Longitudinal Analysis of Medical System Challenges and Opportunities in Post-Conflict Mali: An African Gynaecological and Obstetric Perspective

Post-conflict African states face profound challenges in rebuilding health systems, with maternal and reproductive health services often severely disrupted. Mali's protracted conflict has significantly degraded medical infrastructure, workforce, and service delivery, creating a need for longitudinal analysis to inform recovery. This longitudinal study aimed to systematically identify and analyse persistent challenges and emergent opportunities for the medical system in post-conflict Mali, with a specific focus on gynaecological and obstetric care. A mixed-methods longitudinal design was employed, using iterative data collection cycles. This included analysis of national health management information system data, structured surveys with healthcare providers, and in-depth interviews with stakeholders at all health system levels. A key persistent challenge was the chronic shortage of specialist providers, with a large majority of districts lacking a practising obstetrician-gynaecologist. A major emergent opportunity was the increased agency and leadership roles taken by mid-level providers and community health workers in sustaining essential services. The post-conflict medical landscape in Mali is characterised by entrenched systemic weaknesses and adaptive, community-driven resilience. Sustainable improvement in gynaecological and obstetric outcomes requires strategies that address chronic human resource gaps while formally integrating emergent local solutions. Prioritise task-shifting policies with enhanced training and supervision for mid-level cadres. Develop targeted incentive schemes to retain specialist staff in rural and post-conflict regions. Integrate successful community-led models into national health policy and funding streams. post-conflict health systems, maternal health, obstetric care, medical workforce, health system resilience, Mali, longitudinal study This study provides a long-term perspective on health system adaptation in a post-conflict setting, offering evidence to guide the reconstruction of gynaecological and obstetric services in Mali and similar contexts.