of the DHIS2 system indicate that prompt reporting of data is an issue, suggesting that real time data is not offered. ²³⁰

The West African Network of Medical Biology Laboratories (RESAOLAB Network) has a daily laboratory reporting system that can be used to communicate epedimological data to the health authorities, but there is no information regarding which laboratories use this system in Mali and whether it is connected to the Malian medical authorities. ²³¹

The Ministry of Health produces annual reports on health indicators and diseases, which disaggregates some data according to age and gender. ²³²

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within Mali.

In 2024, the WHO and GPEI reported that Mali has engaged in ad-hoc ES, notably in 2020 and 2023. The report states that "while there has been substantial expansion of the environmental surveillance network, there are still gaps in site quality, including in areas with high transnational populations. Focused action is needed to address gaps and ensure high quality surveillance at all levels." Figure 4 in the report shows poor and limited ES performance at site level in Mali between July 2023 and June 2024.²³³

According to the 2025 Q4 Polio Environmental Surveillance Bulletin, published by the WHO and the GPEI, the Polio Eradication Programme (PEP), WHO Africa Regional Office (AFRO), have supported capacity-building in Mali, which is a priority country, through a refresher training session for ES focal points from government and supporting partner agencies.²³⁴

As of August 2023, in a bid to further optimize ES performance in the Region, reviews WHO were conducted in Mali and Zambia. Two new sites were identified and integrated into the network in Mali, suggesting there is ES capacity, although no further details on whether these are ongoing or national.²³⁵

Moreover, the WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 2 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.²³⁶

2.4.1a Common usage of electronic health records

Score: 50

There is evidence that electronic health records are used, though not commonly.

The Mali National Digital Health Strategy Plan 2024-2028, published by the Ministry of Health in December 2023, has mapped a variety of data systems being used across the country's healthcare system. It has identified private health care facilities using electronic health records in some parts of the country, while 60 state health structures use them (p.26). However, existing documents often cannot be shared between different institutions because they use different systems. The Plan states: "The digitization of patient records and the sharing of information (administrative, medical, care, billing, etc.) between internal and external structures and stakeholders is a necessity. The patient file is an essential tool that must structure the Information System (IS). This file must collect all results (biological and imaging test results, medical and surgical reports, etc.). The foundation of this system is based on standards that enable the exchange of information both within and outside organizations. All subsystems (university hospitals, regional hospitals, community health centers, health monitoring, vertical programs, etc.) must be aligned with this strategic approach." (p.23)

The Digital Health Strategy Plan has identified accessing resources for a shared Malian electronic health records system (p.44) and it is targeting introducing a harmonized, computerized/shared medical record system across 75% of Mali's healthcare facilities (p.56). ²³⁷

In addition, the Ministry of Health launched DISC-MALI, a community information system based on the “Community Health Toolkit” (CHT) to digitize community health in March 2023. The digitalisation effort aims to "improve planning, implementation, monitoring, and reporting on progress towards maternal and child health outcomes" ²³⁸.

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no evidence that Malian authorities have systematic access to electronic health records if individuals in the country.

The Mali National Digital Health Strategy Plan 2024-2028, published by the Ministry of Health in December 2023, outlined the urgency of digitalizing patient records in Mali, as well as the existing difficulties, where electronic health records already exist, of sharing the data between health structures. The plan makes the development of a uniform electronic health record system a priority for the country. ²³⁹ The document suggests centralizing information to facilitate secure access to patient medical records for healthcare professionals. ²⁴⁰

The National Agency for Telehealth and Medical Informatics (ANTIM) is promoting the use of the Openclinic platform to centralize electronic health records. ²⁴¹ ANTIM is the national agency charged with the promotion and development of e-health and medical informatics in Mali, including implementing a system of electronic health and managing databases in the field of telehealth and health informatics. ²⁴²

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no clear evidence that standards to ensure data is comparable are in place. There is no information regarding EHR data standards on the website of the Ministry of Health or the National Agency for Telehealth and Medical Informatics (ANTIM). ²⁴³²⁴⁴

The Mali National Digital Health Strategy Plan 2024-2028, published by the Ministry of Health in December 2023, outlines the need for ensuring data is standardized across the health system. It refers to the development of a Health Information System Interoperability Framework, which is a reference document for technical and semantic rules for health actors who have to share information. It is based on national and international standards (p.32) and the document states that it should be urgently developed. ²⁴⁵ However, no evidence could be found that the document has been developed on the website of the Ministry of Health or of ANTIM. ²⁴⁶²⁴⁷ The National Digital Health Startegy Plan refers to the existence of standards and benchmarks in certain Hospital Information Systems in Mali, without listing which ones (p.41). ²⁴⁸

2.4.2a Data sharing mechanisms

Score: 100

There is evidence of established mechanisms in Mali for sharing animal, human, and wildlife surveillance data. The One Health Platform is a multi-ministerial platform for the management of health at the inter-face between humans and animals. The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali explains that it applies at all levels, for collaboration, coordination and sharing of information between various stakeholders. Human and animal health agents at all levels must be implicated for surveillance and response (p.18-19). The Guide further states that all detected health events must be notified to the relevant sectors in the context of the One Health approach (p.77). ²⁴⁹

One Health is a cross-ministerial approach to managing health issues, particularly zoonotic diseases. The platform includes 12 government departments, and is headed by a Secretariat composed of the departments of health, environment, livestock and agriculture; the national platform meets on a monthly basis to share information on epidemiological surveillance data. ^250251252 There is evidence that the One Health platform has recently been operational across its various levels, holding a review meeting on the implementation of the Regional platforms, a meeting of the sub-committee on risk communication to approve the workplan, and a workshop on data collection for health events in 2024. ²⁵³²⁵⁴

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 100

There is evidence that Mali makes de-identified health surveillance data on infectious diseases publicly available via reports (or other format) on government websites on a regular basis. Since 2015, Mali uses District Heath Information Software (DHIS2) as the electronic system for aggregating routine facility and community service data including disease rates, and DHIS2 indicator data is made public via quarterly reports available on the Ministry of Health website, although these appear to be erratically shared. ²⁵⁵²⁵⁶ Disease specific reports have been identified for malaria but not for a specific infectious disease. ²⁵⁷ The Ministry of Health produces and publishes annual reports covering a variety of health topics, including on deaths caused by infectious diseases such as tuberculosis, meningitis. ²⁵⁸

Mali also shares information through the West African Health Organization (WAHO) outbreaks dashboard shows that Mali is providing surveillance and analysis for infectious diseases. The dashboard covers a number of diseases, including dengue, measles, zika, cholera, etc. with data provided on a weekly basis, numbers of suspected cases, confirmed cases and deaths; as well as details ofthe geographic distribution of the cases. ²⁵⁹

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

Mali has a national data privacy law that would safeguard the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities. Under Law No. 2013-015 on the Protection of Personal Data, personal health information falls under the category of "sensitive data." Improper use of sensitive data, e.g. illegal collection, improper storage, etc. is subject to monetary fines ranging from 2.5 to 10 million francs. ²⁶⁰ Thus, the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities is covered under Mali's data privacy law.

The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali states that: "In order to ensure the protection of patient data confidentiality and privacy during reporting, unique identifiers such as numbers or alphanumeric combinations should be used instead of names, thereby preventing any inadvertent disclosure of identities" (p.143). ²⁶¹

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

There is no evidence of legislation and/or regulations safeguarding the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities, include mention of protections from cyber attacks.

Mali's data privacy law, No. 2013-015 on the Protection of Personal Data, protects personal health information, which fall under the category of "sensitive data," but does not mention protections from cyber attacks. The improper use of sensitive data, e.g. illegal collection, improper storage, etc. is subject to monetary fines ranging from 2.5 to 10 million francs. ²⁶²

Mali's Law No. 2019-056 of 05 December 2019 on the Repression of Cybercriminality states under Chapter I of Title II that "Anyone who fraudulently obtains or attempts to obtain, for themselves or for others, any advantage by hacking into an information system shall be punished" with imprisonment or a fine, however it does not cover protrection of private data, focusing specifically on infractions and resultant punishments. ²⁶³

2.4.5a Cooperative commitments or agreements within regions

Score: 100

As a member of the West African Health Organization (WAHO), Mali is committed to sharing surveillance data with other countries for more than one disease.

WAHO set out its plan for regional data gathering in 2021 and has created a portal which holds information regarding a variety of diseases in member countries, which is populated with data from Mali as of August 2025. ²⁶⁴²⁶⁵ Representatives from Mali attended a WAHO workshop in June 2025 which, among other activities, sought to strenghten data sharing between the member countries. ²⁶⁶ Despite Mali exiting ECOWAS in January 2025, it appears that the country still contributes to and participates in WAHO activites, as demonstrated by the workshop attendance and the existence of 2025 data on the WAHO database.

The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in December 2021, recognizes the importance of sharing surveillance data with neighbouring countries. It suggests that countries should establish procedures for the sharing of data in the context of monitoring and response. It further states that if an epidemic is detected, neighbouring health establishments and districts should be notified (p.20). In its matrix of functions and essential activities at the national level, it states that Mali's national authorities should exchange epidemiological data and reports, including information on the response to the epidemic, with neighbouring countries (p.37-38). ²⁶⁷

Moreover, Mali's adherence to the International Health Regulations (IHR 2005) serves as a primary legal and operational commitment. As a signatory, Mali is obligated to notify the World Health Organization (WHO) of public health events that may constitute a public health emergency of international concern. This legally binding framework necessitates the sharing of surveillance data with the WHO but does not specify provisions to share with other countries. ²⁶⁸

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 100

There is evidence that the national government supports sub-national systems to prepare for future public health emergencies through metrics standardization.

The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published December 2021 by the Ministry of Health, provides metrics standardization to conduct contact tracing. It provides a form to register contacts (p.224), as well as a form to perform the follow up on subsquent days with the registered contacts (p.225). The Guide provides guidance on how to investigate potential contacts that the infected individual may have had, incuding where they may have been (e.g. laboratories, visiting family etc.) and who to question about them (e.g. school teachers, veterinaries etc.) and investigate whether any of these other individuals may have had symptoms following contact with the infected individual (p.208), as well as a case study, outlining potential contact incidents (p.228). The guide also outlines training to be provided to frontline personnel on basic communication around risks, including for contact tracing (p.323-324), while the guide is also intended to be used by establishments which provide healthcare training and it is, thus described as a useful resource for defining the scope of training (p.xxix), potentially serving to develop training on contact tracing. In preparation for an emergency, the Guide outlines the need for the various levels to attend trainings and simulations to be organised by the regional levels and designed at national levels, although these are general, based on the content of the Guide, and not specific to contact tracing (p.33-37). ²⁶⁹

The Manual of the Department of Public Health Emergency Operations (DOUSP) mentions that during the monitoring and alert phases, it is responsible for training the rapid intervention teams, medical urgency teams and other actors of the response (p.20), however, it does not specify what the trainings will cover. ²⁷⁰ Metrics astandardization are not covered in the DOUSP's concept of operations document. ²⁷¹

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is insufficient evidence that Mali provides wraparound services to enable infected people and their contacts to self-isolate and receive medical attention.

The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published December 2021 by the Ministry of Health, provides the recommendation, for example, that in case of pandemics, response teams should: Identify other individuals who have contracted the disease in question and refer them to healthcare facilities or treatment centers or, if necessary, quarantine the household and care for the patient, ensuring that they have access to food, water, essential items (soap, bleach/chlorine, firewood, medicines, sanitary towels, etc.) (p.269). ²⁷²

There is no evidence that the Technical Guide or any other plans address economic relief for quarantine. The March 2020 COVID-19 Disease (COVID-19) Prevention and Response Action Plan does not address providing wraparound services to enable cases and suspected cases to self-isolate as recommended. ²⁷³ There is evidence of financial support having been provided by the government during the COVID-19 pandemic, but this was social protection for poor Malians, rather than connected to quarantine or self-isolation needs. ²⁷⁴

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is insufficient evidence of a joint plan or cooperative agreement between the public health system and border control authorities to identify suspected and potential cases in international travelers.

No evidence of such a plan or approach between the heatlh and border authorities could be found on the website of the Ministry of Health or of the National Border Directorate. ²⁷⁵²⁷⁶

The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published 2021 by the Ministry of Health, has an annex (Annex H, p.67) entitled Guide for Implementing Surveillance and Response Systems at the Point of Entry. ²⁷⁷ However, this is not a joint plan or agreement between the Ministry of Health and other government entities such as the border authorities. It was published by the Ministry of Health and does not outline how other government actors were engaged in the process, if at all. The Technical guide outlines the role of border authorities in ensuring surveillance of ill travellers, response and care for travellers and communication of cases to health authorities. It states that border personnel at certain points should be trained to recognize sick travellers. It further states that at entry points, there should be: the capacity to quickly isolate people with symptoms; that health officials should be accessible, either in person or by telephone to assess the case; that ambulance or other transport vehicles should be available; and in cases of declare public health emergencies, the authorities should be able to rapidly set up screening services for international travellers. In suspected cases, the authorities must immediately complete a passenger locator form/alert notification form and separate the traveler from other passengers, including family members. In cases of asymptomatic travellers, the border authorities must register their details and communicate these to the nearest health center to support follow-up. ²⁷⁸

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

Mali has an applied epidemiology training program (such as FETP) available in country; its citizens can participate in applied epidemiology training programs (such as FETP) in other countries, but there is no evidence that the government provides financial support for such participants.

According the World Health Organization Joint External Evaluation for Mali conducted in June 2017, basic- level FETP exists in the country. ²⁷⁹ World Bank financing under the Regional Disease Surveillance Systems Enhancement (REDISSE) Phase III program (2018-2024) subsequently supported FETP trainings for staff in human, animal and environmental sectors in Mali at basic, intermediate and advanced levels and helped increase capacities in the country, while the African Field Epidemiology Network (AFENET) also runs FETPs in Mali. ²⁸⁰²⁸¹ For more advanced training, Malian health professionals can attend training sessions in Burkina Faso through an agreement with the University of Ouagadougou.

There is no mention in the JEE that the government provides resources to send citizens to advanced FETP training abroad. ²⁸² Mali is a member of the Burkina Field Epidemiology and Laboratory Training Program, a program accredited by the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) and run by the Burkinabe Joseph Ki-Zerbo University, for public functionaries. There is no evidence whether Mali provides financial support for its staff to attend the trainings. ²⁸³

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

Mali has field epidemiology training programs which are explicitly inclusive of animal health professionals. World Bank financing under the Regional Disease Surveillance Systems Enhancement (REDISSE) Phase III program (2018-2024) has supported the implemention by Mali of FETP trainings for staff in human, animal and environmental sectors at basic, intermediate and advanced levels. ²⁸⁴ The Joint External Evaluation for Mali, conducted June 2017, mentions that the country holds basic field epidemiology training programs for physicians and veterinarians. ²⁸⁵ Trainings provided for Malian officials by the African Field Epidemiology Network (AFENET) had participants from animal health ministries, while the trainings provided by the Burkina Field Epidemiology and Laboratory Training Program are open to members of ministries of animal health across its member countries. ²⁸⁶²⁸⁷ The approach to FETP in Mali emphasizes the One Health strategy, which promotes collaboration between different sectors for attaining health goals. ²⁸⁸ In addition, Mali was listed as a beneficiary of the FAO and WOAH In Service Applied Epidemiology Training (ISAVET) Programme which aims to "create a veterinary workforce equipped with applied veterinary epidemiology competencies and skills needed across multiple livestock production systems and value chains". ²⁸⁹

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 0

There is insufficient evidence that Mali has at least 1 trained field epidemiologist per 200,000 people. The World Health Organization (WHO) Joint External Evaluation for Mali, conducted June 2017, states that Mali has insufficient numbers of trained epidemiologists ²⁹⁰. The WHO cooperation strategy for 2023-2027 states that the Ebola and Covid-19 outbreaks helped the country to train a "critical mass" of field epidemiologists (p.28), suggesting that the minimum number may have been reached, however, no specific data is provided as to how many the country now has. ²⁹¹ No data regarding epidemiologists could be found on the website of the Ministry of Health. ²⁹²

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 66.67

There is evidence that Mali has an overarching national public health emergency response plan in place which addresses planning for multiple communicable diseases with epidemic or pandemic potential, hower, there is insufficient evidence on whether it is fully funded. The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in 2021, is a detailed monitoring and response plan developed to respond multiple diseases. For example, it provides general response approaches coupled with specific approaches for certain diseases (such as anthrax, SARS, smallpox, measles, the Ebola virus etc.). The Guide suggests that financing is available for its implementation, stating that at the national level one of the tasks is to update and revise the work plan and budget line relating to the implementation of monitoring and response activities (p.38). However, it appears that it is not totally funded. For example, one of the roles of the World Health Organization (WHO) and other international partners is to support the drafting of funding requests (p.66) and it states that for an effective communication plan, a detailed budget is required and strong advocacy needs to be done to mobilise resources (p.324). Additionally, it seeks to put in place an electronic response system, for which fund mobilisation is required (p.423). This suggests that while the Ministry of Health has a budget for the plan's implementation, it does not cover the totality of what is required. ²⁹³
No additional information regarding financing of Mali's national public health emergency response plan could be found on the website of the Ministry of Health. ²⁹⁴

3.1.1b National public health emergency response plan published in past 3 years

Score: 0

There is no evidence that the overarching plan has been updated in the last 3 years. The current Technical Guide for Integrated Monitoring of Diseases and Response in Mali was published in 2021 and it does not have a specified timeline for updating. ²⁹⁵ No additional information regarding an updated plan could be found on the website of the Ministry of Health. ²⁹⁶

Mali does have an Integrated Strategic Plan For The Control Of Neglected Tropical Diseases 2022-2026 (Plan Strategique Integre De Lutte Contre Les Maladies Tropicales Negligees, MTN), a follow-up to the 2017-2021 plan with the same name, but this is no overarching national public health emergency response plan. ²⁹⁷

3.1.1c One health principles by covering multiple threat types

Score: 100

The plan takes into consideration the one health principles, by covering multiple threat types.
The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in 2021, explains that the One Health approach applies at all levels of the plan. Human and animal health agents at all levels must be implicated for surveillance and response (p.18-19). The Guide further states that all detected health events must be notified to the relevant sectors in the context of the One Health approach (p.77). Zoonotic diseases are part of the plan, which gives guidance on monitoring and responding to zoonotic diseases such as anthrax. As part of the response, it seeks data from laboratories on antimicrobial resistance (p.392) and, for example, in its anthrax response outlines measures to take to reduce the risk of prescribing antibiotics needlessly, which could lead to antimicrobial resistance (p.456). It also gives details of common antimicrobial issues faced when treating certain diseases, such as pneumonia (no page number). ²⁹⁸

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 100

There is evidence that the Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in 2021, considers the impact of health equity and mechanisms for identifying and considerng the needs of vulnerable populations. In terms of health equity, elements that emerge are inclusive community engagement approaches, whereby, for example, district level Permanent Committees for the Management of Epidemics and Disasters, including community leaders and specifying leaders of women and youth groups. (p.239) ²⁹⁹

The Technical Guide outlines the importance of communication around health emergencies and ensuring that it is accessible to all, including marginalized groups (through the use of local dialects to communicate, for example) and ensuring that the actions being promoted to prevent or respond to outbreaks are realistic for such groups. It promotes the analysis of power dynamics in communities and taking special mesures for groups which are difficult to access, such as women, minorities, young people, people with disabilities etc. (p.322-323). In this respect it also suggests identifying mechanisms for communicating with hard-to-reach and vulnerable populations (older adults, persons with disabilities, children, nomads) and isolated communities to ensure they have access to health protection information and assistance; and identify what methods can be used to communicate to vulnerable people. (p.326) With regards to mechanisms, in cholera responses, the guide states that, preferably, there should be separate tents or rooms for women and men, as well as for children, older women and pregnant women (p.309). It also provides guidance on specific groups which are vulnerable to particular diseases or treatments for such groups, for example where weaker drug doses are required for pregnant women and children (no page number). ³⁰⁰

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

There is insufficient evidence that Mali has specific mechanisms for engaging with the private sector to assist with outbreak emergency preparedness and response. However, there is evidence of the important role which the private sector is expected to play in preparedness and response.

The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in December 2021, is aimed at both private and public sector operational-level health workers in primary health care settings (p.27). There is, therefore, and expectation that private sector health actors (including laboratories) contribute to the prevention and response activities.
In addition, the Guide outlines the role of non health actors in the actions, particularly telecommunication companies. Partnerships with the latter can help disseminate the hotline number through test messages to their customers. Messages sent should include the purpose of event-based monitoring, the importance of immediately reporting alerts, and how alerts can be reported (p.114). Similarly, Public Private Partnerships are suggested for expanding network reach to hard to access areas, to support the implementation of monitoring and response and PPPs with telecomms to help put in place and run the electronic monitoring and response system (p.425). Potential approaches to working with telecommunication companies include: take the form of exemptions, corporate social responsibility, and partial tax breaks for companies (p.422). ³⁰¹

The Manual of Operations and Operational Concept of the Department for Public Health Emergency Operations refer to private sector enagegement in monitoring and response, however they do not mention mechanisms for engaging them. ³⁰²³⁰³

No additional information could be found on the website of the Ministry of Health or of the National Institute for Public Health. ³⁰⁴³⁰⁵

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 100

Mali has guidelines in place to implement non-pharmaceutical interventions during an epidemic or epidemic. These are outlined in its Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in 2021. The guidelines include, for example, hand washing, providing access to potable water, removing infectious waste among communities, improving food handling, reducing exposure to infectious or environmental risks. Examples are given around reducing exposure to rodents (p.276)

The guide also promotes to use of communication messages to promote preventive behaviors that are easy to implement and likely to prevent the transmission of the disease (p.272), including with specific messaging to be used (p.295-300). It also includes a guide for health personnel, including on washing hands (p.302). In its outline of the response to COVID-19, the guide explains that non-pharmaceutical interventions are the most effective response to the pandemic and provides some examples, such as limiting air travel (no page number). ³⁰⁶

Mali has developed a National Strategic Plan for Infection Prevention and Control in Mali, which recognizes the gains that have been made in infection control as a result of non-pharmaceutical interventions as a result of the experiences of the Ebola virus and COVID-19 in the country. In terms of epidemic control it outlines the need to put in place a health worker strategy and the development of regulation to reduce professional risks (p.23). ³⁰⁷

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 0

There is no evidence that Mali has activated its national emergency response plan for an infectious disease outbreak, or has completed a national-level biological threat-focused exercise, in the last year (September 2024-September 2025).

There is evidence of heightened surveillance having been triggered by the Ministry of Health for two outbreaks. The first is an increase in Dengue cases in Mali in June 2025. With 336 cases diagnosed, an emergency response was not triggered, although the Ministry of Health increased its surveillance of the disease (with mobile health teams deployed to affected areas) and enacted prevention measures, such as strengthening awareness campaigns, distributing insecticides and targeted cleaning to destroy mosquito larvae; the government also called on the Malian population to collectively mobilize to reduce the spread of the disease and avoid a health emergency. ³⁰⁸ Secondly, following the notification of an Mpox outbreak in Guinea in July 2025, heightened surveillance was triggered in Mali, although no cases were reported in the country. ³⁰⁹

No additional information regarding an emergency response plan being triggered or a national-level biological threat-focused exercise could be found on the websites of the Ministry of Health, of the National Centre for Health Information, Education and Communication. ³¹⁰³¹¹

According to the World Health Organization (WHO), Mali's last simulation exercise took place in September 2023. ³¹² There is no evidence on the website of the World Organization for Animal Health (WOAH) of a simulation exercise having been reported in the last year. ³¹³

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

There is no evidence that Mali in the past year (September 2024-September 2025) has identified a list of gaps and best practices in response (either through an infectious disease response, after action review or a biological-threat focused exercise) and developed a plan to improve response capabilities. According to the World Health Organization (WHO), Mali's last simulation exercise took place in September 2023, and the WHO's data shows no after action reviews having been undertaken by Mali, including following the last simulation exercise in 2023. ³¹⁴³¹⁵
No information could be found on the Ministry of Health website regarding Mali having identified a list of gaps and best practices in response in the last year. ³¹⁶

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no evidence that Mali has completed a national-level biological threat-focused exercise, including with private sector actors, in the last year (September 2024-September 2025).
No information regarding a national-level biological threat-focused exercise could be found on the websites of the Ministry of Health, of the National Centre for Health Information, Education and Communication, or of the World Health Organization. ³¹⁷³¹⁸ According to the World Health Organization (WHO), Mali's last simulation exercise took place in September 2023. ³¹⁹ There is no evidence on the website of the World Organization for Animal Health (WOAH) of a simulation exercise having been reported in the last year. ³²⁰

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Mali has an Emergency Operations Center (EOC) in place. Mali's EOC is called the Department of Public Health Emergency Operations (DOUSP) and falls under the National Institute for Public Health (INSP). It has a manual and a concept of operations that were drafted by the INSP in 2022. ^321322323 The DOUSP's role is referenced in the Technical Guide for Integrated Monitoring of Diseases and Response in Mali. ³²⁴

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is no evidence that Mali's Emergency Operations Center (EOC), the Department of Public Health Emergency Operations (DOUSP) is required to conduct a drill for a public health emergency scenario at least once per year or evidence that they conduct a drill at least once per year. No evidence could be found in this regard on the websites of the Ministry of Health or of the National Institue for Public Health. ³²⁵³²⁶

As part of its Manual of Operations and its Concept of Operations, simulation exercises of different types are expected and examples provided as important tools for the DOUSP to ensure that it functions correctly and can assess capacity needs or gaps, however, there is no indication as to the regularity of these exercises. ³²⁷³²⁸ The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali also refers to simulation exercises, but does not give any indication of regularity of their performance. ³²⁹

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no evidence that Mali has activated its national emergency response plan for an infectious disease outbreak, or has completed a national-level exercise, in the last year (September 2024-September 2025).

No information regarding an emergency response plan being triggered or a national-level biological threat-focused exercise could be found on the websites of the Ministry of Health, of the National Institue for Public Health or of the National Centre for Health Information, Education and Communication. ^330331332 According to the World Health Organization (WHO), Mali's last simulation exercise took place in September 2023. ³³³ There is no evidence on the website of the World Organisation for Animal Health (WOAH) of a simulation exercise having been reported in the last year. ³³⁴

Although not an emergency response, heightened surveillance was triggered in June 2025, after 336 Dengue cases were diagnosed. The Ministry of Health increased its surveillance of the disease (with mobile health teams deployed to affected areas) and enacted prevention measures, such as strengthening awareness campaigns, distributing insecticides and targeted cleaning to destroy mosquito larvae; the government also called on the Malian population to collectively mobilize to reduce the spread of the disease and avoid a health emergency. It is not clear whether a Department of Public Health Emergency Operations response was triggered in this case, as reports refer to the Ministry of Health implementing the activities. ³³⁵

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

No evidence could be found that public health, animal health, the private sector and national security authorities have carried out an exercise to respond to a potential deliberate biological event nor of publicly available standard operating procedures, guidelines, MOUs or other agreeements between public health, animal health, the private sector and national security authorities to respond to a potential deliberate biological event.

The WHO Joint External Evaluation (JEE) for Mali conducted in June 2017 does not mention any exercises to simulate responses to a bioterrorism attack or any guidelines about how public health and security authorities should respond in case of such an attack. ³³⁶ The JEE recommended that Mali draft a protocol or memorandum of understanding between the public health and the security (including border control) agencies to define responsibilities, obligations and practical modalities of intervention for a public health emergency given that such a plan/protocol does not currently exist. There is no such information available on the websites of the Ministry of Health, the National Institute for Public Health and the Directorate General of Civil Protection; the latter serves as a disaster management agency. ^337338339 At the time of the research, the website of the Ministry of Livestock and Fisheries was inaccessible. ³⁴⁰

In terms of overall response to health emergencies, including biological, this is intended to be coordinated through a One Health approach, with a particular focus on public health and animal health actors working together, as well as the integration of the private sector to support the response. However, there is no evidence that the national security authorities are part of Mali's One Health platform. ³⁴¹³⁴²

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 100

Mali has in place in its national public health emergency response plan a section detailing a risk communication plan that is specifically intended for use during a public health emergency.

Mali has detailed guidance on risk communications in public health emergencies in its Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in 2021. ³⁴³ The Guide provides an outline of the roles that each level (from community to national and international) has in contributing to risk communications. It also has a standalone section on risk communication (Section 7, p.314), which states that risk communication should be included in all essential functions and activities of the response (p.316). ³⁴⁴

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 100

Mali's risk communication plan outlines how messages should be adapted to reach populations and sectors with different commuication needs.
The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in 2021, outlines the importance of communication around health emergencies and ensuring that it is accessible to all, including marginalized groups (through the use of local dialects to communicate, for example) and ensuring that the actions being promoted to prevent or respond to outbreaks are realistic for such groups. It promotes the analysis of power dynamics in communities and taking special measures for groups which are difficult to access, such as women, minorities, young people, people with disabilities etc. (p.322-323). In this respect it also suggests identifying mechanisms for communicating with hard-to-reach and vulnerable populations (older adults, persons with disabilities, children, nomads) and isolated communities to ensure they have access to health protection information and assistance; and identify what methods can be used to communicate to vulnerable people (p.326). ³⁴⁵

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

Mali's risk communication plan does not designate a specific positon within the government to serve as the primary spokesperson.
The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in 2021, states that it is up to the Ministry of Health to nominate a spokesperson (p.65) whose name should be communicated to media. It should also be specified to the media that all information about the health emergency will come from that person to ensure clear and coherent messaging (p.273). ³⁴⁶

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 50

There is evidence that the public health system has shared messages via online media platforms to inform the public about ongoing public health concerns and/or dispel rumors, misinformation or disinformation in the past year in a limited way.

The Ministry of Health published a "Statement from the Minister of Health and Social Development on the situation regarding the resurgence of monkeypox (MPOX) cases in the African region" on its Facebook page in July 2025. The statement from the Minister of Health reports that despite the presence of M-Pox in a neighbouring country, Mali has not had any cases and the Ministry of monitoring the situation, as well as advising populations to report to health centres in case of medical issues, as well as following the advice of health services to follow prevention efforts. ³⁴⁷

Prior to this statement, the Ministry of Health has an update from 18 August 2024 regarding Mpox in the African region, with a related message on its Facebook page from 20 August 2024. ³⁴⁸³⁴⁹

There is evidence of health concerns having occurred in recent months which have been reported through national media, referring to communications by the authorities, but which have not been been reported on the online platforms of the health authorities, such as concern regarding Dengue fever infections in Mali. ³⁵⁰

The websites and social media pages of the National Institute for Public Health and the National Centre for Health Information, Education and Communication do not provide any other such information in the past year. ^351352353354

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no evidence that senior leaders in Mali have shared misinformation or disinformation on infectious diseases in the past two years.
While misinformation and disinformation on health issues is common in Mali, particularly through social media, ³⁵⁵ no evidence could be found that senior leaders have been involved in promoting such false information on infectious diseases. No evidence could be found of such information or its refutation by the health authorities, such as on the website of the Ministry of Health or associated social media sites, including of the National Institute for Public Health or the National Centre for Health Information, Education and Communication. ^{356357358359360361362} No articles regarding misinformation or disinformation of senior leaders could be found on the Benbere website, a site that identifies fake news and debunks misinformation. ³⁶³

3.6.1a Percentage of households with Internet

Score: 46.72

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 0

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 36.67

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 62.5

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no evidence that Mali has implemented restrictions on export/import of medical goods, since it has not experienced an infectious disease outbreak that has triggered response mechanisms in the country in the last year (September 2024-September 2025).

There is evidence of heightened surveillance having been triggered by the Ministry of Health for two outbreaks: firstly due to an increase in Dengue cases in Mali in June 2025. With 336 cases diagnosed, an emergency response was not triggered, although the Ministry of Health increased its surveillance of the disease (with mobile health teams deployed to affected areas) and enacted prevention measures, such as strengthening awareness campaigns, distributing insecticides and targeted cleaning to destroy mosquito larvae; the government also called on the Malian population to collectively mobilise to reduce the spread of the disease and avoid a health emergency. ³⁶⁴ Secondly, following the notification of an Mpox outbreak in Guinea in July 2025, heightened surveillance was triggered in Mali, although no cases were reported in the country. ³⁶⁵ In neither of these cases were there indications of import/export restrictions, including on the websites of the Ministry of Health, the Directorate General of Civil Protection or of the Ministry of Security and Civil Protection. ^366367368

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no evidence that Mali has implemented restrictions on export/import of non-medical goods, since it has not experienced an infectious disease outbreak that has triggered response mechanisms in the country in the last year (September 2024-September 2025).

There is evidence of heightened surveillance having been triggered by the Ministry of Health for two outbreaks: firstly due to an increase in Dengue cases in Mali in June 2025. With 336 cases diagnosed, an emergency response was not triggered, although the Ministry of Health increased its surveillance of the disease (with mobile health teams deployed to affected areas) and enacted prevention measures, such as strengthening awareness campaigns, distributing insecticides and targeted cleaning to destroy mosquito larvae; the government also called on the Malian population to collectively mobilise to reduce the spread of the disease and avoid a health emergency. ³⁶⁹ Secondly, following the notification of an Mpox outbreak in Guinea in July 2025, heightened surveillance was triggered in Mali, although no cases were reported in the country. ³⁷⁰ In neither of these cases were there indications of import/export restrictions, including on the website of the Ministry of Health. ³⁷¹ There has been a suspension exports of certain foodstuffs, in October 2024, such as peanuts and sesame seeds, however, this was an economic decision and not related to an infectious disease outbreak. ³⁷²

No evidence on the restriction of export/import of non-medical goods could be found on the on the websites of the Ministry of Health, the Directorate General of Civil Protection or of the Ministry of Security and Civil Protection. ^373374375

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no evidence that Mali has implemented restrictions on inbound or outbound travel restrictions, since it has not experienced an infectious disease outbreak that has triggered response mechanisms in the country in the last year (September 2024-September 2025).

There is evidence of heightened surveillance having been triggered by the Ministry of Health for two outbreaks: firstly due to an increase in Dengue cases in Mali in June 2025. Secondly, following the notification of an Mpox outbreak in Guinea in July 2025, heightened surveillance was triggered in Mali, although no cases were reported in the country. In neither of these cases were there indications of inbound or outbound travel restrictions, including from Guinea, which was affected by the Mpox outbreak. ³⁷⁶³⁷⁷

No evidence of travel restrictions could be found on the websites of the Ministry of Health, on the Ministry of Foreign Affairs and International Cooperation or of Mali Tourism. ^378379380 All COVID-19 restrictions were lifted in Mali in July 2022. ³⁸¹

3.7.2b Risk-based approach to international travel-related measures

Score: 0

No evidence could be found regarding Mali's approach to travel-related measures. While the Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in 2021, provides extensive information about surveillance and response to diseases at Mali's entry points, it does not reference international travel-related measures. ³⁸² No details or information could be found in this regards on the website of the Ministry of Health or of the Civil Aviation Authority. ³⁸³³⁸⁴

Mali includes under its vaccine requirements a certificate of yellow fever vaccination for all travellers over 9 months of age, though the CDC's recommendation is that it should not be required for travellers only travelling to the Sahara regions of the country. ³⁸⁵

4.1.1a Doctors per 100,000 people

Score: 2.29

4.1.1b Nurses and midwives per 100,000 people

Score: 3.35

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

No evidence could be found that a health workforce strategy in place (which has been updated in the past five years) to identify fields where there is an insufficient workforce and strategies to address these shortcomings. While there is evidence that a recent strategy exists, it is not currently possible to confirm whether it identifies fields where there is an insufficient workforce and strategies to address shortcomings.

The World Health Organization (WHO) in its cooperation startegy for Mali for 2024-2027 outlines one of its activities as being to support Mali to develop its 2024-2028 Human Resources in Health Staretegic Development Plan. ³⁸⁶ It also refers to the existence of such a plan for the period 2019-2023 which would be evaluated. However, neither of these documents could be located on the website of the WHO or of the Ministry of Health. A number of documents which could be the human resource strategy appeared to be available on the website of the Ministry of Health, however, they were inaccessible as of September 2025. ^387388389390.

4.1.1d Health system capacity for essential health services

Score: 0

Mali does not have sufficient capacity to deliver essential health services.

According to the Joint external evaluation of the International Health Regulations (‎2005)‎ for Mali, the country scores only 1 for this measure, citing the need for development of operational procedures (OPS) for the acquisition, distribution, receipt, and management of medical supplies; staffing levels to be increased; development of operational procedures (OPS) for the deployment of healthcare personnel during a public health emergency; development of a plan for providing external reinforcement staff in the event of a public health emergency; training of logistics professionals; and improvement of inventory management tools.³⁹¹

According to the World Health Organization's (WHO) Cooperation Strategy with Mali 2024-2027, the country has a healthcare facility density of 0.91% per 10,000 inhabitants, as opposed to the WHO recommendation of 2 facilities per 10,000 people; it has a "low ratio of healthcare professionals to population, which is 6 inhabitants, whereas the WHO recommends 23 inhabitants" (p.20), and there is unequal spread of healthcare professionals, with 36% present in the capital Bamako, which holds only 12.5% of the country's population (p.21). ³⁹² The country's capacity to deliver essential health services is additionally impacted by conflict, with healthcare facilities regularly attacked and low or no healthcare professionals attending facilities and a lack of medical equipment in conflict-affected regions of the country. Approximately 4% of healthcare facilities are now non-functional due to insecurity.³⁹³

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no evidence that Mali has a plan to ensure continuity of essential health services during a public health emergency.
The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in 2021, has a section (section 5.8, p.253) which covers developing a plan for preparedness and response during a public health emergency, however, this focuses on preparing for the emergency response rather than the continuity of essential health services. ³⁹⁴ Other documents responding to health emergencies, such as the 2021 Action Plan for Prevention and Response to COVID-19 or the Mali National Contingency Plan: “Food and Nutrition Security Component”, which covers epidemic and zoonotic diseases, focused on emergency response prevention and measures and do not speak to continuity of services. ³⁹⁵³⁹⁶

The country has a National Multi-Risk Contingency Plan, under the leadership of the Directorate General of Civil Protection, however, the plan for 2025-2026 is currently being developed, and the previous plan could not be located on the websit of the Directorate. ³⁹⁷³⁹⁸ The website of the Ministry of Health was inaccessible at the time of research. ³⁹⁹

4.1.2a Hospital beds per 100,000 people

Score: 1.57

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 0

There is insufficient evidence that Mali has the capacity to isolate patients with highly communicable diseases in a biocontainment patient care unit and/or patient isolation room/unit located within the country.

According to news reports during the COVID-19 emergency, the Hopital de Mali au Point G hospital had an isolation center with 11 beds, but it is not clear whether individual COVID-19 patients were isolated from each other. ⁴⁰⁰ Medecins Sans Frontieres (MSF) and the national health authorities have built a pediatric ward in the reference hospital in the Douentza region, which has 5 isolation rooms, but not further information is given regarding the ward and its capabilities. ⁴⁰¹ The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali outlines the need to map and update isolation rooms for the management of patients with highly infectious diseases, including details on contacts, location, bed capacity, level of expertise, and the type of patients/diseases that can be treated (p.258), however, it does not refer to existing isolation centers nor confirm the presence of individual patient isolation structures. ⁴⁰² No additional information could be found about isolation centers on the website of the National Institute for Public Health, or of the Ministry of Health website. ⁴⁰³⁴⁰⁴

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

There is no evidence that Mali has demonstrated capacity to expand isolation capacity in response to an infectious disease outbreak in the past two years (September 2023-September 2025). There is insufficient evidence that Mali has developed, updated or tested a plan to expand isolation capacity in response to an infectious disease in the past two years.

The Department of Public Health Emergency Operations (DOUSP) was activitated in September 2023 and, additionally, in December 2023 in response to a Dengue and Zika public health emergency, respectively. However, there is no evidence that Mali expanded isolation capacity in response to either of these two emergencies. ⁴⁰⁵⁴⁰⁶

There has been heightened surveillance for infectious disease outbreak, but no response which wuld have required an expansion of isolation capacity. For example, due to an increase in Dengue cases in Mali in June 2025. With 336 cases diagnosed, an emergency response was not triggered, although the Ministry of Health increased its surveillance of the disease (with mobile health teams deployed to affected areas) and enacted prevention measures, such as strengthening awareness campaigns, distributing insecticides and targeted cleaning to destroy mosquito larvae; the government also called on the Malian population to collectively mobilize to reduce the spread of the disease and avoid a health emergency. ⁴⁰⁷ Secondly, following the notification of an Mpox outbreak in Guinea in July 2025, heightened surveillance was triggered in Mali, although no cases were reported in the country. ⁴⁰⁸

The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali states that in preparation for an outbreak, a list of potential isolation sites should be put together (p.446). ⁴⁰⁹

No evidence could be found that a plan for isolation expansion capacity exists or has been updated on the website of the Ministry of Health, while according to the World Health Organization (WHO), Mali's last simulation exercise took place in September 2023 but contents or focus of the exercise were not provided. ⁴¹⁰⁴¹¹

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 0

There is no evidence of a national and/or international procurement protocol or contract framework in place which can be utilized by the Ministries of Health and Agriculture for the acquisition of laboratory supplies (e.g. equipment, reagents and media) and medical supplies (e.g. equipment, PPE) for routine needs.

The Joint External Evaluation (JEE) for Mali, conducted June 2017, indicates that there is a Master Plan for the Supply and Distribution of Essential Medicines (SDAME/SDADME: Schéma Directeur d'Approvisionnement et de distribution des Médicaments Essentiels) that also covers reagents and laboratory consumables and medical equipment, especially diagnostic tests for malaria and HIV. A new version was published in 2022, entitled the SDADME-PS (Guidelines for the Supply and Distribution of Essential Medicines and Other Health Products) demonstrating the wider scope of the purchases. SDADME is a national-level plan that involves several government bodies, including the Directorate of Pharmacy and Medicine (DPM) and the Popular Pharmacy of Mali (PPM). The PPM is a public commercial and industrial establishment which has a contract plan with the Government of Mali to be the main procurer and distributor of medicines and other health products. The SDADME-PS place PPM as the privileged entity for the government to purchase items, however, the document does not provide any procurement protocols or contract frameworks for procurement from suppliers by the PPM ^412413414.
No evidence could be found of a procurement protocol or contract framework on the website of the DPM, while the PPM does not have a website. ⁴¹⁵

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 33.33

There is evidence that the country has a stockpile of medical supplies for national for national use during a public health emergency, but no evidence of a plan to ensure equitable distribution in an emergency.

According to the Joint External Evaluation for Mali conducted in June 2017, Mali has stockpiles of vaccines and medical countermeasures for epidemics and disasters. The Director General of the National Institue for Public Health (INSP) and the Department of Public Health Emergency Operations (DOUSP, which is overseen by the INSP) is responsible for the acquisition and monitoring of stock availability of biological products, equipment, and materials necessary to protect populations from serious health threats. ^416417418

The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali states that reserves of essential supplies for treatment in order to combat outbreaks should be put together at nationa, regional and disgtrict levels, and this should include, for example, oral rehydration salts, intravenous fluids, vaccination equipment, personal protective equipment, sample transport equipment, water purification supplies, disinfectants, spray pumps, and informational brochures on preventive measures for health care workers or the community (p.446). It provides specific guidelines of which medicine, vaccines, pesticides, personal protection items and other equipment should be held (p.259-260). ⁴¹⁹

The JEE outlines how stockpiles are kept at national and regional level, which might point to capacities for equitable distribution, however, it also states that there are poor staff capacities in Mali to act in an emergency. The Guidelines for the Supply and Distribution of Essential Medicines and Other Health Products outline how in emergencies, the Popular Pharmacy of Mali (PPM) can work with non-governmental organizations (NGOs) and other partners to distribute medical and non-medical items, using their special distribution logistics, such as planes, drones and canoes; pointing to efforts towards equitable distribution. The Technical Guide does not outline an equitable distribution approach. ^420421422

No additional information could be found on the website of the Ministry of Health or the National Institute for Public Health. ⁴²³⁴²⁴

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is insufficent evidence to show that Mali has a stockpile of laboratory supplies for national use during a public health emergency.

The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali states that reserves of essential supplies for treatment in order to combat outbreaks should be put together at national, regional and district levels, and it provides specific details of the personal protective material required as well as the laboratory needs (such as specific kits laboratory kits for different health emergencies, p.218-220), these are required as part of the wider stockpile of medical and other items. However, it is unclear whether this is done systematically, since this is a technical guide rather than a directive or legislation. The March 2020 COVID-19 Disease (COVID-19) Prevention and Response Action Plan does not mention laboratory supplies (e.g. reagents, media) for national use. ⁴²⁵

The WHO Joint External Evaluation (JEE) for Mali conducted in June 2017 does not mention laboratory supplies. ⁴²⁶ The Guidelines for the Supply and Distribution of Essential Medicines and Other Health Products outlines the process by the Popular Pharmacy of Mali (PPM) for procuring medical and laboratory items as well as the management of stocks, however, it does not refer to supplies for national use during a public health emergency. ⁴²⁷

The country has a National Multi-Risk Contingency Plan, under the leadership of the Directorate General of Civil Protection, however, the plan for 2025-2026 is currently being developed, and the previous plan could not be located on the website of the Directorate. ⁴²⁸⁴²⁹ No additional information could be found on the website of the Ministry of Health, the National Institue for Public Health or of the Directorate of Pharmacy and Medicine. ^430431432

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 100

There is evidence that Mali requires a review of the national stockpile to ensure the supply is sufficient for a public health emergency. The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali states that reserves of essential supplies for treatment in order to combat outbreaks should be put together, and it states that stockpiles should be reviewed. It suggests doing so every 4 months, as an example (p.256), and provides an example form that can be used. ⁴³³

The March 2020 COVID-19 Disease (COVID-19) Prevention and Response Action Plan mentions the need to create a stockpile of health products and states the quantities of the stockpile at that time, although there is insufficient evidence that this tallying was the result of an annual review of the national stockpile. ⁴³⁴ The WHO Joint External Evaluation for the Republic of Mali conducted in June 2017 does not mention an annual review of the national stockpile, only that Mali has stockpiles of vaccines and medical countermeasures for epidemics and disasters. ⁴³⁵ The JEE notes inadequate material resources, including personal protective equipment, for healthcare staff and at isolation centers.

There is no information available regarding an annual stockpile review on the websites of the Ministry of Health, the National Institute for Public Health or the Directorate General of Civil Protection (which serves as the emergency management agency). ^436437438

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 100

There is evidence Mali has a plan/agreement to procure or leverage domestic manufacturing capacity to produce medical supplies (e.g. MCMs, medicines, vaccines, equipment, PPE) for national use during a public health emergency.

According to the Joint External Evaluation for Mali conducted in June 2017, Mali has stockpiles of vaccines and medical countermeasures for epidemics and disasters and an agreement to procure MCMs when needed. ⁴³⁹ The Director General of the National Institue for Public Health (INSP) and the Department of Public Health Emergency Operations (DOUSP, which is overseen by the INSP) is responsible for the acquisition and monitoring of stock availability of biological products, equipment, and materials necessary to protect populations from serious health threats. ⁴⁴⁰⁴⁴¹

Although Mali has laboratories that can produce vaccines against epizootic diseases, it was not able to produce antibiotics and vaccines for human use at the time the JEE was conducted. ⁴⁴² The government procures the latter through agreements with manufacturers (such as Sanofi Pasteur) and distributors (such as UNICEF), which is noted as a best practice for Mali in its JEE report. ⁴⁴³

Due to the slowness of the importation of medical supplies in Mali and regular lack of medicines available in the country, there are efforts to develop local capacities for producing generic drugs, supported by the World Health Organization, however, there is no indication that this would serve for emergencies ⁴⁴⁴.

An online system has been developed to speed up the approval and import of medical supplies, however, no mention is made of public health emergencies. ⁴⁴⁵ There is no information about the production of medical countermeasures, procurement agreements or expedited importation in cases of public health emergencies available on the websites of the Ministry of Health, the National Institute for Public Health or of the Directorate of Pharmacy and Medicine. ^446447448

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is no evidence of a plan/agreement to leverage public and/or private sector domestic (including regional) manufacturing capacity to produce laboratory supplies (e.g. reagents, media) for national use during a public health emergency, or of a plan/mechanism to procure laboratory supplies (e.g. reagents, media) for national use during a public health emergency, or of a plan/mechanism to expedite laboratory supplies (e.g. MCMs, medicines, vaccines, equipment, PPE) through points of entry.

The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali does not mention the procurement of laboratory supplies or mechanisms for doing so. ⁴⁴⁹ The March 2020 COVID-19 Disease (COVID-19) Prevention and Response Action Plan does not mention the need to produce or procure laboratory supplies (e.g. reagents, media) for national use. ⁴⁵⁰ The WHO Joint External Evaluation (JEE) for Mali conducted in June 2017 does not mention a plan to produce or procure laboratory supplies, only that Mali has stockpiles of vaccines and medical countermeasures for epidemics and disasters. ⁴⁵¹

There is no information about the production of laboratory supplies, procurement agreements or expedited importation in cases of public health emergencies available on the websites of the Ministry of Health, the National Institute for Public Health or of the Directorate of Pharmacy and Medicine. ^452453454

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

There is a mechanism for national and subnational levels for emergency logistics and supply chain management, which covers cold chain management for vaccines.

The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali outlines the process of ensuring that emergency logistics is ensured at different levels (national, regional, district). As part of the preparation it is advised that a mapping is done of health workers who have expertise on logistics, who can be members of the rapid intervention teams and a logstics person should be part of the intervention team (p.202). The intervention team is responsible for foreseeing the logistics around medical supplies, vaccines and protective equipment. Cold chain logistics is overseen by the laboratories for vaccines (p.247). ⁴⁵⁵ Overall, the Department of Public Health Emergency Operations is responsible for overseeing emergency logistics services. ⁴⁵⁶

No evidence could be found that the system is exercised, reviewed, evaluated and updated or that it covers the private sector, on the website of the Ministry of Health or of the National Institue for Public Health. ⁴⁵⁷⁴⁵⁸

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 100

There is evidence that Mali has guidelines for dispensing medical countermeasures for national use during a public health emergency.
The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in December 2021, provides a detailed annex for planning and undertaking a vaccination campaign in response to a health emergency (Annex 6C, p.289). It includes identifying sites, developing micro plans for the campaign, training for the vaccination team, community engagement, logistics of the team, and monitoring of vaccine administration. ⁴⁵⁹

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 0

There is no evidence that Mali has a public plan in place to facilitate workforce surge in an emergency.

The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali does not cover the need for workforce surge explicitly. It covers, instead, aspects such as training for existing personnel at times of emergencies. ⁴⁶⁰ The Department of Public Health Emergency Operations has the possibility of workforce surges during emergencies within its manual of operation. However, these are for the Department itself, rather than for a surge in health workers to respond directly to the emergency. ⁴⁶¹ The March 2020 COVID-19 Prevention and Response Action Plan outlined the need to identify personnel needs, however, it did not go into any detail on the topic. ⁴⁶² The WHO Joint External Evaluation (JEE) for Mali conducted in June 2017 notes the overall shortage of health personnel, as well as the lack of a personnel deployment plan or procedures for dispatching, distributing, and managing medical resources during public health emergencies. ⁴⁶³

The 2010 National Multi-Risk Plan for Disaster Preparedness and Response speaks of "recycling personnel" during cholera outbreaks (p.14) although no surge is mentioned for epizootic emergencies, and it refers to the mobilisation of locally trained personnel at the outset, with other mobilizations depending on the size of the emergency at regional, national and international levels based on government personnel, Mali Red Cross personnel and personnel whose CVs are held for these reasons within the various ministries (p.36). For malnutrition emergencies, it highlights the need for a sketch of health personnel redeployment (p.43). ⁴⁶⁴

The 2021 Mali National Contingency Plan: “Food Security and Nutrition Component” outlines the need to reorganize health services to ensure cases are handled and, therefore, there is a need mobilise health personnel resurces during epidemic or epizootic emergencies. (p.77) In terms of human resources, it covers the need for personnel mobilisation depending on the size of the emergency, from different levels, including from government, various UN and donor partners (p.80), however, this appears to be more for the technical coordination support, rather than people on the ground. ⁴⁶⁵ Neither of these documents constitute a plan for workforce surge.

The Decree On the Relief Organisation Plan in Mali, Plan ORSEC, highlights how in emergencies, the entity responsible for Civil Protection at the local area would be reesponsible for saving people and providing care, etc. and would have at its disposal the Civil Protection logistics and personnel, the armed and security forces, and technical services of the State and of national and international private sector actors (Article 9). ⁴⁶⁶

No additional information regarding workforce surges could be found on the website of the Ministry of Health or of the National Institue for Public Health. ⁴⁶⁷⁴⁶⁸

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no evidence of a public plan in place to receive health personnel from other countries. The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali does not refer to receiving health personnel from other countries as apart of the emergency response measures. ⁴⁶⁹ The March 2020 COVID-19 Disease (COVID-19) Prevention and Response Action Plan does not mention a public plan to receive health personnel from other countries. It indicates if Mali has a severe outbreak that it would advocate to receive health personnel regionally or international but does not include information on how it would receive or manage additional health personnel from other countries. ⁴⁷⁰ The WHO Joint External Evaluation (JEE) for Mali conducted in June 2017 does not mention any plans regarding receiving health personnel from other countries. According to the JEE, the development of staff mobilization procedures at all levels in the event of a health emergency in Mali is an ongoing challenge. ⁴⁷¹

The 2021 Mali National Contingency Plan: “Food Security and Nutrition Component” outlines the need to reorganize health services to ensure cases are handled and, therefore, there is a need mobilize health personnel resurces during epidemic or epizootic emergencies; it does not specify the use of foreign personnel. (p.77) In terms of human resources, it covers the need for personnel mobilization depending on the size of the emergency, from different levels, including from various UN and donor partners and regional settings (p.80), however, this appears to be more for technical coordination support, rather than health personnel. ⁴⁷²

No additional information could be found on the websites of the Ministry of Health or the National Institue for Public Health. ⁴⁷³⁴⁷⁴

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no evidence of a public plan to redeploy existing health personnel within Mali.

The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali does not refer to the redeployment of existing health personnel. It refers to the deployment of rapid response teams, however, they act as investigators and initial respondents to the emergency, without evidence that this is a long-term redeployment solution. ⁴⁷⁵ The March 2020 COVID-19 Disease (COVID-19) Prevention and Response Action Plan does not mention a public plan to redeploy health personnel, however, it states that it would advocate for the mobilisation of local and national human resources. ⁴⁷⁶ The WHO Joint External Evaluation (JEE) for Mali conducted in June 2017 notes the overall shortage of health personnel, as well as the lack of a personnel deployment plan or procedures for dispatching, distributing, and managing medical resources during public health emergencies. ⁴⁷⁷

The 2010 National Multi-Risk Plan for Disaster Preparedness and Response speaks of "recycling personnel" during cholera outbreaks (p.14) although no surge is mentioned for epizootic emergencies, and it refers to the mobilisation of locally trained personnel at the outset, with other mobilizations depending on the size of the emergency at regional, national and international levels based on government personnel, Mali Red Cross personnel and personnel whose CVs are held for these reasons within the various ministries (p.36). For malnutrition emergencies, it highlights the need for a sketch of health personnel redeployment (p.43). ⁴⁷⁸ The 2021 Mali National Contingency Plan: “Food Security and Nutrition Component” outlines the need to reorganize health services to ensure cases are handled and, therefore, there is a need mobilise health personnel resurces during epidemic or epizootic emergencies. (p.77) In terms of human resources, it covers the need for personnel mobilisation depending on the size of the emergency, from different levels, including from government, various UN and donor partners (p.80), however, this appears to be more for technical coordination support, rather than people on the ground. ⁴⁷⁹ Neither of these documents constitute a plan for health personnel redeployment.

No additional information regarding redeployment of existing health personnel could be found on the website of the Ministry of Health or of the National Institue for Public Health. ⁴⁸⁰⁴⁸¹

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 75

Mali's constitution recognises citizens' right to medical care.
The 2023 Constitution of Mali, under Article 10, states that health is a recognized right, however, it does not commit to provision of (free) medical care in any form. ⁴⁸²

4.4.1b Access to skilled birth attendants (% of population)

Score: 50

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 95.41

4.4.1d Coverage of essential health services through universal health coverage

Score: 29.17

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 80.23

4.4.1f Rate of mortality amenable to health care

Score: 68.95

4.4.2a Guaranteed paid sick leave

Score: 66.67

Workers are guaranteed paid sick leave in Mali.
According to the World Policy Center workers in Mali are entitled to up to 3 months of paid sick leave. ⁴⁸³
No evidence could be found that mental health problems are explicitly covered under paid sick leave, including within Law No. 92-020, the country's Labor Code. ⁴⁸⁴⁴⁸⁵

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no evidence of a policy committing to provide prioritized health care services to healthcare workers who become sick as a result of responding to a public health emergency. The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in December 2021, does not include a commitment to provide prioritized health care services to healthcare workers who become sick as a result of responding to a public health emergency. ⁴⁸⁶ The March 2020 COVID-19 Disease (COVID-19) Prevention and Response Action Plan does not mention providing prioritized health care services to healthcare workers who become sick. ⁴⁸⁷ The WHO Joint External Evaluation (JEE) for Mali conducted in June 2017 does not mention a policy to prioritize health care workers who become sixk during a public health emergency. ⁴⁸⁸
No evidence of public statements or policies to this effect could be found on the website of the Ministry of Health or the National Institute for Public Health. ⁴⁸⁹⁴⁹⁰

4.5.1a Existence of system for communication during a public health emergency

Score: 100

There is evidence of a system in place for public health officials and healthcare workers to communicate during a public health emergency.
The Technical Guide for Integrated Monitoring of Diseases and Response in Mali, published by the Ministry of Health in December 2021, is based on a monitoring and response system focused on the sharing of information at all levels, going from communities to the national level and vice-versa, it also calls for information to be shared vertically and horizontally to ensure that all levels are quickly informed about potential epidemics and the response interventions (p.14). The system seeks to expand and improve Mali's capacity to share information by building stronger networks at different levels, including with partners and organisations. The Department of Public Health Emergency Operations is responsible for facilitating the sharing of information horizontally and vertically towards the services, sectors and partners concerned to support an improved response (p.235). As part of the monitoring and response approach, Mali is developing an electronic system which would further facilitate communication between public health officials and healthcare workers; it provides a flow chart linking the communities to the national level (p.430) and is intended to facilitate all aspects of the monitoring and response information sharing, including real-time notification, alerts, management of the response etc. ⁴⁹¹

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 100

There is evidence of a system in place for public health officials and healthcare workers to communicate during a public health emergency including healthcare workers in both the public and private sector.

The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali is aimed at both private and public sector operational-level health workers in primary health care settings (p.27). ⁴⁹² There is, therefore, an expectation that private sector health actors (including laboratories) contribute to the prevention and response activities. Private actors provide primary healthcare support and are, therefore, important actors in the surveillance and response approach, as are private laboratories. Private actors are part of the information structure of the Guide, which is based on a monitoring and response system focused on the sharing of information at all levels, going from communities to the national level and vice-versa, it also calls for information to be shared vertically and horizontally to ensure that all levels are quickly informed about potential epidemics and the response interventions (p.14). The sub-commissions on risk communications and mobilisation includes private sector healthworkers (p.250), while private healthcare workers are specified as intended targets of the risk communication during an emergency (p.317). The system seeks to expand and improve Mali's capacity to share information by building stronger networks at different levels, including with partners and organisations. The Department of Public Health Emergency Operations is responsible for facilitating the sharing of information horizontally and vertically towards the services, sectors and partners concerned to support an improved response (p.235). As part of the monitoring and response approach, Mali is developing an electronic system which would further facilitate communication between public health officials and healthcare workers; it provides a flow chart linking the communities to the national level (p.430) and is intended to facilitate all aspects of the monitoring and response information sharing, including real-time notification, alerts, management of the response etc. ⁴⁹³

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no evidence that Mali's national public health system is monitoring for and tracking the number of healthcare associated infections (HCAI) that take place in healthcare facilities. According to the World Health Organization (WHO), infection prevention and control "monitoring in health care facilities is needed to identify and address critical gaps that contribute to the high incidence of health care-associated infections" (p.vii). ⁴⁹⁴ In the analysis of data carried out when developing the 2022 National Strategic Plan for Infection Prevention and Control in Mali, surveillance of HCAIs was found to be where Mali was weakest. ⁴⁹⁵ No evidence could be found of monitoring and tracking of HCAIs in the Ministry of Health's 2023 Directory, which gathers information from across the country on a variety of topics and causes of deaths. ⁴⁹⁶

4.6.1b Infection prevention and control programme

Score: 100

There is evidence of an infection prevention and control programme in Mali.
Mali has a National Strategic Plan for Infection Prevention and Control in Mali (Plan Stratégique National de Prévention et de Contrôle des Infections (PCI) au Mali). It was validated in 2022 and covers the period 2023-2027. ⁴⁹⁷

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

There is evidence of a plan to ensure a safe environment in health facilities nationally.

The National Strategic Plan for the Promotion of High-Impact Hygiene Practices in Mali 2020-2024 focuses on health facilities (among other spaces), however, it covered the period ending 2024. It aimed to improve access to adequate hygiene facilities, equipment, and products in 100% of health facilities, and other public places in Mali by 2024. ⁴⁹⁸ The National Strategic Plan for Infection Prevention and Control in Mali provides targets to ensure a safe environment in Mali's health centres to support infection prevention and control in the country's health facilities. It covers the period 2023-2027. ⁴⁹⁹

The WHO/UNICEF WASH Country Progress Tracker shows that Mali is making positive progress on WASH in healthcare facilities, however, it is falling short on WASH indicators in national monitoring and in workforce development, as of July 2025. Both aspects show that Mali has either identified a need or that plans are in place to start. ⁵⁰⁰

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is a national requirement for ethical review before beginning a clinical trial. Law No. 09-059 of 28 December 2009 requires all clinical trials to obtain approval from a scientific committee and an ethics committee before commencing. The ethic committee's approval must be obtained first because it needs to be included in the application submitted to the Ministry of Health for review. The law does not state any requirements about the composition of the scientific and ethics committees, but it does state that a research committee can be any centre that is approved by the Minister of Health for one or more types of biomedical research and that there are both Institutional and National Ethics Committees. ⁵⁰¹

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

There is limited evidence to confirm whether there is an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics.

Article 11 of Law No. 09-059 of 28 December 2009 does not provide details regarding expediting clinical trials. However, it states that in cases of emergencies, the consent required for the research for approval by the Ethics Committee can be assumed, sought at a later date, or from family members of the person under trial. This suggests some possibility of expediting processes. ⁵⁰²

The Directorate of Pharmacy and Medicine (DPM) has a manual for registering medication for human use, which has as an indicator: Legal provisions or regulations allow the NRA (National Regulatory Authority) to recognize or rely on marketing authorization decisions, reports, or information from other NRAs or other regional or international institutions (p.36). In addition, the form for a request of a clinical trial on the DPM's website asks whether the medication has already received approval from a third NRA and requires the applicant to submit documents related to clinical trials in the country of origin. ⁵⁰³⁵⁰⁴ However, no details on whether these legal provisions or regulations are in place could be found on the website of the DPM or of the Ministry of Health. ⁵⁰⁵⁵⁰⁶

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 0

There is no evidence that Mali has a dedicated government agency responsible for approving new medical countermeasures (MCM) for humans.
Ultimately, it is the Ministry of Health which is responsible for providing approvals for MCMs following a marketing authorization request overseen by the Directorate of Pharmacy and Medicine (DPM). The DPM manages the marketing authorization process and presents the findings to a National Commission of Marketing Authorization (Commission Nationale d'Autorisation de Mise sur le Marche, CNAMM). The latter reviews the dossiers and makes recommendations for approval to the Ministry of Health. ⁵⁰⁷

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is limited evidence to confirm whether there is an expedited process for approving medical countermeasures (MCM) for human use or mutual recognition of approval decisions taking place elsewhere during public health emergencies.
The Directorate of Pharmacy and Medicine (DPM) has a manual for registering medication for human use which priority review of the approval can be given to new products that represent a major public health interest (p.15), however, no additional details are provided. The manual also has the following indicator: Legal provisions or regulations allow the NRA (National Regulatory Authority) to recognize or rely on marketing authorization decisions, reports, or information from other NRAs or other regional or international institutions (p.36). In addition, the form for a request of a clinical trial on the DPM's website asks whether the medication has already received approval from a third NRA and requires the applicant to submit documents related to approvals in the country of origin. ⁵⁰⁸⁵⁰⁹ However, no details on whether these legal provisions or regulations are in place could be found on the website of the DPM or of the Ministry of Health. ⁵¹⁰⁵¹¹

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Mali has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁵¹²

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

Pandemics and epidemics are integrated into Mali's national risk reduction strategy.
Mali's disaster risk reduction strategy is comprised of several different documents, including Decree No. 2015-0889/P-RM of 31 December 2015 (Plan d'Organisation des Secours, or Plan ORSEC); Presidential Decree No. 0974/PRM of 27 December 2016 (regarding a national platform for disaster risk prevention and management); and National Multi-Risk Plan for Disaster Preparedness and Response. ^513514515516 The Plan ORSEC covers epidemics. ⁵¹⁷

The National Multi-Risk Plan for Disaster Preparedness and Response identifies and lists risk reduction measures for potential emergency situations, including multiple communicable diseases with pandemic potential, specifically cholera and bird flu. It also indicates that the plans for cholera and bird flu could be used for meningitis and yellow fever. ⁵¹⁸ The National Platform for Disaster Risk Reduction has been launched and is administered by the Directorate General of Civil Protection, which serves as the country's emergency management agency. ⁵¹⁹

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 50

Mali does have cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to public health emergencies. Mali is a member of the West African Health Organization (WAHO), a specialized institution of the Economic Community of West African States' (ECOWAS), whose mission is "the harmonization of the policies of the Member States, pooling of resources, and cooperation with one another and with others for a collective and strategic combat against the health problems of the sub-region." ⁵²⁰ One of WAHO's programs specifically focuses on epidemics and public health emergencies. Its program objective is to "build the capacities for surveillance, disease prevention, response and resilience to epidemics and emergencies", under which Regional Center for Disease Prevention and Control has been set up. ⁵²¹⁵²² Mali also contributes health data to WAHO's monitoring dashboard. ⁵²³ A representative of the Ministry of Health attended an emergency meeting on Mpox for ECOWAS Ministers of Health in August 2024. ⁵²⁴ Mali is also a party to the Ouagadougou Protocol for Controlling Epidemics in West Africa, Algeria and Chad, which was signed in 1996. ⁵²⁵ The WHO Joint External Evaluation for Mali conducted in June 2017 points out that Mali's cross-border agreements are essentially focused on animal health and predate 2008. It considers existing cross-border collaboration needs to be improved. ⁵²⁶

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 0

There is insufficient evidence that Mali has cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to animal health emergencies.

The Economic Community of West African States' (ECOWAS) Regional Animal Health Center (RAHC) is based in Bamako, Mali. One of its objectives is to "coordinate and harmonize policies and interventions for the control of transboundary animal diseases and zoonoses" ⁵²⁷. However, with Mali's withdrawal from ECOWAS in 2025, it is unclear if it is still a participant in the RAHC (Mali remains an active participant in the West African Health Organization (WAHO) despite its exit from ECOWAS, providing disease data and participating in WAHO activities). ^528529530

The German development agency, GIZ, is implementing a One Health program focused on pandemic prevention, which brings the RAHC and WAHO (and others) together to establish a transnational system to prevent and control pandemics. ⁵³¹ The WHO Joint External Evaluation for Mali conducted in June 2017 points out that Mali's cross-border agreements are essentially focused on animal health and predate 2008. ⁵³² It considers that existing cross-border collaboration needs to be improved.

There is no relevant information on the websites of the Ministry of Health and the Ministry of Livestock and Fisheries website was unavailable at the time of the research. ⁵³³⁵³⁴

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Mali ratified the Biological Weapons Convention on 25/11/2002. ⁵³⁵

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 100

Mali has submitted confidence building measures for the Biological Weapons Convention (BWC) in the past three years.
According to the BWC National Implementation Measures Database, confidence building measures have been submitted for 2022, 2023 and 2024, but they have not been made publicly available. ⁵³⁶

5.3.1c Submission of UNSCR 1540 reports

Score: 0

Mali has not provided the required United Nations Security COuncil Resolution (UNSCR) 1540 report to the Security Council Committee established pursuant to resolution 1540 (1540 Committee), according to the data available on the 1540 Committee's webpage. ⁵³⁷

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 25

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Mali is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction. ⁵³⁸
Mali is not a member of the Australia Group. ⁵³⁹
Mali is not a member of the Proliferation Security Initiative. ⁵⁴⁰

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

There is evidence that Mali has completed a Joint External Evaluation (JEE) in the last five years, however, it has not published a full public report. According to a regular bulletin published by the Ministry of Health, a second JEE was undertaken by Mali in 2023, and the bulletin presents the new scores; the WHO also has evidence of 2023 scores ⁵⁴¹⁵⁴². However, no evidence of a report could be found on the website of the WHO or the Ministry of Health. ⁵⁴³⁵⁴⁴
The last JEE to be completed and published on Mali was conducted in 2017. ⁵⁴⁵

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

Mali has not completed and published a Performance of Veterinary Services (PVS) assessment in the last five years, according to the data available on the World Organisation for Animal Health website. ⁵⁴⁶

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

Mali has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years, according to the data available on the World Organisation for Animal Health website. ⁵⁴⁷

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 0

There is insufficient evidence that Mali has allocated national funds to improve capacity to address epidemic threats within the past three years.
In response to the direct and indirect financial impact of the COVID-19 pandemic, in its financial laws for 2023 (p.1052), 2024 (p.1068) and 2025 (p.1166), Mali has stated that there would be provisions to deal with epidemic and natural disasters, as mitigation measures. ^548549550 No details regarding the amount and how these funds would be used could be found on the Ministry of Economy and Finance or Ministry of Health websites. ⁵⁵¹⁵⁵²

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

No evidence could be found that the Joint External Evaluation (JEE) report, National Action Plan for Health Security (NAPHS), and/or national GHSA roadmap allocate or describe specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the identified gaps.
The 2017 Joint External Evaluation of IHR Core Capacities of the Republic of Mali does not allocate or describe specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the identified gaps. ⁵⁵³ Mali's NAPHS is not available online. ⁵⁵⁴
No evidence could be found of a GHSA Roadmap for Mali on the website of the Ministry of Health. ⁵⁵⁵

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

The Performance of Veterinary Services (PVS) assessment does not allocate or describe specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the identified gaps. Mali's 2017 assessment states that the National Veterinary Services Directorate should develop new policies, develop a budget and advocate for funding from the government (p.147). It does not describe specific funding. ⁵⁵⁶

5.5.3a Emergency public financing during a public health emergency

Score: 100

Mali has access to a publicly identified special emergency public financing mechansim and funds in the face of a public health emergency. As a member of the African Union, the African Centers for Disease Control and Prevention's (Africa CDC) African Epidemic Fund which was launched in 2025, to support "countries across the continent in outbreak preparedness and response" with flexible funding. ⁵⁵⁷

Mali has received emergency funds from the World Bank in response to severe flooding in 2024, and the latter has developed a project plan for a Proposed Contingent Emergency Response Project. The latter will "further increase the amount of pre-arranged financing for crisis response by allowing reallocation of up to 10 percent of undisbursed balances of World Bank’s Investment Project Financing (IPF) and PforR portfolio in Mali at the end of each fiscal year" (p.6). ⁵⁵⁸⁵⁵⁹

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 0

No evidence could be found of public commitments by senior leaders in the past three years to support other countries to improve capacity to address pandemic or epidemci threats; or improve the country's domestic capacity to address pandemic or epidemic threats by expanding finanicng or requesting support to improve capacity.
No evidence could be found on the website of the Ministry of Health, social media sites of the Ministry of Health, the Presidency or the Prime Minister. The websites of the Presidency and the Prime Minister were not accessible at the time of research. ^{560561562563564565}

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that Mali has requested financing or technical support from donors to improve the country's domestic capacity to address epidemic threats; there is no evidence that Mali has provided other countries with financing or technical support to improve capacity to address epidemic threats.

Mali has sought funding from the World Bank, the Netherlands and the Global Fragility Fund for a programme entitled Advancing Resilience And Inclusive Health Systems For Everyone (arise – Keneya Yiriwali), running from 2024 to 2029. Sub-component 3.4 of Arise – Keneya Yiriwali focuses on "Optimizing Surveillance, Preparedness, and Response to Epidemics and climate-sensitive diseases." Its objective is to "To prevent, detect, and respond to potential health threats" and its activities include "Strengthening disease surveillance, enhancing diagnostic capabilities, conducting capacity-building activities, promoting public health education, supporting digital health technologies, and facilitating multi-sector coordination" (p.10). The programme also seeks to strengthen primary healthcare capacities to face epidemics (p.8) and support communication efforts to promote behavior change among communites and sensitise them to epidemic risks (p.9). ⁵⁶⁶

No information could be found on the website of the Ministry of Health regarding Mali providing other countries with financing or technical support to improve capacity to address epidemic threats. ⁵⁶⁷ The website of the Presidency was not accessible in September 2025. ⁵⁶⁸

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

There is evidence that Mali fulfilled its full contribution to the WHO in 2023, according to the WHO. ⁵⁶⁹

However it did not fulfil its contribution in full for 2024, having paid USD 1,636 with an outstanding balance of USD 27,074. As of 31 December, it had not paid its 2024 balance, nor its 2025 contribution which was due by 01/01/2025. It has a total outstanding balance of USD 55,784. ⁵⁷⁰⁵⁷¹

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

No evidence could be found that Mali has a publicly available plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens (biological materials) along with the associated epidemiological data with international organizations and/or other countries that goes beyond influenza. The 2021 Technical Guide for Integrated Monitoring of Diseases and Response in Mali outlines how the national level is responsible for preparing and sharing specimens with centers that collaborate with the World Health Organization, if necessary, as part of the surveillance and response process (p.38). ⁵⁷² This suggests that Mali is willing to share the required specimens with the WHO, although there is no detailed plan or policy regarding this, nor specification of what can be shared.
No evidence could be found of a plan or policy regarding sharing with international organizations or other countries on the websites of the Ministry of Health or the National Institue for Public Health. ⁵⁷³⁵⁷⁴

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no evidence that Mali has not shared samples in accordance with the PIP framework in the past two years.

For example, according to the World Health Organization (WHO), during week 36 of 2025 (1-7 September), Mali shared influenza virological data for analysis with the WHO. ⁵⁷⁵ The Influenza Surveillance report, which provides data until September 2020, shows that Mali has regularly shared Influenza specimens. ⁵⁷⁶

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

No evidence could be found that Mali has not shared pandemic pathogen samples during an outbreak in the past two years.

Publicly available sources, including those from the World Health Organization, do not indicate a lack of sharing from Mali. In 2024, for example, samples were collected to identify pathogens from suspected meningitis cases. ⁵⁷⁷
No additional information could be found on the websites of the Ministry of Health or the National Institue for Public Health, as well as in Malian and international media sources. ⁵⁷⁸⁵⁷⁹

6.1.1a Policy formation

Score: 25

6.1.1b Quality of bureaucracy

Score: 0

6.1.1c Excessive bureaucracy/red tape

Score: 25

6.1.1d Vested interests/cronyism

Score: 0

6.1.1e Corruption

Score: 27

6.1.1f Accountability of public officials

Score: 0

6.1.1g Human rights risk

Score: 0

6.1.2a Orderly transfers of power

Score: 0

6.1.3a Risk of social unrest

Score: 0

6.1.4a Risk of terrorism

Score: 0

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 25

6.1.5a Presence or risk of armed conflict

Score: 0

6.1.6a Government territorial control

Score: 0

6.1.7a International tensions

Score: 0

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 37.35

6.2.2a UNDP Gender Inequality Index score

Score: 14.81

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 35.99

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 33.33

6.2.4a Public confidence in government

Score: 0

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6a Gini coefficient

Score: 64.3

6.3.1a Adequacy of road network

Score: 25

6.3.2a Adequacy of airports

Score: 0

6.3.3a Adequacy of power network

Score: 25

6.4.1a Urban population (% of total population)

Score: 58.27

6.4.2a Change in forest area (percentage points)

Score: 76.33

6.4.3a Natural disaster risk

Score: 0

6.5.1a Total life expectancy (years)

Score: 27.11

6.5.1b NCD mortality rate

Score: 62.99

6.5.1c Population aged 65+

Score: 96.22

6.5.1d Tobacco use (% of adults)

Score: 70.36

6.5.1e Level of adult obesity (%)

Score: 89.34

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 100

6.5.2a Access to potable water

Score: 85.98

6.5.2b Access to at least basic sanitation facilities

Score: 47.93

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 95.83

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 2.79

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50