Most Malians depend on primary healthcare centres, each of which serves a catchment area with over 15,000 people spread out over several villages. The centres offer basic healthcare, vaccinations and health education, but most are understaffed and poorly equipped. A referral system to district and regional hospitals exists, but for many users access is difficult, and the quality of care varies. In the cities private healthcare is available, but expensive. Many rely on traditional healers, or treat themselves using medicines bought from local markets.

The sector reforms in the 1990s led to the deconcentration of the Ministry of Health with the creation of:

• regional health departments (directions régionales de la santé), responsible for implementing national health policies;
• district health services (équipes socio-sanitaires and centres de santé de référence), responsible for planning and supervising community health centres and providing referral services; and
• community health centres (centres de santé communautaires), responsible for health service delivery in their catchment areas.

Community health associations (associations de santé communautaire, ASACOs) are responsible for managing the health centres, including staff recruitment, resource mobilisation, supplying drugs, planning and monitoring.

Following local elections in 1999 three tiers of local government were established – 703 communes, 49 districts and 8 regions – to be administered through elected councils.