In 2009, a community health worker in the bustling capital of Bamako, Mali, found a young boy at home who had become dangerously ill within a matter of hours. Recognizing he needed urgent medical care, she arranged for him to be taken to a health facility. The journey was five kilometers, but distance was only part of the challenge. The boy’s father carried him on foot, then into an ambulance, then back on foot to cross a river, then into another ambulance. “At that time, it was very difficult for the ambulance to move within the community, because there were no clear roads,” says Djoumé Diakité, MD, co-founder and Mali Country Director of Muso, a nonprofit that had launched its Rapid Care approach the year before to address poor health outcomes in the region. At the clinic, a handful of doctors and nurses were responsible for everything from prenatal care to emergency medicine. The boy had severe malaria-related anemia and needed a blood transfusion. “It was very difficult to have access to blood at the facility,” Diakité says. “I gave my own blood [to replenish the supply].” The boy spent 10 days in the clinic — a sacrifice his family could scarcely afford. Ten days at his bedside meant 10 days without work or wages for his father. Saving the boy’s life also meant feeding the parent caring for him. “That story touched my heart deeply — I imagine myself in that [situation], choosing between feeding [my] family and bringing one of them to the [health clinic],” Diakité says. He and the community health worker (CHW) who found the boy know exactly what would have happened had she not reached him when she did. For decades, the global fight against child mortality focused on building hospitals, funding medical breakthroughs, and expanding formal health systems. Yet in places like Mali, one of the most powerful tools for saving children’s lives was hiding in plain sight: CHWs — mostly women — already living among the families they served, trusted by their neighbors but largely overlooked, underfunded, and excluded from the center of health policy. Muso set out to change that. The system’s blind spot When Muso launched Rapid Care in 2008, about one in seven children in Mali died before their fifth birthday. The medicines to save many of them already existed; the problem was access. In Bamako’s poorest neighborhoods, five kilometers could feel like fifty. And even families who reached a clinic often faced another barrier: Since 1984, national law had required patients to contribute to the cost of their own care, giving community health associations the authority to charge fees at every step. These impossible trade‑offs were playing out in communities across sub-Saharan Africa. Diakité and one of his Muso cofounders Ari Johnson, a physician and global health researcher, saw that healthcare was arriving too late. How could they remove the financial and logistical barriers to preventive and diagnostic services, and reach families before illness became an emergency? For years, CHWs in countries like Mali and Côte d’Ivoire operated in a policy gap: essential in practice, but unsupported and unrecognized on paper. They delivered care without salaries, legal recognition, or the protections that come with formal workforce status. Globally, women make up about 67 percent of the health and social care workforce, yet they remain disproportionately concentrated in lower-paid and unpaid roles. Women in Global Health estimates that at least 6 million women worldwide work as unpaid or underpaid CHWs. (In Bambara, a lingua franca of Mali, Muso means “woman.”) CHWs were already right there in Mali’s underserved communities, already familiar to neighbors. Diakité and Johnson advocated for governments to invest in them. Local authorities pushed back. “They were not confident [that] people who never went to the school of medicine could provide quality care at the household level,” Diakité recalls. “The chief medical officer said to us, ‘If you make a mistake, I will send you to jail.’” Slow access to care created a vicious cycle. Conditions that could have been treated early became emergencies, overwhelming clinics with preventable cases and stretching scarce resources ever thinner. “Once you lose that first contact and the trust is broken, the whole system [pays] the price,” explains Christian Rusangwa, Muso’s Director of Technical Assistance. Muso’s leaders understood that empowering CHWs was worth the risk — that reducing child mortality in Mali, and now through Muso-supported programs in Côte d’Ivoire and Zambia, could begin with something as simple as a knock on the door. The woman everyone calls In Côte d’Ivoire’s rural Madinani district, that knock on the door often comes from Brigitte Kouadio, a professional CHW who is trained, paid, and supervised through a partnership between Muso and the Ministry of Health through proactive community case management, or ProCCM. On paper, she covers about 107 households; in reality, she is woven into daily life. Kouadio visits homes, listens for symptoms, and decides who she can treat herself and who needs to go to a facility. One recent afternoon, a young boy named Okore stopped playing and went to bed with a fever. His mother, Diahou Apo Natacha, called Kouadio, who immediately came to the house to examine Okore and perform a rapid malaria test. When the test came back negative and the boy’s condition looked serious, she gave basic care, then arranged transport to the hospital. “By the grace of God, Muso covered all the costs — we did not pay anything,” Natacha recalls. After three days and a blood transfusion, they returned home. Kouadio visited again to go over the medication and show the family how to give it correctly. Natacha says the CHWs in her village “take very good care of us;” Kouadio says that since that episode, the family has fully embraced her, and they have “become like a second family.” At first, families didn’t believe that care could really be free, assuming there must be a catch. Only after they saw, again and again, that they truly did not have to pay — whether at home or at the hospital — did they start calling as soon as something was wrong. For families used to losing days in the search of healthcare, Diakite says, it was “like they discovered gold in front of their door.” Rebuilding the system around community health workers Behind Natacha’s phone call, there’s now an entire architecture. Since 2008, Muso and the Malian government have worked to co‑develop a model that treats CHWs as the organizing principle; in late 2019, Côte d’Ivoire’s Ministry of Health partnered with Muso to adopt that model into its national health system. Health workers are recruited from within their communities; Muso and government partners train them, equip them with protocols and tools, and pay them a salary. Supervisors visit regularly to review cases, and clinics are staffed and stocked to receive referrals. Care is free at home and in facilities. By rebuilding trust and bringing care closer to home, the model not only reduces preventable illness and death — it helps stabilize the health system itself, allowing every level of care to function more effectively. A common thread supporting the initiative’s success: Trust the people closest to the challenges to develop the most effective solutions. This principle extends all the way to the apps and platforms CHWs use to manage cases. “The state-of-the-art digital tools are designed not in Silicon Valley, [but] in Yirimadio, in the Mopti region, in Madinani or Adzopé,” Johnson says. “They’re designed with the CHWs who understand the problems and the best ways to solve them. That’s the key.” From village fix to national backbone Muso is now working with Côte d’Ivoire’s Ministry of Health on a legal framework that would give CHWs formal status, stipends, training, and social protection. The government counts about 12,000 CHWs nationwide; over the course of just 15 months, Muso helped extend free care, supportive supervision, and digital tools to 8,000 of them. Through a program known as CMU+, the Ivorian government rolled out free care across 2,823 rural health facilities from May to December 2025, opening access to 13 million eligible people. Zambia is next. In 2024, the country’s Ministry of Health signed a memorandum of understanding with Muso to adapt the model in a politically stable nation where healthcare is already free nationwide. For Rusangwa, success there would demonstrate that centering CHWs can improve outcomes not only in places grappling with conflict and fragile health systems, but also in stable, peaceful countries — a crucial step toward Muso’s ultimate goal: “to end the child and maternal mortality crises and deliver universal health coverage at scale.” In Diapé, that ambition looks like a mother reaching for her phone when her child grows hot with fever, and a CHW in a khaki Muso vest walking toward a house where she is welcomed like family. For families on the margins of care, the future does not arrive with a ribbon‑cutting; it knocks on the door. This article was produced in partnership with the Skoll Foundation. The Foundation supports social entrepreneurs tackling society’s most urgent challenges, and its partners are creating lasting, systemic change for those who need it most. Visit Skoll.org to explore more stories of impact. This article For women and children in West Africa, medical treatment often came too late. Then one model changed where care begins. is featured on Big Think.