In recent years, the Faculty of Medicine has played a key role in assisting Benin in battling infectious diseases, such as hepatitis B or those attributable to antibiotic resistance, which can cause widespread death across the country.
A World Health Organization report (2020) states that nearly 50% of deaths in Benin were attributable to communicable diseases between 2014 and 2018.
Since 2018, the Faculty’s Francophone Affairs has led a continuing education program in primary health care focused on the prevention of communicable diseases in Benin. The project is the result of a collaboration between the Fondation Mérieux, the main funder of the project; the Faculty of Medicine; and the Plateforme du secteur sanitaire privé du Bénin (PSSP) (Private Health Sector Platform in Benin). Nearly half of health care facilities in Benin are in the private or religious sector.
Dr. Marie-Hélène Chomienne, associate professor and clinical investigator at the Department of Family Medicine as well as a scientist and founding member of the Institut du Savoir Montfort, has been involved in the Faculty’s Benin projects since 2003. She explains the origins of the program, known as the Mérieux Project.
“The idea arose during a discussion four years ago between Dr. Jean Roy, then vice-dean of Francophone Affairs and director of the Medicine and the Humanities Program, and Mr. Alain Mérieux, head of a large French entrepreneurial family in the biomedical sector and director of the Fondation Mérieux,” says Dr. Chomienne.
The Fondation Mérieux has been fighting infectious diseases in developing countries, including Benin, for some 50 years and has led or funded a large number of initiatives in this regard.
In 2018, the Canadian team travelled to Bénin and met with Dr. Dossou Gbété, chair of the PSSP and infectious disease specialist, to define the thematic content of the training program, and its adaptation to local realities. All partners signed an agreement outlining the terms and conditions of the training program and the roles and contributions of each partner.
The training program is aimed at physicians and other health professionals, and features workshops hosted by clinicians associated with the Faculty of Medicine or Hôpital Montfort. Interactive and designed for active learning, the workshops cover such topics as the prevention of infection, hepatitis B, antibiotic prophylaxis (treatment prior to an infection) and antimicrobial resistance. Woven in are discussions relating to professionalism, ethics and interprofessional collaboration. Program participants are required to develop an intervention plan they can then implement in their respective clinics.
The first two weeks of training were held in Benin’s economic capital city of Cotonou in 2019. Each session brought together about 30 family physicians, specialists and other health professionals from both the public and private sectors. Due to the COVID-19 pandemic, the program was redesigned in 2020 for distance learning. The training was twice offered virtually in 2021, and two other such sessions will follow in 2022, with the hope of returning to Benin toward the end of the year.
To date, approximately 80 health professionals have undergone the training. Program evaluation results indicated that participants felt extremely positive about the training in terms of learning methods, content, expansion of knowledge, and tangible impact in the clinical setting.
“I was able to improve my knowledge and acquire new methods with this training,” says one program participant on the evaluation form. “I am now going back home full of resolutions, especially in terms of improving sanitary training.”
Dr. Chomienne says the effectiveness of the training and the impact at the clinical level have exceeded initial expectations. Through presentations and advocacy with their clinical staff and administration, as well as in their children’s schools, program participants have promoted, among other things, the introduction and reinforcement of hygiene measures (installation of handwashing stations, new protocols for the cleaning of treatment rooms, training of the population in hand washing, et cetera), an end to systematic prescription of post-partum antibiotics, and standardized vaccination of newborns against hepatitis B. And one unanticipated impact of the training, says Dr. Chomienne, is that it made participating clinics COVID-ready.
By improving prevention measures of clinics and health care settings across Benin, the training will ultimately benefit the entire population, not to mention have a country-wide influence, as the program was discussed on national television during prime time.
The Mérieux Project is in line with the University of Ottawa's strategic priorities with respect to Francophonie and its focus on Francophonie in Africa. This alignment extends to the priorities of the Faculty of Medicine's strategic plan, Leading Innovation for a Healthier World, particularly with respect to its priorities of research, Francophonie, and internationalization and global health. The funding received from the Fondation Mérieux should allow the program to continue until 2023.
The Mérieux Project is an expansion of an existing partnership between Benin and the Faculty of Medicine. For almost 20 years, the Faculty has collaborated with universities, health care providers and public entities in Benin—a rich partnership that has netted annual internships for medical students and a wealth of collaborative research projects.
A team from the Faculty, the PSSP, and other Beninese and Canadian partners—some old, some new—are also collaborating on a project touching on social perinatal care (périnatalité sociale), aimed at reducing maternal and neonatal health mortality and morbidity in Benin.
“Such spin-off initiatives from the Merieux project are expanding the Faculty’s presence in Benin,” says Dr. Chomienne.
“The Faculty’s strong and vibrant partnership with Benin holds much promise for its commitment to its priorities in the coming years.”
All other photo credits: Daniel Hubert
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The Bénin Program Fund covers travel costs and purchase supplies needed for activities in Benin.
The Mérieux Project: Adapting training for concrete change
Program evaluation was incorporated into the project at the design stage, facilitating the process of modeling the program and planning training and evaluation activities. In order to report on the relevance and effectiveness of the training, a formative evaluation was conducted for each week of training. By doing so, the content and delivery of the training can be improved from one iteration to the next. In addition, the evaluation methodology included site visits six months after the training to observe the extent to which the content taught and synthesis activities such as the development of an intervention plan contributed to concrete changes.
Evaluation activities also identified gaps in the underutilization of laboratory testing by the clinics from participating clinics, resulting in overuse of antibiotic therapy. As such, a research component was added to the project, which will provide participating clinics with ways to adapt their antibiotic therapy practices to best practices that target the bacteria of concern and then establish the respective susceptibility testing. Recommendations on the best choices of antibiotic therapy in different settings will then be established.