USAID/Benin’s Health Strategy for 2011- 2016 in the Works

Family Health USAID partners meet (Photo USAID)

From July 22 to 23, 2009, USAID/Benin’s Family Health Team held a two-day retreat in Cotonou to discuss the Mission’s health program for the 2011-2016 period. Catherine Andang, Program Officer and Acting Mission Director, participated in the brainstorming exercise. For two days, team members discussed ways to improve the effectiveness of the health program and support the GoB in achieving Millennium Development Goals. Megan Fotheringham, of USAID’s President’s Malaria Initiative Office, and Elizabeth Kibour, of the USAID Global Health Regional Country Support Office, both travelled from Washington, D.C. and provided valuable technical support in laying the groundwork for the design of a new USAID health strategy for Benin. Participants in the meeting identified strengths, weaknesses, challenges, opportunities, and future contributions of the USAID health program. The retreat outcomes will materialize in a draft of USAID/Benin’s new conceptual framework and health strategy to be developed before the year ends.

Just prior to the retreat, on July 21, USAID/Benin organized a meeting with health sector stakeholders to identify key challenges and gaps in Benin’s health sector and to highlight USAID/Benin’s comparative advantage. Public and private sector donors, NGOs, USAID implementing partners, bilateral donors, UN organizations, and officials from the Ministry of Health participated. Health officials presented the priorities that the Government of Benin has articulated in its ten-year health development plan. In her opening remarks, Catherine Andang, Program Officer and Acting USAID/Director, emphasized that USAID/Benin seeks to align its health program to Benin’s priorities. She added that USAID is positioning its health program to better serve the needs of disadvantaged Beninese populations and assist the country achieve the Millennium Development Goals.

Improved Availability of Antimalaria Commodities in Borgou/Alibori

A mid-wife of the Karimama health center is satisfied with ANC clinic performance (Photo USAID).

Responding steadfastly to recent USAID recommendations to prevent expiries of antimalaria treatments (ACT) at the Central Pharmacy (CAME), the National Malaria Control Program (NMCP) acted to improve the availability of commodities in health facilities in northern health zones. Not-for profit private health facilities received all ACTs drugs with short remaining shelf life, while fresh ACT stocks were stored in CAME’s regional depots in Natitingou and Parakou. USAID is supporting the rolling out of antimalaria commodities donated under the Presidential Malaria Initiative in six of the nine northern health zones.

“Now that ITN are available at health facility, more pregnant women are coming for their antenatal care visits and for follow up visits” commented the mid-wife of the Karimama health center.

USAID Distributes 40,000 Free Bednets in Ouémé

Catherine Degboesse from the village of Dekin, center, receives a free bednet. (Photo USAID)

In May 2009, a USAID team observed the distribution of bednets donated to Benin under the Presidential Malaria Initiative to villagers in the communities of Dekin, Hounhoué, and Afio. These communities were selected for free bednet distribution in lieu of Indoor Residual Spraying because of their location in the middle of the Ouémé river flooded areas. This is the second distribution of free bednets. A first distribution of 20,000 bednets took place in 2008. After a review of census statistics, the Ministry of Health and National Malaria Control Program requested 40,000 bednets to be distributed this year in the flooded areas communities of the Ouémé Département.

“I sleep better under the bednet.” As Anastasie Houdonou, a villager from Afio, testified, populations react positively to the free bednets distribution.

Households received one bednet per bed where a pregnant woman or a child under 5 years of age sleeps. Distribution teams go house to house not simply to hand out bednets, but to unwrap and set up each bednet. Unwrapping and setting up bednets is time consuming but is justified for many reasons: to ensure that household members (mothers) learn about what causes malaria and how to properly setup the bednet over the bed to protect themselves and children from mosquitoes bites that cause malaria; to collect for proper disposal the wrapping plastic that contains toxic strains of the insecticide that impregnates bednets, which otherwise the population may use to store food or clothes; to ensure that bednets can no longer be sold as new at the market; to allow for the monitoring and control bednet distribution by counting the number of wraps returned to the storehouse.

Joint Health Sector 2008 Performance Review

Maternity deserted by striking health personnel leaves pregnant mother in dispair (Photo USAID)

On April 27-29 the Ministry of Health convened the annual sector performance review. Among the issues discussed was the reorganizing of the Ministry of Health and the fulfilling of the July 2008 World Bank’s audit recommendations. The review led to the development and approval of a roadmap towards a more performing public health system. One key task calls for a reform of the Central Pharmacy (CAME) in order to strengthen the management of the pharmaceutical chain of supply. Also discussed was the performance-based experiment being carried out in the health sector of Rwanda and that Benin plans also to conduct with support from the World Bank.

Most donors attended. In her opening remarks, Ms. Janet Schulman, Acting USAID Director, stressed the need for the Ministry of Health to give its utmost priority to primary health care and to put an end to stock-outs of medicines in health facilities by better managing the supply chain of pharmaceuticals.

A $21 Million Malaria Operational Plan for Benin

A pregant woman with ANC kit including the free USAID-donated bednet and SP she received after a prenatal visit to Karimama health center (Photo USAID)

The Malaria Operational Plan (MOP), developed by USAID health partners gathered in a workshop held April 6-8 in Cotonou, is to fill priority gaps in antimalarial interventions, scheduled in fiscal year 2010 by the Government of Benin, with activities funded under the President’s Malaria Initiative (PMI). Participated in the development of the MOP, the National Malaria Control Program, USAID/Benin, the PMI team based at USAID/Washington and CDC/Atlanta participated . UNICEF, CRS, Africare and the Clinton Foundation also attended. Approval of the MOP by PMI leadership in Washington is expected by September 2009.

Benin Launches Second President's Malaria Initiative (PMI) Indoor Residual Spraying

Operator spraying the walls of a house with insecticide. (Photo USAID)

On March 9, 2009, as part of the President’s Malaria Initiative (PMI), Benin launched its second Indoor Residual Spraying (IRS) campaign. IRS is a component of the country’s strategy to combat malaria. A joint USAID-Centers of Disease Control and Prevention (CDC) team visited communities in Ouémé department to witness the progress of the IRS campaign.

Indoor Residual Spraying in Action

The USAID team included Nathan Miller, Benin/PMI Advisor, and Michael Lynch, a medical epidemiologist with CDC / Atlanta. PMI funds IRS operations in the Ouémé department only.

The visit started at the Porto Novo IRS warehouse where Research Triangle Institute (IRS) National Coordinator, Eugene Kiti, and Damien Kodjo, Environmental Consultant, met the visitors. Travelling to Awonou, a hamlet 15 km north of the town of Adjohoun, the team observed the spraying of two houses. As one team of operators was spraying the houses, others reminded villagers on safety procedures they must observe  before and after their houses have been sprayed to avoid direct contact with the insecticide. For IRS to succeed, communities must accept and cooperate with spray operators. More

Anti-malarial Efforts Challenged

Sleeping under a mosquito bednet is the most effective way to protect against contracting malaria . Illicit sale of over priced anti malarial products, like bednets and ACTs, threaten PMI’s efforts to combat malaria in Benin. (Photo USAID)

The permanent availability of anti-malarial drugs and other products is a key element of success in the fight against malaria. In Benin, an important challenge for the health system is to ensure that supplies of anti-malarial products are uninterrupted so that every citizen has access to products whenever s/he needs it, regardless of where s/he lives.

As part of the President’s Malaria Initiative (PMI), USAID has helped Benin’s National Malaria Control Program (NMCP) with the acquisition of health commodities for the treatment and prevention of malaria. Since October 2007, PMI has made available 1.1 million artemisinine-based combination treatments (ACT), 2.3 million tablets of sulfadoxine-pyrimethamine (SP) for the preventive treatment of pregnant women, 650,000 mosquito bed nets impregnated with long-acting insecticides (ITNs), and 30 kits of microscopes and laboratory consumables for the accurate and rapid diagnosis of malaria. More

USAID Hands Over of 280,000 Mosquito Bednets from the President’s Malaria Initiative to the Government of Benin

USAID Acting Director Catherine Andang, left, hands over a long lasting insecticide-treated mosquito bednet to Dr. Dorothée Yevide of Benin Ministry of Health.

Port of Cotonou , January 16 – On behalf of the U.S. Government, Ms. Catherine Andang, USAID Acting Director, handed over the 280,000 long lasting insecticide-treated mosquito bednets to the Government of Benin. Dr Dorothée Yevide, Deputy Director of Cabinet for the Minister of Health, represented the Government of Benin. 

In their speeches, both Catherine Andang and Dr Dorothée Yevide stressed that bednets are an important measure to prevent malaria and that the National Malaria Control Program (NMCP) will ensure bednets are given to children under five years of age during immunization clinics and to pregnant women during pre-natal consultations.

The 280,000 bednets are the first of a three-part consignment of nets procured under the President’s Malaria Initiative (PMI) program in Benin for FY 2008.  The total number of bednets procured is 835,000. A second delivery of 280,000 is planned for April and a third shipment of 275,000 bednets is expected in June 2009.

Each health zone of Benin (including the Hubert Maga National Hospital and the Mother and Child Hospital of Cotonou) will receive PMI bednets, except those of Ouémé and Plateau, which already received bednets from UNICEF.

For FY 2008, PMI also acquired important quantities of drugs to prevent and treat malaria and microscopes to allow for rapid diagnoses.  In FY 2009, USAID will also procure anti-malarial drugs and commodities, including additional bednets and microscopes.

USAID conducted a joint site visit with UNICEF, WHO, the World Bank and the National Malaria Control Program on October 22-24, 2008 . The purpose of the visit was to assess and observe the distribution and use of artemisinin-based combination treatment ( ACT) for malaria at the health facility level. ACT is used to treat simple cases of malaria.  PMI has provided 1,073,000 treatments to the Government of Benin for distribution at health facilities. This supply complements the donation of ACTs by the World Bank Booster program to cover the total needs of Benin in 2008, and part of its needs in 2009.  Successful malaria control depends on the availability and use of ACT drugs to treat children under five of age and pregnant women who are USAID’s target population.  Before PMI, USAID was among the first donors to provide ACT drugs to treat malaria in Zou-Collines regions. The visit was successful and allowed the Government of Benin and donors working in malaria to observe successes and identify issues that are currently being addressed by the Ministry of Health.

Ambassador Gayleatha B. Brown and former Minister of Health Kessile Tchala cut the ribbon to inaugurate the renovated health center at Doyissa

Ambassador Gayleatha B. Brown and former Minister of Health Kessilé Tchalla accompanied by former USAID/Benin Director Rudolph Thomas inaugurated 10 renovated health centers in Zou and Collines in August 2008. Ambassador Brown, the Minister of Health and the delegation stopped in Avlamè health center in Zogbodomè and Doyissa health center in Savalou to cut the ribbon and visit the renovated centers. This activity was designed under the USAID/PISAF funded project to improve work conditions for health workers and increase access to quality health services to communities.

Dr Ghislaine LOKO, the MSH/SPS Country Manager.

Between November 17 and December 12, 2008, a team of experts led by Bertrand Cheney, expert in finance and pharmaceutical commodities management, conducted a President’s Malaria Initiative (PMI)-funded evaluation of Benin’s Central Medical Store (CAME). This goal of the assessment was to identify opportunities to strengthen CAME operations and avoid stock-outs of drugs. Management Sciences for Health (MSH) is charged with implementing the recommendations. The report of this evaluation is expected in mid-January 2009. Also, MSH/SPS (Strengthening Pharmaceutical System), the PMI implementing partner for commodities logistics strengthening, opened its office in Cotonou in November 2008 with three staff members.

Ambassador Gayleatha B. Brown, right, hands out a certificate of recognition to Madam Bachabi, a Beninese wholesaler of social marketing health products.

In her remarks, Ambassador Brown highlighted the efforts of those who are engaged in the social marketing of health products, and of women in particular, who, as mothers, are at the frontline in the fight against malaria, HIV/AIDS, diarrhea and cholera, and other preventable diseases in Benin.