Community-based quality of care for malaria control in Benin

BACKGROUND. Malaria causes 10,000 to 13,000 deaths of under-five children in Benin every year (i.e. 1/3 of deaths in this age group). Since many deaths occur in the community, effective interventions must focus on optimizing community prevention and care. THE INITIATIVE. In 2006, Plan Benin, an international, child-centered humanitarian organization, allied with the USAID-funded QAP/HCI project to adapt a successful facility-based method for quality assurance to community settings. QAP/HCI supported Plan Benin to (a) to establish volunteer quality improvement teams in 20 villages in the Couffo Department; (b) to train these teams in malaria prevention, treatment and care and (c) to help team volunteers collect and analyze data to assess the quality and coverage of their own village programs. Village teams met every few months to share experiences, results and lessons learned and to plan activities based on their findings and learning from other teams. INITIAL FINDINGS. While the average use of bed nets was overall very high (>80%), considerable heterogeneity existed between villages and between mothers and children. Moreover, community recognition of malaria danger signs, appropriate treatment and care seeking was very poor. INITIAL RESPONSES. Some village teams prioritized emergency transport and established solidarity funds by local subscription; others organized more favorable transport rates with local vehicle owners. Team volunteers held nightly home visits to distribute nets and provide counseling. CONCLUSIONS: This quality assurance method is effective for helping communities learn from each other and to find rapid, feasible and hopefully sustainable local solutions. Results from its midterm evaluation will be presented in San Diego.