Family Health > Programs

The Benin Integrated Family Health Program

PROSAF - Promotion Intégrée de Santé Familiale dans le Borgou et l’Alibori

"People support what they help create." This is the principle on which the Benin Integrated Family Health Program (PROSAF) in the northern half of the country is built. This five year, 11.8 million dollar project, awarded in early 1999, is implemented by a consortium of four organizations lead by URC (University Research Corporation, LLC) in close collaboration with the Regional Health Directorate (RHS) of the Borgou and Alibori. The other executing partners are l’Association Béninoise pour la Promotion de la Famille (ABPF),), the Cooperative League of the United States of America (CLUSA) and the Program for Appropriate Technology in Health (PATH). The program uses a systems improvement approach to contribute to the USAID mission’s Strategic Objective 2, which is "the increased use of family health services and prevention measures within a supportive policy environment".

Quality Assurance is the principle approach used in implementing PROSAF. This systems improvement approach integrates improving the satisfaction of clients, the use of data for decision making and systems thinking through teamwork. Because the program focuses on systems there must naturally be a multi-pronged and multi level strategy.

PROSAF is a decentralized program which is reinforcing two aspects of the Ministry of Health’s decentralization policies: the re-energizing of the co-management of health centers with the community through the Bamako Initiative community structures; and support to the development of the health zones primarily through reinforcement of the health zone management teams capacities.

PROSAF's five Results Packages serve as the framework of the program strategy within which program activities are implemented, monitored and reported. These five Results Packages are:

1. Improve health planning and coordination by:
• Strengthening departmental and health zone capacity to develop strategic and annual operational plans by using their epidemiological and programmatic data so that they can address problems and coordinate more effectively
• Working to reinforce the coordinated leadership of the regional health services directorate of the public and private sectors, donors, USAID cooperating agencies, and other groups making resource contributions
  
  
2. Increase access to family planning/maternal and child health/sexually transmitted disease/human immuno-deficiency virus (FP/MCH/STD/HIV) services and products by:
   
   
• Supporting community-based distribution approaches and social marketing
  
  
• Ensuring that clinics offer an integrated package of family planning, maternal and child health and STD/HIV/AIDS services through training staff and improving drug supplies
  
  
• Adapting and operationalizing the distribution system of essential family health products
  
  
3. Increase the capacity of health care workers to provide quality services by:
   
   
• Increasing training capacity and skills transfer, improving and strengthening supervision, and introducing quality assurance methods and tools to ensure that the processes of care and support function effectively and efficiently
  
  
4. Increase knowledge and behaviors supporting the use of FP/MCH/STD/HIV services, products, and prevention measures by:
   
   
• Strengthening behavior change communication strategies, focused both on traditional, community-focused media to improve understanding and generate demand and on an increased range of communication agents: health workers, social workers, community leaders, etc.
  
  
5. Increase public involvement in the planning and delivery of community-level health services and prevention measures by:
   
   
• Developing sustainable structures for community involvement in the design, planning, management, and financing of family health services
  
  
• Strengthening the capacity of local NGO’s to organize and develop village health management committees
  
  
• Supporting health center management committees in developing and implementing action plans to address priority needs in training, revenue generation and health promotion

To date some of the key results in improved planning and coordination are

• A department-wide management and quality of care assessment implemented
• The vision and mission statement of the new DDSP three-year Strategic Plan (2000-2002) developed
• Three-year Strategic plans for four health zones based on community inputs and strategic directions identified in the Management Assessment developed
• Quality Assurance introduced at all levels of health system
• Quarterly Data Monitoring Guide developed and implemented
• Information on decentralization disseminated throughout the departments

• Regular planning and coordination mechanisms with the DDSP, partners and the HZMT established

Key results in increased access to services are:

• Revised the system of logistics management for family health products, including a departmental warehouse
• Trained more than forty health workers to use the new logistics management tools
• Trained health workers and community members in the use of FPLM composite indicator scoring tool for effective management of family health products
• Developed consensus on the definition of integrated family health services
• Developed CBSA training curriculum, and trained 20 CBSA Trainers and 115 CBSA (including ABPF’s zones)

The principal accomplishments in improving health worker capacity to deliver quality health services have been:

• IMCI community norms integrated into the CBSA curriculum
• The content, dissemination and use of MOH policies, norms and standards evaluated
• Consensus obtained on in-service training and the introduction of formative supervision systems for family health
• The training module for formative supervision developed
• A performance monitoring system established to strengthen and reinforce skills acquired through training
• Training sessions organized based on specific needs identified by health care providers
• The departmental training team established and trained them in adult learning methods

To increase the demand for health services and preventive care through increased knowledge and behavior change strategies the following results have been accomplished

• Carried out survey on family health knowledge, attitudes and practices
• Trained traditional and popular media to develop and organize the diffusion of messages on family planning and child health
• Developed curriculum on interpersonal communication and held initial training for 18 health workers
• Established Departmental IEC/BCC Committee and trained members in communication techniques and strategies
• Supported RHS in organization of World Health Day, World Population Day, National Vaccination Days, and World AIDS Day activities in the Borgou/Alibori

Results so far in ensuring increased community involvement in health services delivery are:

• Community participation assessed in health service management through self-assessment, and skills taught in planning and management
• A study conducted of income generating activities in Benin and a model recommended to be used in the Borgou/Alibori

PROSAF works in all 7 health zones in the 2 departments of Borgou and Alibori but concentrates it community efforts principally in 2 target zones, Banikaora and Sinendé / Bembéréké.

In this coming year the systems for which a consensus has been achieved: training, supervision, community based services, communication for behavior change, family health product management, will be further operationalized, particularly at the zone level. Quality assurance principles and techniques are being used at the community level to solve long-standing problems that require local study and solutions. Community members and health personnel have discovered that there is much they can do on their own. A program for local income generation activities will start this year.

The family health norms and standards are being reinforced with the operational level protocols. Implementation of IMCI and EOC will be enhanced by the community level interventions planned through the community based service providers and the use of radio and traditional media to motivate attitude and behavior change.

PROSAF is innovating through an integrated curriculum for family health services that includes emphasis on interpersonal communication, use of data, and offering holistic / integrated care for clients. New training methods are encouraged with the newly created resource in the departmental training team. The improved supervision system will put an emphasis on a coaching attitude and use of data, bringing coherence to service delivery and health personnel’s understanding of their contribution to their health zone and its population’s health status.

The revolutionized and fledgling family health products logistics and distribution system will need support from the RHS to become truly operational, but the actors at the periphery are very aware of their role in making it work by making correct and regular orders

The success of this multi-pronged bottom-up approach of PROSAF relies on the communities and health workers deciding how these goals will be achieved. Thus PROSAF works at the community level to build the capacity of both the health workers and other community resources to develop successful integrated and sustainable health activities.

TOP