Collaborative Approach to Community-

based Malaria Prevention in Benin

Judy Chang | Plan International USA

CORE Group Fall Meeting

September 15, 2010

© Plan

Plan International

• A child-centered, community development organization with over 70 years of experience

• Benefits approximately 15 million people in 48 developing countries in Asia, Africa and the Americas

• Began operating in Benin in 1994

• Works in 754 villages in Benin, covering the domains of health, water and sanitation, education, household food security, and child rights

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Background – Malaria in Benin

• A principle cause of morbidity and mortality among infants and pregnant women

• Utilization of ITNs is low (34%)

• Very few mothers (~14%) seek care and treatment from health facilities for their children

• Limited human resources for health – average of one health agent per village

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Plan’s Improvement Collaborative

• Dates: April 2007-June 2009

• Coverage: 50 villages in the communes of Aplahoué and Djakotomey in the Couffo department of Benin

• Improvement topics: Malaria—LLINs, malaria case management, malaria treatment in children and pregnant women, IPTp

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Goal and objectives

• Goal: To contribute to the reduction of child and maternal mortality rates by improving behaviors related to the prevention and treatment of malaria by the community itself

• Objectives: • Increase from 34% to 60% the use of LLIN• Promote appropriate management of malaria in households

and communities• Increase by 40% timely care seeking for complicated

malaria among children under five and pregnant women• Strengthen collaboration between health structures and

communities through home visits and support to community groups.

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Implementation package

• Establishment and training of Quality Improvement Teams (QITs)

• Information, education, and communication on malaria prevention and treatment (LLIN utilization, identification of signs of serious malaria)

• Home visits and night visits to reinforce good behaviors

• Home-based treatment of malaria with ACTs• Establishment of a referral and counter-referral

system between CHWs and health facility staff

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Measurement

• Key indicators monitored by QITs:• % of children under 5 who slept under a mosquito net the previous

night• % of children under 5 who had a fever within the last 2 weeks and

who were treated according to the guidelines• Number of children under 5 who were referred to a health center

through the community referral system• % of pregnant women who slept under a mosquito net the previous

night• % of children with serious malaria who were brought to a health

center within 24 hours

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Coaching, learning, and communication among teams

Activity Purpose Frequency

QIT meetings • Report monitoring data and project progress

Bimonthly

Inter-village learning sessions for QITs

• Share innovative methods developed

• Assess each QIT’s effectiveness relative to one another

Quarterly

Coaching by animators from partner NGOs

• Improve QITs’ teamwork, problem solving, and monitoring of progress

Monthly

Advisory Committee supervision and meetings

• Monitor project activities• Make recommendations to

project implementation team

Quarterly

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Results – LLIN utilization

Target: 60%

34%

80%90%

70%

34%

0%

20%

40%

60%

80%

100%

Baseline (2006) Final (2009)

Per

cen

tag

e

Children under 5 Infants 0-11 months Pregnant women

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Results – Home care and management of fever

Target: 40%

25%

55%

0%

10%

20%

30%

40%

50%

60%

Baseline (2006) Final (2009)

Per

cen

tag

e

Children under 5 who received timely and appropriate home treatment

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Results – Early referral of serious malaria

Target: 40%19%

95%

0%

20%

40%

60%

80%

100%

Baseline (2006) Final (2009)

Per

cen

tag

e

Mothers of children under 5 who could identifyat least one sign of serious malaria

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Results – IPTp

• 40% of pregnant women received IPTp

• Malaria consultations among pregnant women at health centers decreased from 92 to 66 per year

• No malaria-related deaths were recorded among pregnant women

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Best practices

• Conducting home visits and night visits

• Creating local responses to identified barriers

• Establishing accountability of QIT members

• Increasing collaboration between communities and health facilities

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Challenges

• Engaging health facility staff in supervision and coaching of QITs

• Counter-referrals

• IPTp

• Sustained support and scale up

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Conclusions

• The project was successful in creating a favorable environment for sustained behavior changes• Development of

entrepreneurial spirit and shared learning among QIT members

• Increased ownership of community health

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The preceding slides were presented at theCORE Group 2010 Fall Meeting

Washington, DC

To see similar presentations, please visit:www.coregroup.org/resources/meetingreports