Summary & Key Points
"Malaria, HIV infection, and Tuberculosis, being major public health issues, are among the diseases against which the State of Côte d'Ivoire, through the Ministry of Health, Public Hygiene and Universal Health Coverage (MSHPCMU), has been actively fighting for decades."
Malaria, HIV infection, and Tuberculosis are major public health issues and are among the diseases against which the State of Côte d'Ivoire, through the Ministry of Health, Public Hygiene, and Universal Health Coverage (MSHPCMU), has been actively fighting for decades. However, despite the stated commitment to eradicate them, challenges persist, particularly regarding access to healthcare, especially in rural areas.
To effectively combat these three diseases, the PAC-CI Program, through the PROXISANTE project, developed and implemented strategies aimed at improving the integration of HIV, malaria, and tuberculosis prevention and care into the community health system through Community Health Agents (CHAs). This project was implemented in three localities of the Toumodi Health District (Kpouébo, Djékanou, and Kokumbo) from 2021 to 2023, thanks to a collaboration between the PAC-CI Program and the Community Health Directorate (DSC), with financial support from the 5% Initiative of Expertise France.
To be closer to the infected and affected populations in rural areas, PROXISANTE relied on task delegation to 24 CHAs who were recruited from the pool of the Toumodi Health District and trained to provide home care to 1,200 households, under the supervision of the nurses of the health areas they depend on, the EPE NGO, and the District.
It was to share the final results of this study that the PAC-CI Program invited, on December 2, 2024, in the Thérèse N’DRI-YOMAN room, the various stakeholders to participate in the feedback meeting to assess the project, highlighting its strengths and weaknesses, and to make practical recommendations for scaling up.
Present at this meeting were the leaders of the PAC-CI Program (Dr. Raoul Moh, Executive Director, and Dr. Patrick Coffie, Scientific Director), project managers, Dr. Maika Bangali, head of the PROXISANTE project, etc., and stakeholders (Dr. Françoise Kadja, Director of Community Health and Health Promotion (DSCPS), the representative of the Toumodi Health District, the representative of the National Tuberculosis Control Program, Mrs. Liliane Kouassi, representative of the EPE NGO, the representative of the 24 CHAs, and a project beneficiary).
After the inaugural speeches of Dr. R. Moh and Dr. F. Kadja, Dr. Philipe Msellati, project manager at the PAC-CI Program, first recalled the protocol of this study, emphasizing the objectives on which PAC-CI has committed: Identifying, within the target populations, cases of uncomplicated malaria and treating and referring cases of non-malarial fever or severe malaria to the health center for care; Identifying suspected cases of tuberculosis and referring suspected cases to health centers for diagnosis and care of confirmed tuberculosis cases; Identifying people infected with HIV, integrating them into care, and reinforcing adherence to treatment; and Contributing to the reduction of maternal, infant, and juvenile mortality in the three localities.
Following him, the representative of the Toumodi Health District presented the main programmatic results of the project, highlighting the contribution of the PROXISANTE project in achieving the District's objectives. This was made possible, first, through the evaluation of the acceptability of said project by the 1,200 households distributed among Kpouébo, Djekanou, and Kokumbo.
On this subject, the sociologist Joël Djaha, a researcher at the PAC-CI Program, highlighted the activities of the CHAs, including the establishment and facilitation of group discussions. This socio-anthropological approach not only explained the merits of the project to the beneficiaries but also reinforced awareness messages, identified social perceptions of the targets regarding the various themes addressed in the study, and encouraged their involvement. The representative of the CHAs will confirm the essential role played by their peers, the relevance of the project's implementation methodology, and its impact on the beneficiaries.
The Coordinator of the Espoir Pour Enfant (EPE) NGO shared with the assembly the role of her organization in this study. This primarily involved ensuring effective monitoring of project activities across all localities. This work was made possible through close collaboration with the health and prefectural authorities of the District.
Finally, Dr. Bangali presented the final results of the study. She immediately showed that these results are in line with the targets set at the beginning of the project. She emphasized that PROXISANTE positively impacted certain health indicators of the district, such as the mortality rate due to severe malaria, the maintenance of patients under ART in care twelve months after treatment initiation, and the number of people knowing their serological status.
However, some weaknesses were identified. These include the constant adaptation of the initial strategy in relation to the realities on the ground to ensure the smooth running of activities and the achievement of the set targets, and the identification of presumed cases of tuberculosis. This second weakness could be linked to an insufficient understanding of the signs to look for and the methodological choice concerning the study population.
To conclude, the Director of the DSCPS indicated the next steps to be taken to ensure the sustainability of the achievements of this important project. It will be a matter of presenting the project results to the office of the Minister of Health, Public Hygiene, and Universal Health Coverage in the coming days, so that he can familiarize himself with them and propose the way forward.
