1. EOP Evaluation of BASICS iCCM
Project Benin 2009 to 2012
USAID funded MSH implemented
Freeman Paul
Deussom Gabriel
Paraïso M Noël
Glèlè Yolaine

2. Acknowledgements
• USAID Washington and USAID Benin
• Ministry of Health Benin & Staff, National, 5 HZs
• MSH Basics staff Parakou
• Project Partners 5 NGOs & Africare, UNICEF, CRS
• Bryan Comstock U of Washington- sampling
• Community members, surveyors, supervisors 6 HZ
Disclaimer. All views expressed are those of the authors and do not
necessarily reflect the opinion of USAID or the GH Tech team.
Idea for CC study from USAID Benin but all design, implementation
and write up by team.

3. Benin
• Infant MR 73/1000 Child MR 115/1000 -2012
• Malaria, ARI, diarrhea, anemia < 5 mortality
• 47% of rural children < 5 stunted – 2012
• 20% of rural children < 5 sleep under ITN-2012
• Health Workforce Density < 0.05 /10,000p -2012
Francophone
Traditional Muslim
Population
9, 100,000 (2011)
Democracy
Life E at B 56.8yrs
Fertility 5.1 c/w

4. Project Interventions
• iCCM c.s. CHWs rural villages > 5 km from H. F.
• Coordinate with MOH, UNICEF, Africare--CHW
• Rx Malaria, ARI, diarrhea, refer/escort to HCs
• CHWs home visits link mothers with HCs
• CHWs ed about/support EPI, ITN
• Supervisors/Educators/Drug Supply local HCs
• Community based information system HCs
• Local NGOs support CHWs –ESP remote areas

5. Project Site Northern Benin
5 Health Zones
93 Health Centers
1048 CHWs trained
193 trainer/supervisors
trained
202,116 Infants less than 5
yrs
~16-20% of the under 5
population of Benin
5 local NGOs associated
with the project
Began :30 July 2009
Ended : 29 Ju;y 2012
34 / 36 Months
HZ Tchaourou
BORGOU
HZ Bassila
DONGA
HZ Djougou-Ouaké-Copargo
DONGA
COVADES
HZ HZ Kandi-Ségbana-
Gogounou
ALIBORI
HANDICAP PLUS
HZ Banikoara
ALIBORI
CBBE
GRADE
DEDRAS
Project Cost: $ 4,377,056

6. Evaluation Questions
• Coverage and quality of iCCM delivery
• Capacity and sustainability of HZs and local
NGOs to support CHWs
• Achievement of project objectives & activities
• Lessons learned and best practices.

7. Evaluation Methods
• Three intervention HZ selected- Kandi, Tchaourou, Djougou
• Key Informant Interviews- at all levels- MOH, local partner NGOs,
UNICEF, Africare, CRS, others.
• Focus Groups- CHWs, mothers, community
• leaders, HC staff
• Document review
• Case Control study
• Standardized Observation of Clinical Skills of 120 CHWs
Observation Checklist Source. Adapted from Community based
Distributors Quality of Care Assessment IRC 2011

8. Case Control Study
• 3 Intervention HZs compared w 3 control HZ
In villages 5 to 10 km from local HC in South
• 30 clusters of 10 mothers w children < 5 who had
fever, cough, or diarrhea in the past two weeks
versus 30 clusters of 10 control HZ (600 total)
• CHWs not trained in iCCM present in control.
• Sampling power 80% to show differ > 10%
• Standardized questions – trained interviewers

9. Results
CHW Coverage Level by Health Zone
Banikoara Bassila D-C-O K-G-S Tchaourou Total
Total
villages
(>5kms)
462 104 472 348 330 1716
Covered
Villages
(>5kms)
181 54 250 147 109 741
RC/HZ
trained
186 108 360 223 172 1049
%
coverage
39% 50% 69% 42% 33% 43%
Source: Project Data, January 2011, BASICS.

10. Total numbers of cases treated by CHWs
Number of Children aged
Less than 5 years
Treated by CHWs
During project Treated for Male Female Total
Malaria 22357 19467 41824
Diarrhea 2497 2220 4717
Source .Project CHIS Cough/Pneumonia 3742 3461 7203

11. Household Homevisits by CHWs
0
5000
10000
15000
20000
25000
30000
35000
40000
FY 2011 FY2012
Household Visits by CHWs

12. Case Control General Results
• Demographics of guardians same by sex, age
• Mothers home only I 183 (63%) v C 110 (37%
• Education no F.ED I 264 (86%) v C 181(62%
• There were CHWs untrained in iCCM in control
• 236 mothers sought HC for child from CHW in
intervention area c/w 108 who sought HC
from CHW in control

13. Person/s Approached for Initial Care
INTERVENTION CONTROL TOTAL
CHW 240 (78.7%) 108 (36.2%) 348 (57.7%)
Health Center 26 ( 8.5%) 95 (31.9%) 121 (20.0%)
Local Store 15 ( 4.9%) 82 (27.5%) 97 (16.0%)
Traditional
Practitioner
4 ( 1.3%) 9 ( 3.0%) 13 ( 2.1%)
Parent/Friend 20 ( 6.6%) 4 ( 1.4%) 4 (0.7%)
305 (100%) 298 (100%) 603

14. Time Delay Before Seeking Health Care
In Intervention And Control Areas
INTERVENTION CONTROL
Delay in seeking
health care
Less than 12 hours 117 (49.6%) 11 (10.2%) 128
12 to 24 hours 77 (32.6%) 36 (33.3%) 113
24 to 48 hours 25 (10.6%) 46 (42.6%) 71
More than 48 hours 17 ( 7.2%) 15 (13.9%) 32
N 236 (100%) 108 (100%) 344

15. Use Of Health Care Before The Presence Of
local CHW Compared With Control
Initial Source of
health care
INTERVENT
ION
CONTROL Total
Health
Center
147
(61.25%)
86
(79.63%)
223
(66.95%
)
P =
0.000
Self-
Medication
67
(27.92%)
43
(39.81%)
110
(31.16%
P = 0.027
Traditional
Practitioner
3
(1.25%)
10 (9.265) 13
(3.74%)
P = 0.000
N 240
(100%)
108
(100%)
348

16. Mothers’ Perception Of The Benefit Of
Having CHW Care For Their Children
Project CONTROL Total
CHWs live nearby 193
(80.42%)
76
(70.37%)
269
(77.3%)
P = 0.038
Accessibility to
health care
177
(73.75%)
53
(49.07%)
230
(66.09
%)
P < 0.0001
Availability of
medications
130
(54.17%)
62
(57.41%)
192
(55.17
%)
P = 0.57
240
(100%)
108
(100%)
348

17. Mother’s perception of the quality of
care given by CHW
PERCEPTION INTERVENTION CONTROL
Correct treatment given by
CHW
90.5% 70.3%
Satisfied with health care
given
97.5% 87%
Access to follow up health
care valued
50% 23.1%

18. Skills of CHWs observed
• Simulation of the examination a two old child
presenting with fever (Real mothers and child)
The 119 RCs observed:
• Asked
– about the age of the child in 94%,
– about fever in 93%,
– about diarrhea in 82%, respiratory symptoms in 75.6%
– and length of time of symptoms in 94% of cases.
• Examination
– 49.6% uncovered the child’s chest
– 51% counted the child’s respiratory rate using a counting
device.

19. Use of LLIN by Project Households
•
0
1000
2000
3000
4000
5000
6000
7000
8000
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Use of LLIN by Households in the Community
Children having slept under
a LLIN the previous night
Households with a LLIN
confirmed installed

20. Major Implementation Lessons
• Collaboration – regular contact- CHW same
• Local NGOs
• Work AIDS – job, supervision, HIS  HZ comp
• CHWs locally chosen—CHW referrals followed
• Local links-community-HC-HZ-central MOH
• Collaborative supervision

21. Local NGO members

22. 22
Workaids Developed by Project

24. Supervision Clinical Skills
• July 2011 assessment of CHW clinical skills
found widespread deficiencies
• Collaborative Approach developed.
• Individual coaching of CHW on-site and
• during CHW visits to local HC using Check List
At HC visits CHWs give one another feedback/help.
Within each village local quality teams established to
work with local CHW.

25. Performance of the CHWs and
Supervisors in Clinical Assess. On FU.
0
10
20
30
40
50
60
70
80
90
100
% Functional
RC
% Supervised
RC
% Functional
Coach
% RC correctly
asking
questions to
search for GDS
and GS
Evolution of the Copargo Commune CHW performance within 6 months of
the implementation of the Collaborative Approach
Results Obtained
Post Training Follow-up
Supervision at 3 months
Supervision at 6 months

26. Hidden details
• 85% of CHWs were male

27. Thank you ! The team

28. Reasons Given for not using CHWs
Reasons given for
not using CHW
Intervention Control TOTAL
Nil answer given 15 (23.0%) 32 (16.8%) 47 (18.4%)
Do not use them 19 (29.2%) 80 (42.1%) 99 (38.8%)
Absence of
information about
CHWs
18 (27.7%) 55 (28.9%) 73 (28.6%)
They are not available 13 (20%) 23 (12.1%) 26 (10.1%)
N 65 (100%) 190 (100%) 255 (100%)