Increasing Access to Quality Care for Children in Benin

Stanislas Nebie. {Photo credit: MSH.}Photo credit: MSH.

Benin has historically had one of the highest death rates for children under the age of five, but the Bamako Initiative of 1987, in which African ministers vowed to increase the availability of healthcare services, ushered in an era of community-based health care reform that has shown considerable success. MSH’s Basic Support for Institutionalizing Child Survival (BASICS) project, funded by USAID, works with the government in Benin to implement a community-based, integrated management system for child illness.

MSH spoke with Stanislas Nebie, Chief of Party for the BASICS Benin, about the child health challenges in the country and how MSH is meeting those challenges.

What was the child health situation in Benin before BASICS? And what is the situation today?
Before BASICS began working in Benin, existing health services were underutilized. For example, only 37 percent of fever cases and 21 percent of diarrhea cases were treated in health centers in 2006. The greatest factor causing this underutilization was the geographic inaccessibility of health centers. Ninety percent of the population in the district of Tchaourou, for example, live more than 10 kilometers from a health center. In addition, many people in the country were ignorant of the warning signs of child illness, so cases were not treated as soon as they should have been. The primary challenge of BASICS Benin has been to increase the accessibility of quality basic care for children in order to reduce infant mortality.

Today, community health workers deployed by the BASICS project are available in many remote areas—covering more than 200,000 children under the age of five in five health zones—to provide case management at the community level for child illness. The project has succeeded in training and supporting 1,048 community health workers to provide community-based care to children under five, involving five local nongovernmental organizations in supporting the community health workers, and modifying governmental policies to allow community health workers to treat more cases. Between September 2010 and March 2011 alone, community health workers treated 27,060 cases of child illness in the project area, referred 1,043 cases to health centers, and made 14,822 home visits to increase awareness of child illness, immunization, and nutrition.

How has MSH empowered the people of Benin through BASICS?

The BASICS project has empowered the people of Benin by engaging them in providing health council to their communities and improving the health of their children. More than 1,000 community health workers, nearly 200 doctors and nurses and nongovernmental organization program officers, and all the community members they work with have contributed to this effort. Community members have been empowered by the education they have received from community health workers.

How has BASICS strengthened the entire health system in Benin?
BASICS Benin has worked with the government to develop guidelines for community case management, establish a statistical data system, engage Ministry of Health field staff, build the capacity of the health workforce, and improve systems for referrals, diagnostics, and supervising staff.

How will BASICS work last after the project has ended?
We believe the work will go on long after we are gone because BASICS has strengthened the entire health system and engaged local entities at all levels of the project. We have involved local mayors in providing incentives to the community health workers and local nongovernmental organizations in supporting the community health workers. These organizations are supported in turn by diverse donors, including UNICEF, UNFPA, the Global Fund, and others.

What work is needed in the future to continue improving health in Benin
Through additional USAID efforts, we hope to work with the government of Benin to formally include community health workers in the national health system, institutionalizing and supporting their role, and supporting the communication strategy at the same time. We also hope to improve the flow of medicines that community health workers need to provide quality care to the population and improve the quality of care at the referral level.