Over the last several decades, Benin, a small country in West Africa of about 11 million people, has made major advancements in health.
However, because maternal and child mortality rates remain high, especially in rural areas, the country has invested significantly to reach underserved communities with high-quality health services.
Between 2012 and 2018, the USAID-funded Advancing Partners & Communities (APC) project partnered with Benin’s Ministry of Health (MOH) to strengthen community health systems, particularly family planning.
Better Health Outcomes for All
Benin is expanding access to health care through community health workers (CHWs), who are nominated by community members. They are trained and supported by local nongovernmental organizations (NGOs) and the MOH to provide basic health education and services. As community members, these volunteers help identify and solve problems, and link otherwise hard-to-reach people with health centers.
Since 2010, CHWs have provided education and services as part of the MOH’s package of basic health services and practices, known as PIHI. Critical to healthy, thriving communities, PIHI services help improve health areas related to malaria; water, sanitation, and hygiene; maternal and child health; nutrition; and family planning.
Through support from APC and the MOH, three Beninese NGOs trained CHWs and gave them ongoing supervision to provide PIHI services in 10 health zones prioritized by USAID, where health service access was poor. More than 3 million people live in these zones.
CHWs give their fellow community members health information during campaigns, group sessions, and home visits. They tell their neighbors about health interventions and products, provide them with basic health services, and refer them to higher levels of care when needed. On a typical day, a CHW may provide someone with rapid diagnostic testing for malaria, treat a child who has a high fever or diarrhea with oral rehydration solution and provides family planning counseling.
Developed Capacity Through NGOs
Sia N’Son is a motivated local NGO that has worked on health and microfinance projects since 1995 to advance community development. Through CHWs, Sia N’Son brought PIHI services to several health zones in southeast and northwest Benin.
Staff from Sia N’son and two other NGOs, Bupdos and Dedras, built their technical, organizational, and managerial skills through APC workshops and mentoring. Not only can these NGOs now conduct high-quality programming; they are better prepared to receive and manage USAID funding, which is key to continuing their community health work.
“I like APC’s strategy because it takes into consideration our current needs and activities to build our capacity. It’s a flexible and adaptable strategy, and we have truly appreciated their support.”
— Halima Coulibaly, project manager for PIHI activities, Sia N’Son
Local Leaders Take Ownership
In Benin, mayors have an important role in directing resources for their towns. APC-supported NGOs helped 18 mayors allocate funding and develop strategic plans to guide community health activities.
The mayors also learned about their role in keeping their communities healthy. Bio Sounon Boco, the mayor of Tchaourou District in northern Benin, realized that health financing is crucial to building resilient communities, and budgeted 1.1 million cfa (approximately $2,000 US) for community health activities in 2019.
“I must admit that the NGO enlightened us by explaining our role in community health. We quickly came to realize the importance and decided that we should provide support for the achievement of community health in Tchaourou.”
— Mayor Sounon Boco
Family Planning
In 2016, the MOH began to allow CHWs to provide DMPA-SC, also known as Sayana Press.® DMPA-SC is a small, pre-filled, easy-to-use injectable contraceptive that lower-skilled health workers, such as CHWs, can be trained to give women.
The Maternal and Child Health Unit of the MOH and APC led a consortium to introduce DMPA-SC in communities in the 10 USAID priority health zones. The consortium trained facility-based health workers and CHWs to administer the contraceptive, provided ongoing supervision to CHWs after the training, and developed job aids and data collection tools for CHWs.
The consortium’s other members were: Beninese Association for Social Marketing and Communication for Health, Beninese Association for Family Planning, University Research Corporation, USAID, United Nations Population Fund
CHWs receive support from the consortium partners during monitoring visits so that they can overcome challenges, including difficulties completing data collection forms and product stockouts. CHWs are also encouraged to ask questions and discuss successes.
In Their Own Words
Véronique Honfo lives in Calavi. After learning about the benefits of family planning from her local CHW and discussing it with her husband, she decided to try DMPA-SC. She is pleased that she can simply call a CHW from her village to provide the next injection in her home and encourages her friends to adopt family planning as well.
The Government of Benin has committed to expanding access to DMPA-SC by nationally scaling the method in the public sector, introducing it in the private sector, and piloting self-injection of the contraceptive by women themselves.
“Today, we the women are also able to plan births, and therefore devote more time for our income-generating activities to support our husbands.”
— Véronique Honfo, family planning client
Yaya Alaza is an Imam in Agrogrossi village in northwestern Benin. He learned about family planning from CHWs and health facility staff, and the need to space births for a healthier community resonated with him. He passed this information on to his congregation members and has become a family planning champion.
Religious leaders and community members across the 10 health zones attended sessions on family planning and its benefits. Participants learned about the full range of family planning method options available in Benin and the consortium talked about DMPA-SC. Community members attended the sessions in large numbers and gave positive feedback about the discussions.
“Once we were told about the benefits of family planning, I made room for a short pep talk at the end of prayer to discuss with men about family planning.”
— Imam Yaya Alaza
Since 2012, the USAID-funded Advancing Partners & Communities project, led by JSI Research & Training Institute, Inc. and its partner, FHI 360, has worked in over 40 countries. APC advances and supports community programs that improve the overall health of communities and achieves other health-related impacts, especially related to family planning. APC increases access to community-based health services, spanning a spectrum of health issues.
Photos: Joshua Yospyn, JSI. Tishina Okegbe, FHI 360.
This publication was produced by Advancing Partners & Communities, a cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-12–00047 beginning October 1, 2012. The authors’ views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the United States Government.
