Despite the unprecedented speed of COVID-19 vaccine development, vaccination coverage in Mali was low. Research has primarily focused on individual vaccine hesitancy, overlooking systemic issues related to the implementation of vaccination in health facilities. This article analyses the implementation of Mali’s national vaccination strategy in 2021 and 2022 to understand the challenges associated with COVID-19 vaccination coverage and the lessons learned. The study employed a qualitative design. Data collection involved field observations (n = 15 days) and semi-structured interviews (n = 57) conducted at two Primary Health Centres ( Centres de Sante Communautaire, or CSComs) in Bamako, Mali. The analysis utilised a conceptual quality implementation framework to identify factors that influenced the successes or limitations of the campaign. Vaccination campaigns intensified gradually between 2021 and 2023. The implementation used a top-down approach controlled mainly by the staff of the Health District. The limited involvement of CSComs in key vaccination activities (planning, capacity building, supervision) prompted them to develop adaptation strategies to meet their assigned objectives. The analyses showed that the implementation of the national vaccination strategy did not have the same intensity depending on the quality phases of implementation. The CSComs conducted very few evaluation activities. We cannot fully understand vaccine coverage without a comprehensive analysis of implementation mechanisms. This study emphasises the importance of developing local capacity, tailoring strategies to align with community realities, and improving documentation of field practices for future public health interventions.

As the Universal Health Insurance Plan (RAMU) is being implemented in Mali, community-based health insurance (CBHI) — one of the pillars— must innovate to meet the challenge of universal health coverage. An experimental CBHI was tested in central Mali between 2017 and 2021. This innovative CBHI professionalizes and organizes risk sharing on a larger scale, moving from municipalities to circles (department). A mixed-method study was carried out to assess the acceptability of this innovation among elected representatives of CBHI offices. In April 2021, 118 questionnaires were administered, followed by 43 qualitative interviews from the same sample in October 2021. Sekhon el al. (2017) seven dimensions of acceptability was used as the conceptual model. More than half of individuals (58%) reported above-average acceptability. Elected officials feel well supported in their activities by the Technical Union of Malian Mutuality (UTM), the umbrella organization of CBHI. They show some confidence in their ability to perform their duties effectively despite varying levels of commitment that often fall short of expectations and needs, which they justify by their volunteer status. Elected officials note that the system is very effective despite the nonoptimal conditions linked to the prevailing insecurity. Professionalization appears to be an unavoidable condition for the performance of the innovation, as well as the new community assembly. However, elected officials are concerned about the sustainability. The UTM will play an important role in continuing its support and fulfilling its functions as a delegated management organization within the framework of the RAMU.