Reducing Malaria Morbidity and Mortality in Benin – the ARM3 Story [French]

Funded by the American people and
implemented by MCDI, the ARM3 project, launched in 2011, aimed to accelerate the reduction of mortality and morbidity due to malaria in
all regions of Benin. To achieve this, the team implemented
many activities in all regions of the country in close collaboration
with the National Malaria Control Program. In this domain, ARM3 has done a great amount of work, and has accompanied us in our mission. They assisted us in training health workers. 1571 public sector health workers were trained in malaria prevention. 752 health workers and 556 laboratory technicians were trained in malaria diagnostics. 2384 public sector health workers were trained in malaria case management. 1456 community health workers were also trained. 15 government employees from departmental health oversight committees were trained. ARM3 provided technical assistance to the national pharmaceutical supply chain concerning how it handles malaria commodities. It was new ground for all the links of the supply chain, even at the level departmental health committees. The work of ARM3 in terms of training, coaching, and supervision, all of their work, helped us to strengthen our capacity and to improve the management of malaria commodities. We know that the health of the general public, when it comes to for malaria case management, is largely provided by the public sector. The private sector handles around 40% of consultations and is not much involved. Therefore, there exists a gap in service delivery that ARM3 has contributed in filling. But to go further, ARM3 has worked to fill other gaps in human resources and communication. There are also problems related to utilizing strategies for workers at each level of the health system. Workers at health centers, who are often in contact with the community, They are our resource on the ground, and we have to use them in determining which communication strategy we should use in order to obtain our target. In the beginning of the project, in 2012, we started to progressively introduce the malaria rapid test at the community level. We had the chance to train selected communtiy health workers on how to use the Rapid Diagnostic Test (RDT). And I assure you that now the RDT is at the heart of community health… in a way that is easy, fast, and professional. It must be said also that ARM3 brings medical supplies to the community level. It is because of these commodities, including Coartem (an antimalarial), that we are able to supply the community health workers. Before the project came, the community was suffering. There was stagnation in the implementation of community activities. Because of ARM3, we were able to restart monthly evaluation groups. Another important thing is the involvement of village leaders. Village leaders are now directly collaborating with community health workers in villages and hamlets. Now we are going further. Community groups are also getting involved, and now the local elected officials are getting involved due to the sustainability of the project. Concerning the rate of malaria, which was very high, we have seen a reduction. It is true that it is difficult to say that this is due the work of only one project, but we have seen that since the arrival of ARM3 that the curve has begun to go down. And, we have had a substantial decrease in malaria-related morbidity. We have also seen, over the past 3 months, that the infant mortality rate is still quite high; however, this is due to other seasonal factors. What does all of this mean? It means that the communities have changed. They seek out healthcare earlier, and they take medicines that prescribed for malaria. Therefore, I can say the rate is decreasing, even though I haven’t done qualitative community level studies. But, these indicators, when they decrease, we know that a community has changed its behaviors. These actions have already had tangible impacts, and measurable impacts. I can say that in 2017, according to our statisticians, the statistics for the
Sabadoubanthé health zone reveal that cases of serious malaria stand at 2%. In 2013, 5% of our cases were serious malaria. I would like to explain that this truly shows the importance and the effects of these interventions and the community health workers. ARM3 trained us on interpersonal communication and malaria case management, as well as how to use RDTs, or rapid diagnostic tests. Before we had the tests, when patients would come exhibiting symptoms, the symptoms that we knew to be those of malaria, we would give them anti-malarial medication. But sometimes, it was not actually malaria. Since we have received RDTs we are able to determine quickly. With the RDT, we know instantly “this is malaria, or this is not malaria.” This provides guidance in diagnosis. The greatest beneficiaries of the project are the grassroots population who have had their daily lives transformed progressively as the disease has been better controlled. Before the bednet distribution, many of our children were often sick, and when we would take them to the hospital, the health workers would say that it was malaria. Some of the children had to be taken to Natitingou, and it was said that their health was declining. After the free distribution of bed nets, the griots were involved, and they passed from hamlet to hamlet to raise awareness in the communities so that they could effectively use the bed nets that they had received. After this awareness raising campaign, everybody understood. Now the population sleeps under the bed nets that they received. Thus, the number of malaria cases has gone down dramatically. When we go to the hospital, we pregnant women are put in groups and taught about malaria. Also, in our consultations we are given free malaria prophylaxis medication to protect our babies and ourselves from malaria. Overall, this assistance has helped us keep our babies safe, avoid miscarriages, stillbirths, and also help with the expenses related to treating malaria. These activities are truly important. Today we have at our side a person that we call a community health worker who assists us and provides consultations for our children. Sometimes, she even makes house calls. She gives us plenty of advice, like how to use compresses to treat fevers and when to take children to the hospital. When we have consultations with her, and the rapid test is positive, She directs us to the hospital. However, sometimes that is not necessary when her first aid treatment is effective. Before we received the bed nets and the awareness campaigns, people were sick all the time, especially in the rainy seasons. Then it was much worse, and all the money that we made was spent on healthcare. But since awareness has been raised and we have received the bed nets, we sleep under the nets each night, and malaria has become rare. Being that ARM3 is ending in 2018, the least that we can say is that the principal targets have been achieved and the beneficiaries are not hiding their satisfaction and their recognition. First of all, I thank ARM3. I thank the American people, and I thank all those who intervene in health, above all those who have assisted us in this project which was funded by the American people. Words fail me in my attempt to thank the American people, because this is a project that came along during a period in which we did not have any partners. Sabadoubanthé didn’t have any partners. Apart from the allocations from the national budget that we received, we had no partners. Thank you, truly! Good work! May God protect you! We thank you very much! I would like to say thank you to ARM3 and to the American people, because I am very happy. May God watch over you and come to your aid! Due to your actions against malaria,
we are feeling good. I am very happy. But the fight against malaria doesn’t stop here. The final victory over this deadly disease depends on the sustainability of the achievements made by the ARM3 project and an even larger change in the behaviors of the Beninese people. While waiting for this, we join our voice with those of the beneficiaries of the ARM3 project in saying thank you to the American people.

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