Putting community health at the heart of local development
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Written by Méré Chabi Boum, Community Health Systems Specialist for the USAID Integrated Health Services Activity, led by Management Sciences for Health
Community health workers (CHWs) play an important role in improving the health of the population. In the nine communes of Atacora in Benin, CHWs are tasked with many responsibilities, including treating mild cases of malaria, diarrhea, and respiratory infections; disseminating promotional leaflets on health-related themes within the community; conducting home visits; and performing screenings and providing referrals for malnourished children under five years old.
Unfortunately, CHWs often rely on private companies, nongovernmental organizations, and development agencies for their funding, and their services could become unsustainable if this funding were to stop.
In 2019, the Government of Benin, through the Ministry of Health, created the Fonds d’Appui au Développement des Communes (FADeC), which is a mechanism used to transfer resources from the central to the local level, enabling communes to take responsibility for the health of their communities. The aim of the FADeC is to make community health activities sustainable, ensure better supervision of CHWs at the local level, and empower communes to take responsibility for managing their own community health funds and budget.
In addition, the US Agency for International Development (USAID) Integrated Health Services Activity supported the Government of Benin in helping communes implement this mechanism, both in supervising CHWs and in managing the funds to pay them. To ensure a strong and common understanding of the mechanism, the activity actively disseminated and explained the guidelines on how to manage the funds to the communes and developed, with the communes, a supervisory guide for CHWs. The mayor of each commune nominated a Health Focal Point responsible for supervising CHWs.
Strengthening supervisory capacity in the communes
To strengthen the supervisory capacity of Health Focal Points, the activity conducted informational sessions on key community health indicators, as defined by the Ministry of Health, to reduce under five child morbidity and mortality, including provision of care for children with fever, malaria, diarrhea, or cough and for those whose vaccination status is not up to date. CHWs also received training on the tool used to collect community health data.
This work and support led to real progress for all community health indicators. For example, in the department of Atacora, the number of children between 6 and 59 months seen by CHWs with a fever who had a positive rapid diagnostic test for malaria and were treated with artemisinin-based combination therapy increased from 6,465 between July and September 2019 to 31,899 for the same period in 2020. These three months have the highest rate of malaria transmission. These results show an improvement of services usage and an improvement in the quality of malaria care.
Thanks to this technical support, commune Health Focal Points are now able to effectively monitor and assess the performances of CHWs (in coordination with the Infirmiers Chef de Poste of the health areas and the people responsible for research and social mobilization in health zones). In addition, Health Focal Points are now responsible for presenting the community health situation to local officials during the monthly communal councils—another important step in ensuring sustainability of these efforts.
Ensuring payment to CHWs through the FADeC
In addition to the support provided for the supervision of CHWs, the activity supported the communes of Atacora to use funds to pay CHWs. To do so, the activity disseminated Benin’s national guidelines on fund management and helped communes develop a mission statement (a contract with specific objectives to justify the payment of CHWs), which is signed by each CHW.
Each month, CHWs submit a report to the health center of their health area that includes data on their activities. These reports help the Chef de Poste, with technical support from the activity, present program results and assess the work of each CHW before submitting the report to the commune’s Health Focal Point. The Health Focal Point then reviews and verifies compliance of the supporting documents and approves payment for each person. Thanks to the work of every stakeholder, the 290 CHWs of the communes that already received FADeC funds were paid for all four quarters of 2020.
Sharing his satisfaction regarding the work achieved, the mayor of Matéri indicated that, “Before the intervention of the activity, Matéri didn’t have any connections with community health-related activities...The commune wasn’t aware of community health data. Since 2019, Matéri received the support from the USAID Integrated Health Services Activity for capacity building of community health staff. This capacity building helped the commune to monitor activities and it is now deeply involved in these interventions and considers them a priority.”