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 remain major public health challenges, and the Ivorian government, through the Ministry of Health, Public Hygiene, and Universal Health Coverage (MSHPCMU), has been actively combating these diseases for decades. Despite strong efforts to eradicate them, persistent challenges remain, particularly in accessing healthcare, especially in rural areas.
To effectively combat these three diseases, the PAC-CI Programme, through the PROXISANTE project, developed and implemented strategies to improve the integration of HIV prevention and care, malaria, and tuberculosis into the community health system via Community Health Workers (CHWs). The project was implemented in three locations within the Toumodi Health District (Kpouébo, Djékanou, and Kokumbo) from 2021 to 2023, in collaboration with the PAC-CI Programme and the Directorate of Community Health (DSC), with financial support from the 5% Initiative of Expertise France.
To bring services closer to infected and affected populations in rural areas, PROXISANTE relied on task delegation to 24 CHWs recruited from the Toumodi Health District pool and trained to provide home-based care to 1,200 households, under the supervision of nurses from the health areas they serve, the EPE NGO, and the District.
On December 2, 2024, the PAC-CI Programme invited stakeholders to the Thérèse N’DRI-YOMAN Hall to share the final results of this study during a debriefing meeting. The goal was to assess the project’s implementation, identify strengths and weaknesses, and make practical recommendations for scaling up.
Attendees included PAC-CI Programme leaders (Dr. Raoul Moh, Executive Director, and Dr. Patrick Coffie, Scientific Director), project managers, Dr. Maika Bangali, PROXISANTE Project Manager, and stakeholders such as Dr. Françoise Kadja, Director of Community Health and Health Promotion (DSCPS), the Toumodi Health District representative, the National Tuberculosis Control Programme representative, Ms. Liliane Kouassi, EPE NGO Representative, a representative of the 24 CHWs, and a project beneficiary.
Following opening remarks by Dr. R. Moh and Dr. F. Kadja, Dr. Philippe Msellati, PAC-CI Project Manager, outlined the study protocol, emphasizing the objectives PAC-CI committed to: identifying cases of uncomplicated malaria and referring non-malarial fever or severe malaria cases to health centers for care; identifying suspected tuberculosis cases and referring them for diagnosis and treatment of confirmed cases; identifying people living with HIV, integrating them into care, and strengthening treatment adherence; and contributing to reducing maternal and child mortality in the three locations.
Next, the Toumodi Health District representative presented key programmatic results, highlighting PROXISANTE’s contribution to achieving the District’s health goals. This was made possible, in part, by evaluating the project’s acceptability among the 1,200 households across Kpouébo, Djékanou, and Kokumbo.
Sociologist Joël Djaha, a researcher with the PAC-CI Programme, highlighted the CHWs’ activities, particularly group discussion sessions. This socio-anthropological approach not only helped explain the project’s rationale to beneficiaries but also reinforced sensitization messages, identified social perceptions of the target groups regarding the study’s themes, and encouraged their involvement. The CHW representative confirmed the essential role of peers, the relevance of the project’s implementation methodology, and its impact on beneficiaries.
The Coordinator of the NGO Espoir Pour Enfant (EPE) shared her organization’s role in the study, which primarily involved ensuring effective monitoring of project activities across all locations. This was achieved through close collaboration with health and prefectural authorities in the District.
Finally, Dr. Bangali presented the study’s final results, noting that they aligned with the project’s initial targets. She highlighted that PROXISANTE positively impacted certain district health indicators, such as the mortality rate due to severe malaria, the retention of patients on ART 12 months after treatment initiation, and the number of people aware of their serological status.
However, some weaknesses were identified, including the need to constantly adapt the initial strategy to field realities to ensure smooth operations and achieve targets, as well as the identification of presumptive tuberculosis cases. The latter issue may stem from insufficient understanding of the signs to look for and methodological choices regarding the study population.
To conclude, the DSCPS Director outlined next steps for sustaining the project’s achievements, including presenting the results to the Minister of Health, Public Hygiene, and Universal Health Coverage in the coming days so that the Minister can review them and determine the way forward.
