MCHIP Leader with Associate Award GHS-A- 00-08-00002-00, Cooperative Agreement No. 656-A-00-11 -00097-00 FY2014 3rd Year of the Project Quarterly Report: April 1 to June 30, 2014 1. Project Duration: July 431, years 2014 1 2. Starting Date: April 12, 2011 3. Life of project funding: $29,835,179; will increase to $32,835,179 once Modification 6 of the Cooperative Agreement is fully executed. 4. Geographic Focus: National 5. Program/Project Objectives The goal of the MCHIP/Mozambique Associate Award is to reduce maternal, newborn and child mortality in Mozambique through the scale-up of high-impact interventions and increased use of MNCH, FP/RH, and HIV services. The project has eight objectives: • Objective 1: Work with the MOH and all USG partners to create an enabling environment at national level to provide high-impact interventions for integrated MNCH / RH / FP services in the community and Health Facilities • Objective 2: Support efforts of the MOH to increase national coverage of high impact interventions for MNCH through the expansion of the MMI, in collaboration with USG partners in all provinces • Objective 3: Support the MOH to strengthen the development of human resources for the provision of basic health services and comprehensive Emergency Obstetric and Neonatal Care and RH • Objective 4: Support the expansion of activities for prevention of cervical and breast cancer using the single-visit approach and assisting in the implementation of "Action Plan for the Strengthening of and Expansion of Services for Control of Cervical and Breast Cancer" of the MOH • Objective 5: Assist in the development, implementation, and management of FP/RH services for selected health facilities • Objective 6: Promote and test the introduction of neonatal circumcision services in selected health units • Objective 7: Partnerships developed and strengthened (MOH and all USG partners) at the national level to promote high impact integrated MNCH services • Objective 8: Work with the MOH and all USG partners to define, implement and monitor standards of care at the point of service in essential areas 6. Summary of the reporting period Objective 1: Work with the MOH and all USG partners to create an enabling environment at national level to provide high-impact interventions for integrated MNCH / RH / FP services in the community and Health Facilities IR1.1 Strengthened policies and planning processes for MNCH/RH/FP Flowcharts During Quarter 3, MCHIP received approval from the Ministry of Health to move forward with the printing of the package of flowcharts for reproductive health, maternal and neonatal health, post-partum and post-natal care, and organization of integrated care for women and children. USAID has requested to conduct a final revision of the flowcharts prior to printing. Once MCHIP receives this feedback, the project will conduct a public bid for printing of the package of flowcharts for all Model Maternity facilities, as well as printing of selected flowcharts as posters for display in health facilities. 2 Family Planning During Quarter 3, MCHIP supported the MOH to finalize the Acceleration Plan to Increase the Utilization of FP Services and Modern Methods of Contraception. This plan was approved by the Ministry of Health during the reporting period. Maternal and Newborn Health During Quarter 3, MCHIP worked in collaboration with the MOH and other partners to develop the framework and objectives for the Plan to Accelerate the Operationalization of the National Integrated Health Plan, with a focus on key, short-term activities to reduce maternal and newborn morbidity and mortality. MCHIP will provide technical assistance in Quarter 4 to write this plan, working closely with MOH counterparts and key SWAp members. Women & Child Health Department During Quarter 3, MCHIP and the Ministry of Health conducted interviews for three key advisor positions for the Ministry of Health’s Women and Child Health Department (MOH – National Directorate of Public Health, including an MNH Advisor, Family Planning Advisor, and Logistics Advisor. Successful candidates were identified for all three positions, and the Family Planning Advisor and Logistics Advisor were contracted by MCHIP and seconded to the MOH. The MNH Advisor will be contracted and will begin in Quarter 4. IR1.2 Implementation of consensus Community Mobilization strategy in support of MNCH/SRH/FP During Quarter 3, MCHIP supported the creation of 29 new Community Health Committees (CHC) in Maputo Province (2), Sofala (3), Manica (1), Cabo Delgado (14), and Inhambane (9). Twenty-eight of these CHCs developed action plans based on identified priority health problems in their communities, which included the following issues: • Poor quality care and long waiting time to receive care at health facilities due to the insufficient number of health care workers • Births outside of the health facility because women work in the fields far from their homes and some of them go into labor there. When they return home from the fields, their husband or mother-in-law may not be there and therefore they do not have permission to leave for the health facility and end up giving birth at home. • Malaria • Malnutrition • Snake bites • Thrombosis • Conjunctivitis and matequenha/tunguiasis(flea-related illness) • Anemia • Difficulty in continuing methods of family planning because of the long distances that women have to walk to collect more pills. In order to respond to some of these identified problems, CHCs included the following priorities in their action plans: • Construction of waiting homes for pregnant women • Home visits to distribute mosquito nets and to encourage their correct use • Nutritional education • Promotion of prevention methods for malaria, thrombosis, diarrhea, conjunctivitis, and matequenha 3 • In relation to family planning, the CHCs proposed to train TBAs and APEs in community-based distribution of FP methods (including pills), as well as a transportation plan for community members to arrive at health facilities. During this quarter, focus was placed on consolidating existing Co-Management Committees. Only one new co-management committee was created during this quarter in Maciene Health Center (Gaza), a decision made by the Provincial Health Directorate. In order to guarantee a successful consolidation in the implementation of the community mobilization strategy, MCHIP supported the implementation of the following coordination meetings between the District Health Services, Administrative Post Chiefs, health facilities, partners, community health committees, and co-management committees: • Gaza: A total of 30 participants, including health technicians from all peripheral health facilities, program heads (MCH, Vaccinations, Oral Health, Adolescent Health, Pharmacy), the Director of the Rural Hospital, the head of community health, the administrative post chief, local chiefs, and partners (Pathfinder, World Relief and MCHIP), attended the coordination meeting. • Manica: One coordination meeting with 30 participants was held in Chimoio, and another was held in Manica with 13 participants • Tete: A coordination meeting was held in Tete City with 80 community members, 17 CHC members, the Medical Chief and Provincial Health Director, and members of the Tete Provinicial Hospital’s Humanization Committee. A coordination meeting was also held in Mutarara with community members from Tranquino, representatives from the Mutarara Rural Hospital, and MCHIP. • Cabo Delgado: A provincial community mobilization meeting was held with 34 participants, including SESP representatives from all districts in the province and one community member from the Co-Management Committee of each district. Also in Quarter 3, two meetings were convened by the district health services in Pemba City, in which 25 health technicians, health facility managers, MCH nurses, and partners were present. The objective of these meetings was to analyze district-level health indicators and coordination activities of partners working at district level in the province. IR1.3 Strengthened Health Information System for MNCH/RH/FP Data collection tools and registers In Quarter 3, MCHIP printed copies of the finalized registers and monthly summary forms for the MOH, which were then submitted to the Minister of Health for his review and approval. MCHIP is currently coordinating with the MOH on the specifications for the public procurement bid for mass printing of the new registers. Also during the reporting period, MCHIP, in collaboration with other partners, provided support to the MOH to develop and harmonize the training packages for the each of the register books. In addition, during the reporting period, MCHIP worked with the MOH, USAID, CDC, and other partners to define a guide for the monitoring of the implementation of the SRH/MNCH registers. The objectives of the monitoring of the implementation of these instruments are the following: • To assess the level of health providers’ knowledge regarding the use/completion of information in the new SRH/MNCH registers; • To assess health providers’ attitudes regarding the use of the new registers; 4 • To assess the successes and challenges of reporting information by cohort; • To assess the consistency of aggregate data reported at various levels and to identify challenges, successes, and lessons learned in the implementation of the revised registers. Technical Assistance to Strengthen Provincial-level M&E Capacity During Quarter 3, the MCHIP Monitoring and Evaluation Team conducted