The document summarizes a project in Benin that tested innovative strategies for community engagement to improve child health outcomes. It implemented a quality improvement collaborative approach at the community level through monthly quality improvement team meetings and quarterly learning sessions to review health indicator data and identify strategies. This was combined with financial incentives for community health workers (CHWs) and compared to financial incentives alone. The results showed CHWs who participated in the combined intervention had higher performance scores. Community support was a key factor in high CHW performance, though retention was not affected. Lessons learned include the need for sustained supportive supervision and adaptation for non-numerate audiences.

1. www.chs-urc.org
Empowering communities. Improving systems.
Innovative Strategies for
Community Engagement
CHS Benin Child Survival Project
Sara Riese, MA, MPH

2. Empowering communities. Improving systems.
Context
• CHS has long history in Benin and with the
community health system
• Prior to 2010, Benin had no clear community
health policy
• In 2010, guidance was
released clarifying the CHW
package, including motivation
• CHS implemented the USAID-
funded Partnership for
Community Management of
Child Health (PRISE-C)
project in Benin from 2010-
2014

3. Empowering communities. Improving systems.
Community
System
• Create conducive
environment for
promotion of MCH
• Improve knowledge,
attitudes, and
practices towards
MCH
Formal Health
System
• Improve support to
CHWs through formal
health system
mechanisms
(supervisors)
CHWs
Project Strategy

4. Empowering communities. Improving systems.
Innovation
• Adapt the quality-improvement
collaborative approach for
implementation at community level
• Test it (in conjunction with financial
incentives) in comparison with the
financial incentives alone

5. Empowering communities. Improving systems.
Hypothesis
• Improved overall performance and
retention through:
– data-driven quality improvement
methods
– non-monetary incentives
– regular structured engagement of
the community in the CHWs work

6. Empowering communities. Improving systems.
Implementation (Project side)
• Formative research
– To identify members of the Quality
Improvement Team
• Quality Improvement Training
– 5 days
• Quarterly Learning Sessions
– 4 collaboratives
• Regular coaching and supportive
supervision
• Monitoring and Evaluation

7. Empowering communities. Improving systems.
Implementation (Village side)
• Minimum once a month meeting of
Quality Improvement Team to review
indicators and identify strategies to
improve
– Data from CHW registers
• Implementation of strategies chosen
• Participation in Quarterly Learning
Sessions to share results of
strategies and learn from other
teams

8. Empowering communities. Improving systems.
Best Practice Indicators
• % of health education talks held
• % of children under 5 who had a home visit from a
CHW in the quarter
• % of children 6-59 months correctly treated for malaria
• % of children 2-59 months correctly treated for diarrhea
• % of children 2-59 months correctly treated for ARI
• % of referrals for malaria, diarrhea, ARI, and
malnutrition in children 2-59 months which were
justified
• % of children from 0-59 months who live in a
household with a handwashing station at/near the
latrine
• % of infants from 0-6 months who are exclusively
breastfed

9. Empowering communities. Improving systems.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2 3 4 5 6 7 8 9 10
Quarter
Proportion of referrals which were
justified
Collaborative 4

10. Empowering communities. Improving systems.
Results
• CHWs who participated in the
combined intervention had higher odds
of achieving a high performance score
during the project period than those
who received only financial incentives.
• Community support and engagement
was a key determinant of high CHW
performance.
• Retention was not impacted by the
collaborative + financial incentive
intervention.

11. Empowering communities. Improving systems.
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 2 3 4 5 6 7 8 9 10
CHWPerformanceScore
(Maximumof1)
Quarter
CHW mean performance scores
over time
SAO (Intervention) DAGLA (Control)
QI Training
in SAO

12. Empowering communities. Improving systems.

13. Empowering communities. Improving systems.
Lessons Learned
• Providing a structure and
mechanism for engagement of the
community with the CHWs can
result in improved performance
• Need for sustained supportive
supervision
• Need for adaptation of aspects of
intervention
– Data discussions with non-numerate
audience

14. Empowering communities. Improving systems.

15. Empowering communities. Improving systems.
Discussion Question
Do you think we would have found
similar performance improvements if
we had developed structures and
mechanisms for CHWs to engage with
existing community bodies, such as
village health committees?

16. Empowering communities. Improving systems.
Thank you
Marthe Akogbeto and the PRISE-C
team
CHWs
QIT members