Integrated Family Health Project – Projet Intégré de Santé Familiale (PISAF)

The Challenge

PISAF sought to improve the health status of the Beninese through collaboration with the Benin Ministry of Health Directorate for Maternal and Child Health (DSME), non-governmental organizations, government agencies, donors, other USAID projects, communities, and the private sector. The project’s activities supported the Government’s national policies and strategies and USAID’s health objective: to increase the use of health services, products, and preventive measures in a supportive policy environment. PISAF’s three main targeted results areas were: create a supportive implementation environment; increase access to quality services and products; and increase demand for health services, products, and preventive measures.

Overview and Objectives

The Integrated Family Health Project (PISAF) built on URC’s accomplishments over seven years in northern Benin to improve management systems (i.e., planning, programming, logistics, information systems, supervision) and mobilize communities. PISAF focused on maternal and neonatal health, child health, malaria, family planning, and HIV/AIDS. Through the President’s Malaria Initiative, PISAF improved the capacity of health services staff and managers and strengthened facility-based services. It also strengthened national-level data collection and reporting systems for malaria.

Objectives included:

• Conduct periodic assessments in Zou/Collines to assess the health system’s performance and identify areas needing improvement;
• Support ascendant planning of health priorities from the community level to the departmental level;
• Improve the quality of family health services by engaging health workers in improvement collaboratives and in the use of data for decision making;
• Develop an integrated family health service delivery package of best practices to improve health care performance in maternal, newborn, and child health services;
• Increase financial access to health services by supporting membership in community-based insurance organizations, “mutuelles”;
• Improve the availability of essential family health medicines and supplies through logistics support to district pharmacies;
• Apply IT solutions to improve drug and human resource management at the district level;
• Improve immunization coverage through service integration, monitoring, and outreach support;
• Conduct community mobilization campaigns to increase demand for family health services;
• Build the capacity of community health workers to treat common childhood illnesses (e.g., malaria, diarrhea, and pneumonia) in the home;
• Improve the prevention of obstetric fistula while strengthening case detection, referral for treatment, and re-integration;
• Support the creation of a national supervision system for malaria case management;
• Focus on the prevention and repair of obstetric fistula and improvements in vaccination coverage in Zou/Collines;
• Pilot emergency triage assessment and treatment for children under five at 13 hospitals nationwide; and
• Introduce intermittent preventive treatment of malaria during pregnancy at all health facilities nationwide.

Achievements

• Identified and referred 67 cases of obstetric fistula, with an overall success rate of 79% in a four-month period.
• Evaluated health system management in Zou/Collines, providing information on the current level of indicators calculated in 2006 to determine the progress PISAF had made.
• Designed logistics management software and a web platform, Medistock, and scaled it up to the national level; all zone warehouse managers were using it for drug management at project close-out.
• Designed human resource management software, called LogiGRH, and implemented it in Zou/Collines.
• Completed six collaboratives to improve clinical services and health care management, resulting in an integrated family health package in all hospitals and public health centers in Zou/Collines. Key results include 1) reducing postpartum hemorrhage from 2.0% to 0.7% by introducing a protocol (the Active Management of the Third Stage of Labor) in hospitals and 2) increasing the provision of essential newborn care from 9% in January 2008 to 73% in December 2010.
• Helped 52 health facilities in Zou/Collines increase by 52% their performance in treating febrile children under five with artemisinin combination therapies (ACTs): The proportion of children over five and adults who had been diagnosed with malaria through a rapid diagnostic test and were correctly treated with ACTs increased by 24% in one year.
• Facilitated the creation of 57 mutuelles to improve financial access to health services and spearheaded a national forum to enhance the professionalism of these organizations and promote collaboration among them.