Most health care is provided by the public medical services. At Bamako are the Institute of Tropical Ophthalmology and the Marchoux Institute for Leprosy, which, in addition to treating patients, carry out research. The number of private doctors and well-equipped medical institutions is small. In 1985–95, only 30% of the population had access to health care services. As of 1999, total health care expenditure was estimated at 4.3% of GDP. The pharmaceutical policies adopted in recent years have resulted in the destruction of the public network of drug distribution. Despite the high level of health care investment, lack of organization and misappropriation of money has impaired the effectiveness of the health care system.
The principal diseases are malaria, leprosy, tuberculosis, enteritis and other intestinal diseases, cholera, pneumonia, and infectious and parasite-related diseases such as schistosomiasis, onchocerciasis, and trypanosomiasis. Anemia, malnutrition, and tetanus are also widespread. In 1995, there were 2,048 new cases of cholera reported. At the end of 2001, the number of people living with HIV/AIDS was estimated at 110,000 (including 1.7% of the adult population) and deaths from AIDS that year were estimated at 11,000. HIV prevalence in 1999 was 2.03 per 100 adults.
Malaria is widespread, as is guinea worm. In 2000, 65% of the population had access to safe drinking water and 69% had adequate sanitation. In 1997, immunization rates for children up to one year old were: tuberculosis, 76%; diphtheria, pertussis, and tetanus, 52%; polio, 52%; and measles, 56%. Only 3% of children under one year old received a yellow fever vaccine in 1994. Diarrheal diseases claimed the lives of 22,400 children under the age of five in 1995.
As of 2002, the crude birth rate and overall mortality rate were estimated at, respectively, 48.37 and 18.32 per 1,000 people. About 7% of married women (ages 15 to 49) used contraception as of 2000. The fertility rate was 6.3 in 2000. In 2000, the infant mortality rate was 120 per 1,000 live births; the maternal mortality rate in 1998 was high at 580 per 100,000 live births. The average life expectancy was 42 years in 2000. An estimated4.3 million women, or 80% of women, underwent female genital mutilation in 1996.