USAID/Benin : integrated community case management (iCCM) performance evaluation

and implemented by MSH/BASICS. The purpose of the program as defined by USAID/Benin was "to support implementation of integrated community case management of childhood illnesses among children under-five for malaria, diarrhea, and pneumonia, and provide immunization and nutrition messages, by community-based organizations and community health workers." The focus of the project was on the integrated management of common childhood illnesses, including malaria, diarrhea and pneumonia. The geographic coverage included the five health zones of Kandi-Segbana-Gogounou, Banikoara, Ouak-Copargo, Djougou-Bassila and Tchaourou in the Departments of Alibori, Donga and Borgou. The general objectives of the iCCM evaluation were: (1) to assess the integrated community case management(iCCM) projects achievement of objectives and targets; (2) measure coverage and quality of care of community level service delivery; and (3) attempt to understand the projects contribution to observed results by comparing service coverage and quality in USAID focus health zones with those in non-USAID focus health zones. The evaluation was also designed to assess the capacity and sustainability of health zones and local NGOs to support community level workers and compile lessons learned for scale-up and challenges encountered. Evaluation findings indicate that the project has established good quality iCCM with good coverage in semi-remote (more than 5 km from the nearest health facility) villages in rural Benin using members of local communities. This statement is supported by these results: (1) 1048 community-based community health workers (RCs, "Relais Communautaire") were trained, equipped and supervised to establish iCCM; (2) over 86,000 clinical contacts took place and children were treated with established standard treatments for malaria, diarrhea and acute respiratory infection; (3) RCs were trained and deployed in 1716 villages, 43% of all villages more than 5 kilometers from the nearest health facility in the five health zones covered by the project; (4) significantly more children were treated at the community level within the first 12 hours of the onset of illness than those in control villages; (5) many patients were receiving treatment who previously did not attend for clinical care and relied on self-medication or traditional healers; and (6) RCs performed an average of 3,000 household visits per year over the last two years of the project to encourage mothers to take preventive action for their child"s health. It should be noted, however, that 83% of the RCs are male, which given religious and cultural precepts in Benin, may make prove to be an obstacle to the delivery of maternal health services and family planning as it has in other countries. In addition to these findings, lessons learned and several recommendations are included in the report. (Excerpt, modified)