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www.chs-urc.org

Empowering communities. Improving systems.

Innovative Strategies for Community Engagement CHS Benin Child Survival Project

Sara Riese, MA, MPH


Context • CHS has long history in Benin and with the

community health system • Prior to 2010, Benin had no clear community

health policy

• In 2010, guidance was released clarifying the CHW package, including motivation

• CHS implemented the USAID-funded Partnership for Community Management of Child Health (PRISE-C) project in Benin from 2010-2014


Community System • Create conducive

environment for promotion of MCH

• Improve knowledge, attitudes, and practices towards MCH

Formal Health System • Improve support to

CHWs through formal health system mechanisms (supervisors)

CHWs

Project Strategy


Innovation

• Adapt the quality-improvement collaborative approach for implementation at community level

• Test it (in conjunction with financial incentives) in comparison with the financial incentives alone


Hypothesis

• Improved overall performance and retention through: – data-driven quality improvement

methods – non-monetary incentives – regular structured engagement of

the community in the CHWs work


Implementation (Project side) • Formative research

– To identify members of the Quality Improvement Team

• Quality Improvement Training – 5 days

• Quarterly Learning Sessions – 4 collaboratives

• Regular coaching and supportive supervision

• Monitoring and Evaluation


Implementation (Village side)

• Minimum once a month meeting of Quality Improvement Team to review indicators and identify strategies to improve – Data from CHW registers

• Implementation of strategies chosen • Participation in Quarterly Learning

Sessions to share results of strategies and learn from other teams


Best Practice Indicators • % of health education talks held • % of children under 5 who had a home visit from a

CHW in the quarter • % of children 6-59 months correctly treated for malaria • % of children 2-59 months correctly treated for diarrhea • % of children 2-59 months correctly treated for ARI • % of referrals for malaria, diarrhea, ARI, and

malnutrition in children 2-59 months which were justified

• % of children from 0-59 months who live in a household with a handwashing station at/near the latrine

• % of infants from 0-6 months who are exclusively breastfed


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2 3 4 5 6 7 8 9 10 Quarter

Proportion of referrals which were justified

Collaborative 4


Results • CHWs who participated in the

combined intervention had higher odds of achieving a high performance score during the project period than those who received only financial incentives.

• Community support and engagement was a key determinant of high CHW performance.

• Retention was not impacted by the collaborative + financial incentive intervention.


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0.1

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0.9

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1 2 3 4 5 6 7 8 9 10

CHW

Per

form

ance

Sco

re

(Max

imum

of 1

)

Quarter

CHW mean performance scores over time

SAO (Intervention) DAGLA (Control) QI Training

in SAO



Lessons Learned • Providing a structure and

mechanism for engagement of the community with the CHWs can result in improved performance

• Need for sustained supportive supervision

• Need for adaptation of aspects of intervention – Data discussions with non-numerate

audience



Discussion Question

Do you think we would have found similar performance improvements if we had developed structures and mechanisms for CHWs to engage with existing community bodies, such as village health committees?


Thank you

Marthe Akogbeto and the PRISE-C team CHWs QIT members

Government & Nonprofit

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