Pisaf – Integrated Family Health Program Final Report March 2006 – November 2012
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MINISTRY OF HEALTH BEN N PISAF – INTEGRATED FAMILY HEALTH PROGRAM FINAL REPORT MARCH 2006 – NOVEMBER 2012 FEBRUARY 2013 PISAF, the Integrated Family Health Program (Projet Intégré de Santé Familiale), is managed by University Research Co., LLC, in collaboration with Abt Associates under USAID Cooperative Agreement N°680- PISAF A-00-06-00013-00. The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government. On the cover: Top left: Basile was diagnosed with severe malaria at 11 months old by PISA F-trained community health worker Cossi Dansou (center). Basile’s mother (right) and older brother (left) look on. Cossi’s rapid intervention probably saved Basile’s life. Lower left: CHW demonstrates how to hang and use a bed net Top right: Pamphlets on Family Planning and Fistula Lower right: A pediatrician trained in ETAT examines a child admitted to HOMEL hospital Benin Integrated Family Health Program FINAL REPORT MARCH 2006 – NOVEMBER 2012 PISAF, the Integrated Family Health Program (Projet Intégré de Santé Familiale), is managed by University Research Co., LLC, in collaboration with Abt Associates under USAID Cooperative Agreement N° 680-A-00-06-00013-00. The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government. Table of Contents Acronym List ........................................................................................................................iv Introduction .......................................................................................................................... 1 Major Achievements ............................................................................................................. 2 Implementation Approaches/Strategies ................................................................................ 5 IR 1: Create a supportive implementation environment .......................................................... 7 IR 2: Increase access to quality services and products ........................................................15 IR 3: Increase demand for health services, products, and prevention measures .................. 27 Lessons Learned and Recommendations .......................................................................... 37 Final Observations and Recommendations......................................................................... 39 Annex 1: Performance Monitoring Plan ................................................................................41 Annex 2: Comparison of Actual Activities and Results with Life of Project Plan .................... 49 Annex 3: Strategy Documents and Study Reports .............................................................. 55 Annex 4: Tools and Job Aids Developed by PISAF .............................................................. 56 Annex 5: Success Stories/Technical Briefs ......................................................................... 57 Annex 6: Posters Presented at Open Door Day Conference................................................ 73 Annex 7: List of items available on PISAF Final Report CD ....................................................75 iii Acronyms ACT Artemisinin-based combination EEZS Zonal Supervision Team PBI Performance-Based Incentives therapy EONC Essential Obstetric and Newborn PIHI High Impact Interventions ALDIPE Association for Integrated Care Package (Paquet d’Intervention à Development and Environmental ETAT Emergency Triage, Assessment, Haut Impact) Protection (Association de and Treatment PIIHI Integrated Package of High Lutte pour un Développement Impact Interventions Intégré et pour la Protection de FP Family Planning l’Environnement) PISAF Integrated Family Health Project (Projet Intégré de Santé Familiale) AMTSL Active Management of the Third HC Health Center Stage of Labor PMI President’s Malaria Initiative HRM Human Resource Management ANC Antenatal Care PMTCT Prevention of Mother-to-Child HZ Health Zone Transmission of HIV ARV Antiretrovirals PROSAF Integrated Family Health Program IEC Information, Education, (Programme de Promotion BACAR African Office for Support and Communication Advice for Achievements (Le Intégrée de Santé Familiale dans IMCI Integrated Management of Bureau d’Appui – Conseils le Borgou et l’Alibori) Childhood Illness d’Afrique pour les Réalisations) IP Integrated Package (Paquet QA Quality Assurance BCC Behavior Change Intégré) Communication QIT Quality Improvement Team IPC Interpersonal Communication RAMU Universal Health Insurance Plan CHW Community Health Worker IPT Intermittent Preventative (Régime d’Assurance Maladie Treatment COGEC Communal Management Universelle) Committee (Comité de Gestion IR Intermediate Result de la Commune) RDT Rapid Diagnostic Test ITN Insecticide-treated bed nets RMIS Routine Malaria Information DDS Departmental Health Director System LLIN Long-Lasting Insecticide-Treated (Directeur Départemental de la Mosquito Net Santé) SO5 Strategic Objective 5 DRH Human Resources Unit (Direction MOH Ministry of Health des Ressources Humaines) URC University Research Co., LLC DRZ Zone Distribution Warehouse NGO Nongovernmental Organization USAID United States Agency for International Development (Dépot Répariteurs de Zone) NMCP National Malaria Control Program iv Introduction niversity Research Co., LLC (URC), in collaboration with malaria-focused activities to the project work plan at the central Abt Associates, has provided technical assistance to level and in all health departments. In 2010, PISAF received Uthe Ministry of Health (MOH) of Benin since March 2006 additional funding to reduce the incidence of obstetric fistula in through the USAID-funded Integrated Family Health Project or Zou and Collines. PISAF (Projet Intégré de Santé Familiale). PISAF has supported A one-year extension (2011-2012) changed the project’s the Government of Benin’s national health policies and strategies emphasis with two new foci: to scale up best practices in and USAID’s health objective: to increase the use of health integrated family health to the Atlantique/Littoral Departments services, products, and preventive measures in a supportive and to strengthen national leadership for quality improvement policy environment. The project improved the health status of and institutionalization of best practices. Work under the the Beninese through collaboration with government agencies, extension also included professionalizing community-based other donors, and USAID projects, communities, and the private health insurance schemes or mutuelles and enhancing sector, as well as with nongovernmental organizations (NGOs). community-facility linkages in Zou/Collines. The project has had several distinct phases. Emphasis during This final report presents the achievements in family health and the first five years was on strengthening the health system health systems indicators. It highlights the major implementation and service delivery in the Departments of Zou and Collines, strategies used and presents more detailed outcomes for with limited support in the Borgou/Alibori Departments—a each of the program’s three intermediate results. The report is continuation of the predecessor project, PROSAF (Promotion available in English and in French. Intégrée de Santé Familiale dans le Borgou et l’Alibori). In 2008 the project expanded significantly with the addition of funds provided under the President’s Malaria Initiative (PMI), adding FINAL REPORT 1 Major Achievements Zou/Collines 2006–2011 Indicator 2007 2011 % of target population with access to (i.e., receiving at least one element of) 24% 37% the family health services package Number of couples (of reproductive age) with protection provided by contraceptive methods during a one-year period, based on the volume of all 14,860 contraceptives sold or distributed free of charge to clients during that period % of health centers that received at least four formative supervision visits per 54% 81% year % of health zone supervision teams (EEZS) that executed at least 75% of their 78% 100% annual action plan Availability of family health products 78% 85% Number of contraceptive products distributed in public health facilities 49547 Number of people within target population with access to family health 318209 569575 services Mothers using any modern method of contraception* Zou 14% Zou 32% Collines 26% Collines 26% Children less than 5-years old that slept under a bed net the night before* Zou 25% Zou 98% Collines 24% Collines 96% Pregnant women that slept under a bed net the night before* Zou 21% Zou 92% Collines 26% Collines 44% HIV testing among pregnant women* Zou 23% Zou 71% Collines 9% Collines 38% Women who could cite at least 2 postpartum danger signs* Z/C 63% Z/C 91% Women who could cite at least 3 newborn danger signs* Z/C 40% Z/C 73% Women who could cite at least 3 sick child danger signs* Z/C 25% Z/C 73% * Data for 2006 from the DHS, Data from 2010 from the PISAF EQGSS Survey 2 PISAF – Integrated Family Health Program Zou/Collines 2011–2012 Indicator 2010 Baseline 2012 % of all women delivering at participating health facilities receiving all three steps of AMTSL (Data 79% 87% from first 3 quarters of each year for comparability) % of CHWs who have received a quarterly supervision visit from the health zone supervision team 40% 100% % of children 0-59 months triaged upon