Community involvement reduces infant deaths in Benin

 

Bamako Initiative revitalizes primary health care in Benin

Community involvement in primary health care in Benin has helped reduce child death rates, boost immunization coverage, and increase access to antenatal care.

In the early 1980s in Benin, a child had a slim chance of survival and good health. At the time, Benin had one of the highest under-five death rates in the world: 203 deaths for every 1000 live births. And only one-third of women had access to antenatal care.

Less than 30% of the population had access to functioning primary health care (PHC) services and the government spent only about US$ 1.50 per capita a year on health.

What changed the situation dramatically was the introduction of a series of community-based health system reform strategies, which helped make primary health care more effective and equitable. Innovations included the reliable supply of affordable essential drugs combined with community co-management, cost-sharing and community-based monitoring of an integrated minimum package of PHC services. These include immunization, health and hygiene education, treatment of minor illnesses, and maternal and child health care.

When UNICEF provided substantial funding for the Expanded Programme on Immunization (EPI) in 1985 to help achieve the objective of Universal Child Immunization by 1990, Benin used the funds not only to improve immunization but also to revitalize their PHC systems.

The health system reform strategies were subsequently formally adopted in 1987 in Bamako by African Ministers of Health, UNICEF and WHO, as the Bamako Initiative. By 1990, the strategies had helped revitalize the entire existing primary health care network in Benin and the country achieved the objective of reaching 75% of children through the national immunization programme.

When a combined economic and political crisis hit West Africa in the early 1990s and undermined the gains made in EPI, Benin -- thanks to the Bamako community-based initiative -- continued to achieve high immunization rates and significant reductions in death rates among the under-fives.

As a result, by 1998, death rates among infants and children under five were down by nearly 20%, immunization coverage was being sustained at around 80%, and about 65% of women were using antenatal services.

Within a few years of its inception, the Bamako Initiative was adopted widely throughout West and Central Africa, but not always as successfully as in Benin. The remaining challenge in Benin is to build on the Bamako Initiative experience in order to accelerate large scale implementation of other health initiatives such as Roll Back Malaria, Stop TB, and the International Partnership Against AIDS in Africa.

Bamako Initiative

A recent analysis of the results achieved through the Bamako Initiative highlights the key conditions for success:

• A health system reform approach that addresses service delivery, drug supply, financing, and management in an integrated and coherent way.
• Strong community involvement in planning, managing, monitoring, and problem-solving, especially regarding supply and demand of an integrated package of PHC services.
• Broad-based partnerships that include government, communities, researchers, and donors relying on frequent and frank dialogue and building on the comparative advantage of each.
• Flexibility in approach and regular adaptation of strategies to meet changing needs.
• Strong networking among public health professionals and community leaders, both within and between countries, in a cooperative spirit that facilitates learning from experience, peer review, mutual support, and positive competition.