USAID Benin: Health

Benin is among West African countries where the mortality rate is still high, with a maternal mortality rate of 498 for 100,000 live births according to the 2001 Demographic and Health Survey. USAID has assisted the Ministry of Health (MOH) to reduce maternal and neonatal mortality in Benin in partnership with IntraHealth on two projects, PRIME (1998 - 2004) and ACQUIRE (2004 - 2006).

The ACQUIRE Project is implemented in the Oueme/Plateau, Zou/Collines and Borgou/Alibori regions and has three main components:

Other fields of intervention include the introduction of post abortion care, improved in-service and pre-service training of midwives and medicine doctors, and the introduction of the Integrated Management of Childhood Illnesses (IMCI) in national schools of nursing and midwifery.

Emergency Obstetric and Neonatal Care (EONC):
This program, which began in health facilities and communities in 2003, encourages referral of obstetric emergencies to health centers where adequate care is available. Interventions at the community level are an important component of strengthening EONC. In Malanville/Karimana health zone, community members and village health workers collaborate to raise awareness among women and their families of the advantages of coming to the health center instead of staying at home to deliver. Communities contribute financially to a village fund to send women to health facilities for care during obstetrical emergencies. As a general rule, men contribute about $1 to the fund, and women contribute about $0.50. With support from the village development associations, bank accounts were opened for the village EONC funds. The success of EONC is reflected in improvements in community participation, strengthened partnerships between communities and health providers, and the quality of care in health facilities, There are countless success stories, including the case of a pregnant woman who was expecting to give birth to twins. At the time she was in labor, she couldn't find anyone to take her to the hospital, and delivered the first baby at home.

A woman safely transported to the health center delivered her second baby at the hospital and her life was saved.

When the community coordinator became aware of her labor, he quickly contacted the village committee, and the woman was safely transported to the health center before the second baby was born. She then delivered the second baby at the hospital and her life, as well as those of her two babies, was saved.

Prevention of Post-partum Hemorrhage (PPPH) through Active Management of the Third Stage of Labor (AMTSL):
In Benin, a major cause of maternal mortality is post-partum hemorrhage, or excessive bleeding immediately following delivery. Preventing hemorrhage can be done with simple, but effective measures. First, the midwife administers oxytocin just before delivery of the placenta. This drug encourages stronger contractions of the uterus which in turn helps constrict blood vessels and reduce bleeding. The health worker also massages the abdomen in order to help the uterus contract itself. Since these techniques have been widely introduced in health facilities, hemorrhages have been drastically reduced. This technique is applied in 85% of the deliveries in health zones supported by the initiative. Figures show that these health centers recorded fewer complications and referrals, resulting in reduction of cost for both the government and families.

A midwife carefully listening to the baby's heartbeats during a prenatal consultation

One satisfied client shared her story. "When I got pregnant I started the prenatal consultation right away because the midwife was always welcoming and she advised me to come for consultations. She prescribed medicine when necessary. She advised me to come to hospital as soon as I started my labor, which I did. When I arrived, she took my vital signs and then I delivered. After delivery, she gave me an injection. After a few minutes I had stomach pains and she delivered the placenta. She showed me how to massage my stomach for a while. I did this for a while under her supervision and then I was transferred to the recovery room. It was all so easy!"

Post Abortion Care: Abortion is not legal in Benin. However, women do seek abortions and these are performed by untrained people in less-than-hygienic circumstances. Many result in women's deaths. Post-abortion care is cost-effective and can contribute to saving women's lives. This care includes emergency treatment for complications of miscarriage or induced abortion; family planning counseling and services; provision of other reproductive health services such as management of sexually transmitted infections; and counseling tailored to each woman's emotional and physical needs. An important result of good post abortion care is helping women avoid further unwanted pregnancies and other reproductive health problems. USAID through the collaboration with the MOH, has made post abortion care services more available to women in need-following miscarriage or induced abortion. As a result of this pilot project, women with post abortion complications are treated in a couple of hours rather than two-to-three days as before.

Sustainability: USAID has implemented cost-effective programs in close collaboration with the Ministry and other partners. Programs have resulted not only in improvements at the health facility and community level, but also in the creation of a small group of skilled Beninese trainers who can continue to build capacity. Because IntraHealth has worked in such close collaboration with key MOH officials, they now have the skills and experience to continue activities. By integrating the new best practices into pre-service training, through the nursing and midwifery schools, and in-service training, long term impact will continue.

For more information contact USAID-Benin

USAID SUPPORTS THE MINISTRY OF HEALTH TO REDUCE MATERNAL AND NEONATAL MORTALITY THROUGH ACQUIRE PROJECT