SCS Guinea: Citizen Involvement in Health Governance
Funding provided by: United States Agency for International Development Cooperative Agreement No. AID-675-LA-17-00001
Quarterly Report: Fiscal Year 2019, Quarter 2: January 1, 2019 - March 31, 2019
Submitted: April 29, 2019
Submitted to:
Mark Koenig Agreement Officer Representative USAID/Guinea [email protected]
This report was prepared with funds provided by the U.S. Agency for International Development under Cooperative Agreement AID-675-LA-17-00001. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development.
TABLE OF CONTENTS
ACRONYMS LIST ...... ii SECTION A: PROJECT OVERVIEW ...... 1 PROJECT DESCRIPTION ...... 1 SUMMARY OF QUARTERLY ACTIVITIES AND RESULTS ...... 2 SECTION B: ACTIVITY IMPLEMENTATION ...... 4 IR 1: OPPORTUNITIES EXPANDED FOR ELECTED AND APPOINTED OFFICIALS AND CITIZENS TO ENGAGE IN CONSTRUCTIVE DIALOGUE ...... 4 IR 2: MORE EFFECTIVE CIVIC ADVOCACY FOR HEALTH REFORM ...... 15 SECTION C: ACTIVITY PERFORMANCE MONITORING, EVALUATION AND LEARNING ...... 22 SECTION D: MANAGEMENT AND ADMINISTRATIVE ISSUES ...... 29 SECTION E: LESSON(S) LEARNED ...... 30 SECTION F: PLANNED ACTIVITIES AND EVENTS FOR NEXT QUARTER ...... 31 ANNEX ...... 34
SCS-Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page i ACRONYMS LIST
AFJ Association des Femmes Journalistes de Guinée (Association of Women Journalists in Guinea) AGIL Alliance Promoting Governance and Local Initiatives AGUIFPEG Association Guinéenne pour l’Implication des Femmes dans le Processus Electorale et la Bonne Gouvernance or Guinean Association for the Involvement of Women in the Electoral Process and Good Governance AIDE-Guinée Initiatives, Actions and Development for Guinea AMELP Activities Monitoring, Evaluation and Learning Plan BSD Bureau de Stratégie et Développement (Office of Strategy and Development) CECIDE Centre du Commerce International pour le Développement (Center for International Trade for Development) CEGUIFORD Centre Guinéen pour la Formation, la Recherche et le Développement (Guinean Center for Training, Research and Development) CENAFOD Centre Africain de Formation pour le Développement (African Training Center for Development) CIHG Citizens’ Involvement in Health Governance CJMAD Comité Jeunes Mon Avenir D’abord (Youth Committee My Future First) CNERS Comité National d’Ethique pour la Recherche en Santé (National Ethics Committee for Health Research) CNOSCG Conseil National des Organisations de la Société Civile Guinéenne (National Council of Guinean Civil Society Organizations) COSAH Comité de Santé et d'Hygiène (Health and Hygiene Committee) CSO Civil Society Organization DO Development Objective EU European Union FEDIPHU Femmes pour le Développment Intégré et la Promotion Humaine (Women for Integrated, Human Development) FEGUIPAH Fédération Guinéenne pour la Promotion des Associations de/ou des Personnes Handicapées (Guinean Federation for the Promotion of Associations of People with Disabilities) FY Fiscal Year HFG Health Finance and Governance Project INAASPO Initiatives and Actions for the Improvement of Populations’ Health INSP Institut National de Santé Publique (National Institute of Public Health) IR Intermediate Result LGL Le Lyceum Groupe (The Lyceum Group) MATD Ministry of Territorial Administration and Decentralization MEL Monitor, Evaluation and Learning MOH Ministry of Health MP Member of Parliament MSS Mutuelle de Santé et Services (Mutual of Health and Services) NA National Assembly NGO Non-Governmental Organization
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page ii PASA Projet d’Appui à la Santé en République de Guinée (EU Health Program) PASOC Programme d’appui à la société civile (EU Civil Society Support Program) PCUD National Platform of United Citizen for Development PNACC Programme National d’Appui aux Communes de Convergence (National Program of Support to Convergence Communes) RAJGUI Réseau Afrique Jeunesse de Guinée (African Youth Network of Guinea) RFA Request for Applications SFCG Search for Common Ground SG Secretary General SI Social Impact SNPS Service National de Promotion de la Santé (National Service for Health Promotion) TA Technical Assistance TFP Technical and Financial Partner UNDP United Nations Development Program UNFPA United Nations Population Fund UNICEF United Nations International Children’s Emergency Fund USAID United States Agency for International Development WHO World Health Organization
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page iii SECTION A: PROJECT OVERVIEW
Project Description
The objective of the Citizens’ Involvement in Health Governance (CIHG) project is to improve citizen understanding of and participation in Guinea’s health system reforms. By expanding meaningful opportunities for Guineans to engage in their country’s health reforms and see the impact of their participation, CIHG is playing a vital role in post-Ebola recovery and contributing to strengthening public trust in Guinea’s health sector governance and improving health service delivery.
CIHG’s objective and activities contribute to two of USAID’s development objectives (DO) as described in the United States Agency for International Development (USAID)/Guinea’s Country Development Cooperation Strategy: • DO 1 “Utilization of Quality Health Services Increased” • DO 2 “Governance and Economic Processes Strengthened” o Intermediate Result (IR) 2.1 “Transparent, Competitive, and Accountable Governance Strengthened”
To achieve CIHG’s objective, three organizations have pooled their distinct abilities to act as one, unified team. FHI 360 coordinates overall implementation and leads technical activities related to advocacy, social accountability, civil society strengthening and training for government officials. Search for Common Ground (SFCG) strengthens media outlets and supports health reform information dissemination and citizen dialogue, thereby increasing access to quality information about health reform. Finally, Social Impact (SI) is responsible for the sound design and effective implementation of CIHG’s monitoring, evaluation and learning (MEL) systems to ensure activity results are captured, communicated, and utilized to inform learning and improve programming.
The activity’s technical strategy entails several components: 1) support to government officials’ so that they better understand the key elements of health reform and how civic engagement can improve reform; 2) support to media outlets and community theater troupes so they more effectively inform citizens about health reform and facilitate issue based discussion about it; 3) support to civil society organizations (CSOs) and networks to provide evidenced-based recommendations on health reform and more effectively lead health reform analysis and advocacy efforts; and 4) support for expanded opportunities for constructive health-governance dialogue between government and civil society on health reform.
Through these activities, CIHG aims to ensure that civil society and media actors are channelling citizen voices and serving as both partners with government and watchdogs for health reforms, improving the culture of social accountability in Guinea.
SCS-Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 1 of 35 Summary of Quarterly Activities and Results
The project’s two most significant achievements this quarter were the organization of the on March 25-26 and the execution of the second nation-wide community theater campaign. To ensure maximum local buy-in for the forum on health, FHI 360 worked closely with the Ministry of Territorial Administration and Decentralization (MATD), the Ministry of Health (MOH) and a leading CSO in the health sector, Alliance Promoting Governance and Local Initiatives (AGIL) to design the event. The forum brought together more than 150 Guineans who all have a critical role in ensuring that decentralization of the public health sector results in improved service delivery. The objective was to increase local officials’ (elected and civil servants) knowledge of their specific responsibilities in health reform and how to engage civil society in that process. Given Guinea’s long history of centralized power, it was critical for local officials to hear national leaders’ loud, clear and unequivocal support for decentralization and that national leaders are indeed empowering local actors to use the authorities and responsibilities recently delegated to those at the local level to improve health governance. Forum participants included the MOH and MATD ministers and their general secretaries, representatives of the elected officials (Health Commission MPs and mayors of 40 communes of convergences), public servants (governors, prefects, prefectural health directors, and directors of micro-projects), members of COSAH (health and hygiene committees), CSO representatives and the media.
Also, this quarter, 17,932 Guineans in 76 locations throughout the country participated in inter- active community theater performances to raise awareness about health governance and foster community dialogue about improving it. Compared to the first campaign in 2018, this quarter’s campaign demonstrated several improvements in the quality of the shows and audience size, thanks to partners’ willingness to apply lessons learned and constructive feedback. Troupes increased their pre-performance community research to better target the performances. Performers themselves demonstrated a stronger mastery of health reform issues, enabling the troupes to better translate the themes in their scenarios. Not surprisingly, this also improved their stage play and allowed them to cover a greater variety of themes. The dialogue fostered by the performances even resulted in some on-the-spot commitments from local officials to take specific actions to address the problems flagged, such as addressing the lack of electricity and increasing opportunities for citizen involvement.
CSO research on health reform began in earnest this quarter. The Association des Femmes Journalistes de Guinée (AFJ or the Association of Women Journalists in Guinea), AIDE-Guinée (Initiatives, Actions and Development for Guinea), Comité Jeunes Mon Avenir D’abord (CJMAD or Youth Committee My Future First), and Mutuelle de Santé et Services (MSS or Mutual of Health and Services) also finalized their research proposals, recruited staff, trained data collectors, collected and analyzed data, and began writing their research reports. Their research reports will be finalized next quarter. USAID approved the fifth (and likely final) research sub-award for the Centre Africain de Formation pour le Développement (CENAFOD or the African Training Center for Development) at the end of January. CENAFOD quickly began work to recruit, train and deploy its team. In late March, USAID approved the first mobilization grant, a one-year award with the Alliance for the Promotion of Governance and Local Initiatives (AGIL). Three more mobilization grants are pending USAID approval: AGUIFPEG (Association Guinéenne pour l’Implication des Femmes dans le Processus Electorale et la Bonne
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 2 of 35 Gouvernance or Guinean Association for the Involvement of Women in the Electoral Process and Good Governance), CNOSCG (Conseil National des Organisations de la Société Civile Guinéenne or National Council of Guinean Civil Society Organizations), and FEDIPHU (Femmes pour le Développment Intégré et la Promotion Humaine or Women for Integrated, Human Development). CIHG will submit two more mobilization projects to USAID for approval in the upcoming quarter. CSO partners were provided structured training and, on the job coaching to strengthen their technical, administrative and financial management.
To bring government closer to the citizens it serves, CIHG supported several activities. We supported two press conferences to increase government accountability and dialogue with citizens on health governance. The National Assembly (NA) Health Commission presented its formal report on the 2018 visits to health facilities, sharing recommendations with the MOH and media. The Minister of Health was present in a display of support and collaboration. The MOH has already begun implementing many of the NA’s recommended actions. Similarly, in a powerful display of trans-governmental unity, the president of the NA Health Commission, the Minister of Health and the Minister of Territorial Administration and Decentralization held a joint press conference after the forum on health decentralization to stress the need for local actors to use their newly delegated authorities and work together to make health decentralization a success.
Thanks to CIHG, the Health Commission prepared its 2019 Operational Plan, applying lessons learned from its 2018 plan. The commission and CIHG CSO partners met to discuss the CSOs’ research and mobilization projects and ways that the members of parliament (MPs) could help increase the effectiveness of the CSOs’ work. CIHG also worked extensively throughout the quarter with the MOH to prepare a workshop on health communications to bring together MOH communications officials with CSOs and the media. (The event was held in early April).
To improve radio journalism, CIHG provided follow-up training to 84 journalists from 19 different radio stations in February and March. Participants improved their post-training test scores by 78% compared to their pre-test scores. The trainees produced four radio programs during the training to apply their new skills. The shows are currently being edited and will be broadcast next quarter. Parliamentary Radio also received support from CIHG in the production of two episodes of its Monday “Citizen Space” program using material from the two aforementioned press conferences and researching additional information to include in the shows to provide more in-depth coverage of health governance. Twenty-two journalists from 11 stations also came together in January to identify ways to improve their programming and understand additional themes on health governance, which they will cover in future radio shows. The shows will address reluctance to seek pre-natal care and to vaccinate children, the proliferation of expired and damaged medical supplies on the market, and solutions for improving staffing at health centers, among other topics. Four in-depth, analytical articles on health governance were researched and written this quarter by nine journalists, three articles the result of teamwork. The articles will be published in the outlets for which the journalists work in the next quarter. The scripts for the TV series Djembe were finalized, and production is set to begin shortly.
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 3 of 35
SECTION B: ACTIVITY IMPLEMENTATION
IR 1: Opportunities expanded for elected and appointed officials and citizens to engage in constructive dialogue
Sub-IR 1.1: Elected and appointed officials better prepared for engaging citizens’ in health reform dialogue
➢ Activity 1.1.1: Dissemination of CIHG Baseline and Follow-on Research
CIHG continued its dissemination of the findings of its baseline and follow-on research, distributing an updated summary of the research to participants of the Forum on Health Sector Decentralization: elected officials (members of parliament and mayors from Convergence Communes), state officials (MOH and MATD national directors, regional governors, prefects), civil society leaders, and representatives from technical and financial partners (TFPs) involved in the health sector. CIHG has previously shared information about its research with its civic partners; a full translation was completed this quarter and provided to CSOs to complement and enrich the research projects on which CSOs are currently working.
➢ Activity 1.1.2: Strengthening NA Leadership in Health Reform
NA Presentation of Recommendations from Field Visits: This quarter, the Health Commission completed it report of key findings and recommendations following the July- August 2018 visits to health facilities. On February 27, the commission publicly presented the final report before representatives from the MOH, including the Minister of Health himself, civil society leaders, the media, legislative staffers, and TFPs1. In total, 61 people participated, including 12 women. The report was presented by Dr. Ben Keita, the president of the Health Commission, supported by eight other MPs serving on the commission. CIHG provided technical assistance to support the completion of the report and its public release.
The presentation reviewed the key findings of the 2018 site visits. The NA noted some improvements in health facilities, as compared to what they saw during their 2017 visits, related to hygiene and sanitation of premises, supply of equipment and materials, management of human resources, the frequency of official health center inspections, and delivery of services that are mandated to be provided at no cost. Despite these improvements, the NA identified a number of issues that continue to negatively influence the performance of the health system. The NA highlighted that MOH planning and communication should be strengthened and grants to health facilities accelerated and provided on time. In addition, numerous health facilities require renovations, including hospitals. Corrective action is also needed to improve decentralization of specialized services, and the supply of pharmaceutical and other medical supplies. More equipment is needed and maintenance of that equipment strengthened. Finally, the NA noted that
1 As reported on US Embassy Facebook page: https://www.facebook.com/145424508823830/posts/2375571452475780/
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 4 of 35 community members continue to report being charged for health services that are mandated to be free of charge (for example, cesarean sections).
In view of these findings, the Health Commission made several specific recommendations to the MOH, many of which the MOH has already started addressing. The recommendations include: - Renovation of the second national hospital (Ignace Deen University Hospital) as the renovations of the Donka Hospital are being finalized - Quickly completing of delayed hospital construction work - Establishing a system for equipment maintenance in each prefecture - Supporting the Central Pharmacy of Guinea to improve their service - Developing and implementing a decentralization strategy of some specialized services (for example, otorhinolaryngology, diabetology, and urology) - Improving the Ministry of Health’s communication with citizens - Effectively implementation the community health policy throughout the country - Respecting budgetary decentralization as provided for by the 2019 Finance Act
Following the presentation, MPs responded to questions from participants on the report and other issues such as a national budget line item for the care of indigent patients and the prospect of NA visits to prisons, private clinics and more remote locations to assess the health conditions in those locations. Regulation of the pharmaceutical industry and the counterfeit pharmaceutical market were also discussed, prompting MOH representatives to explain the government’s ongoing measures to improve regulation and harmonize standards with Guinea’s neighbors. For example, Guinea has 107 pharmaceutical wholesalers, compared to three or four in most neighboring countries, making it more difficult monitor wholesalers. The MOH also shared several other priority actions for 2019: recruiting 4000 community health workers, accelerating the provision of equipment to health facilities and implementing the recently finalized Community Health Policy.
The Minister of Health expressed his support for the commission’s. In addition, MPs and Minister of Health agreed to the three following actions: - Continued organization of quarterly meetings between the Health Commission, civil society and the MOH; - Biannual MOH press conferences to share MOH actions with the public; and - MOH distribution of the Health Commission report to MOH staff at the local level to foster implementation of recommendations that require local action.
This report-sharing event was an opportunity for constructive dialogue among health-sector stakeholders to advance concrete improvements to the public health system. The event received wide coverage from the public and private media, both online and broadcast outlets. The following are links to local reports: - https://maguineeinfos.com/2019/02/27/gouvernance-sanitaire-un-mois-apres-la-visite-de-terrain-une- commission-sante-presente-ses-resultats/ - https://kalenews.org/guinee-gouvernance-sante-restitution-des-resultats-des-visites-de-structures-sanitaires/
NA-Civil Society Dialogue: To foster stronger relationships between the NA and civil society, especially CIHG partners who will be advocating to the NA for specific reforms, a meeting was held on February 28 for CSO representatives, MPs and legislative staff. In all, 39 participants
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 5 of 35 attended, including nine women. USAID and FHI 360 representatives also participated in the event. The meeting started with presentations of four CSO research projects funded via CIHG and two prospective mobilization projects (one has since been approved by USAID). Other prospective mobilization sub-awardees were invited but not able to attend. The presentations were as follows: - The level of access for women to health facilities in the regions of Kindia, Boké and Conakry presented by Association des Femmes Journalistes de Guinée (AFJ – the Association of Women Journalists in Guinea) - Participation and access by communities to health care presented by Aide Guinée - Community participation to health reforms through health and hygiene committees (COSAH) by Centre Africain de Formation pour le Développement (CENAFOD - African Training Center for Development) - Community Involvement in the fight against malaria in the regions of N'zérékoré and Faranah by Mutuelle de Santé et Services (MSS or Mutual of Health and Services) - Youth participation to health governance presented by Réseau Afrique Jeunesse de Guinée (RAJGUI - African Youth Network of Guinea) - Project on the Health - Decentralization Approach presented by AGIL (Alliance Promoting Governance and Local Initiatives)
The presentations were followed by questions from NA participants and constructive discussions about each project. The dialogue largely focused on the level of involvement of relevant Ministries (MOH, MATD and the Ministry of Social Action), the usefulness of the research findings, and the actions that CSOs will likely be requesting from MPs. The legislators expressed their appreciation for the quality of the projects and committed to supporting CSO advocacy efforts to improve the health sector based on the research findings. CSO participants asked MPs to establish a periodic consultation mechanism with civil society, to which the MPs favorably responded. CIHG project will examine how best to support the establishment of such a consultation mechanism so that it is owned by local actors and is inclusive. Wanting to get the most of this opportunity with legislators, civic leaders flagged other important health issues for the NA’s attention. Among the concerns raised were the disappearance of trucks with counterfeit pharmaceuticals that had been impounded by police and the issue of patient consent when providing blood samples on the use of the samples. The latter was raised because blood samples from Ebola patients have been transferred to researchers outside the country. MPs said that they would look into the various issues discussed.
Health Commission’s 2019 Annual Operational Plan: On February 15, “With CIHG support and the approach of CIHG of CIHG organized a workshop for 22 involving media in its activities, the Health Commission is people, including six MPs and 16 [now] known to be active and many other partners have started to contact us for partnership.” legislative staffers. With CIHG’s – Dr. Ben Keith, President of the Health Commission technical support, the commission evaluated the execution of their 2018 action plan to inform their 2019 plan. The commission’s mandate extends beyond health and includes youth, sport, arts, culture and historic heritage. It was found that 80% of the health activities planned for 2018 were implemented, with only 53% of activities completed targeting youth and 38% for the sports, arts, culture and patrimony historical having been implemented.
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 6 of 35 The commission members and staff attributed the high success rate for health activities in part to CIHG’s support. The participants also analyzed the impact of the activities executed during 2018. The results of that work include: - During the legislative session in April 2018, the commission tabled a law to care for people living with chronical diseases and conditions such as diabetes, kidney disease, and high blood pressure; - Improved reporting of commission activities as a result of the successful completion of computer training by MPs and support staff; - Visits to health facilities and exchanges with citizens, so that elected officials better understand constituents’ concerns related to health governance and allowing MPs to make specific recommendations to the MOH, recommendations on which the MOH is already taking action; - The budget analysis that prepared MPs to engage more critically and constructively with different ministries to improve the budget; and - The organization of press conferences on the results from their visits to the health facilities and the 2019 budget to inform citizens of MP efforts to improve the health system.
The participants used these findings to identify relevant and realistic activities for 2019. CIHG will support the following activities from the plan: - Training on advocacy and lobbying: how MPs can use their positions to affect change - Organization of quarterly meetings among MPs, MOH and CSOs - Regional accountability forums to be supported by CIHG’s sub-award with CENAFOD
➢ Activity 1.1.3: Strengthening MOH Leadership in Health Reform
On February 5-7, CIHG staff participated in a MOH meeting with other TFPs to help the MOH prepare its 2019 Operational and Action Plan. Given challenges in executing the 2018 plan, the 2019 plan identifies specific targets for Regional and Prefectoral Health Directorates (Direction Regionale de la Santé or DRS and Direction Préfectorale de la Santé or DPS) that feed into overall MOH objectives. Those targets were included in performance contracts that the MOH signed with each DRS and DPS. Among the national objectives is the extension of community health activities to 100 communes,2 including MATD’s 40 target communes of convergence. During the meeting, the MOH announced the launch of eight thematic groups to facilitate the coordination with MOH’s partners. CIHG will participate in two: governance of the public health system and community health.
CIHG also worked extensively with the MOH on the multi-stakeholder health communications workshop discussed below under Activity 1.2.1.
➢ Activity 1.1.4: Strengthening MATD Leadership in Health Reform
On February 21, the Project Director and Program Manager met with the Secretary General (SG) of the MATD. CIHG secured the SG’s full commitment for MATD support of the Forum on Health Decentralization. CIHG wanted to ensure that the event was co-owned by the Ministry.
2 Guinea has a total of 342 communes (38 urban and 304 rural), so the target is to extend community health activities to 30% of the nation’s communes.
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 7 of 35 MATD leadership had asked CIHG to provide support to the Programme National d’Appui aux Communes de Convergence or National Program of Support to Convergence Communes (PNACC) steering committee. As such, in line with stanard practice in Guinea, CIHG had worked with MATD on a memorandum of understanding. However, the SG informed CIHG that the minister decided that a memorandum of understanding (MOU) was not necessary. The PNACC steering committee did not meet this quarter and therefore CIHG technical assistance was not necessary. Lastly, the SG said that he would ensure that CIHG staff was invited to participate in the Interministerial Commission for the Monitoring of the Convergence Initiative Piloting (CISPIC) set up by the government. CIHG’s involvement in the CISPIC will allow us to share our CSO partners’ work and help them gain access to senior officials to advocate for additional reforms.
National Forum on Health Decentralization: On March 25-26, in collaboration with the MATD, MOH and one of our civic partners, AGIL, CIHG organized a national forum on the decentralization of the public health system3. The objective of the event was to increase local officials’ (elected and civil servants) knowledge of their responsibilities in implementing health reform and how to engage civil society in that process. Given the previously centralized nature of governance in Guinea, it was critical for local actors to hear from national leaders support for decentralization and encouragement for local actors to use the authorities now delegated to local level. The forum brought together more than 150 people. Participants included the MOH and MATD ministers and their general secretaries, representatives of the elected officials (Health Commission MPs and mayors of 40 communes of convergence), public servants (governors, prefects, prefectural health directors, and directors of micro-projects), members of COSAH (health and hygiene committees), CSO representatives and the media. Thirty-one women participated; since the invitation list was limited to persons in specific positions (for example, the elected mayors of target communes), CIHG had no flexibility to increase women’s participation in this particular case. Also present were the United States Ambassador, the USAID Mission Director and other USAID staff as well as TFPs working in the field of health in Guinea.
The event was structured so that: − Participants learned the roles and responsibilities of each stakeholder in health service delivery under recent reforms; − Participants mastered the community health financing system; − Participants mastered the lines of accountability in the new system; − Participants identified specific actions that they can take to advance effective health decentralization; − Participants identified specific actions to better include civic participation in community health management; − Participants understood the convergence of actions under the government’s the National Program of Convergence Communes; and
3US Embassy Facebook Page: https://www.facebook.com/145424508823830/posts/2414203085279283/
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 8 of 35 − Participants, especially members of civil society and the media, learned how to better position their advocacy to advance reform and improve service delivery.
“I come out of this forum trained and " For me, this forum has allowed me to informed about what we as local elected understand that we, the elected officials can bring to rebuild the trust between representatives, will now be at the center of all our people and their health center. Social health actions in our communities. Citizens mobilization and participation actions will have elected us, and health is one of the now be priorities in our planning.” issues on which they will evaluate us, and we
must address it to their satisfaction." – Ibrahima Alima Koulibably, Mayor of Kinièran – Sekou Oumare Sako, Mayor of Banora
Health Decentralization Press Conference: At the closing of the forum, for the first time a joint press briefing was held by the President of the NA Health Commission, the Minister of Health and the Minister of Territorial Administration and Decentralization. The objective was to share the initiatives of these three critical governmental institutions to advance decentralization and improve public health services. They explained the importance of all actors – from the grassroots to national level – understanding their roles in health governance. They presented several important issues identified during the forum and stressed that addressing those challenges would require better collaboration among all local stakeholders: COSAHs, territorial administrators, elected officials, health professionals and citizens. Fifteen journalists attended and asked a number of questions addressing such topics as: 1) Implementation details of planned MOH activities; 2) The granting of 15% of the mining income to the different communities; 3) The selection criteria of the 40 communes of convergence and the need to widen the program to all communes; and 4) The role of traditional medicine in health governance.
In addition to broadcasts covering the event that aired the same day, numerous articles were written, including: - https://lecourrierdeconakry.com/fin-du-forum-national-sur-decentralisation-du-secteur-de-la-sante-a- conakry/ - https://mediaguinee.org/la-sante-communautaire-au-centre-dun-forum-national-a-conakry/ - https://www.guineemonde.com/medecins-tradipraticiens-quen-pense-le-ministre-de-la-sante/ - https://www.guineemonde.com/forum-sur-la-sante-les-participants-se-quittent-avec-un-sentiment-de- satisfaction/
Sub IR 1.2: Improved facilitation of issued based discussion and constructive dialogue by media outlets and community theater troupes
➢ Activity 1.2.1: Effective health reform communications and media programming developed Multi-Stakeholder Health Communications Workshop: In order to strengthen the MOH’s communication strategy and help all interested stakeholders better disseminate information about health governance, CIHG worked extensively with the MOH during Q2 to prepare a multi-
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 9 of 35 stakeholder workshop that was held on April 3-5 and will be reported on in the next report. The event brought together representatives from CSOs, the media and the MOH to reflect on MOH messaging and identify ways to further to improve public understanding of health sector reform.
This activity, initially scheduled for March, was postponed at the request of the Service National de Promotion de la Santé (SNPS or National Service for the Promotion of Health), which is in charge of health promotion activities. In the planning process, CIHG sought to work closely with MOH counterparts – both the MOH senior management team or cabinet, as well as SNPS staff – so that the event was owned as much by the MOH as by CIHG. Ensuring their buy-in and support proved to be labor-intensive. CIHG also involved the Association of Journalists in Health in the preparation of this event not only to benefit from their expertise, but also to foster their relationship with the MOH.
The workshop will enable participants: • To understand the main tenets of the MOH communication strategy and available tools; • To identify opportunities to facilitate implementation of the communication strategy; • To make recommendations on improve the various stakeholders’ communication on health reforms; and • To develop a voluntary, joint communication action plan involving the MOH, CSOs and the media.
➢ Activity 1.2.2: Develop the capacity of local radio stations Training of partner radio stations: CIHG continued its training program of partner radio stations which has been described in detail in previous quarterly reports. In Q2, 84 journalists were trained, of which 33 were women (39%) from a total of 19 radio stations. The interactive training sought to improve participants’ reporting overall and as it relates specifically to health governance. It also strengthened participants’ understanding of conflict sensitivity and how to integrate that awareness into their radio productions. The participants learned about health reform, conflict analysis, rumor management, interactive programming and optimal use of popular radio formats, among other topics. The training workshop dates and participating stations were as follows: - February 18-22: Radio Rurale Boké, Radio Rurale Boffa, Espace Kakandé Boké and Voix de of Boffa (4 stations) - February 21-25: Radio Rurale Mandiana, Radio Rurale Dinguiraye, Milo FM of Kankan and Bambou FM of Faranah (4 stations) - February 25 - March 1: Radio Rurale Labé, Radio Rurale Pita, Radio Rurale Dalaba, Espace FM of Labé (4 stations) - February 28 - March 4: Radio Rurale Kissidougou, Radio Rurale Guéckédou, Radio Rurale Yomou, Radio Rurale Macenta, Radio Rurale Beyla, Niandan FM of Kissidougou and the community radio of Diécké (7 stations)
Participants’ scores on the training seminar post-tests improved on average by 78% in comparison with pre-test scores (68% post-test average vs 38% pre-test). To sustain and advance these learning achievements, CIHG has further onsite coaching planned in coming quarters.
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 10 of 35 Each training session ended with the production of an interactive radio program in the local language to allow trainees to apply their new skills and to increase programming on health governance. These programs are being edited and will then be broadcast locally. Recordings will be uploaded and shared with USAID once finalized. The end-of-training radio programs addressed different topics. The Boké program addressed sanitation in health facilities and citizen initiatives to reinforce the relationship between health workers and health facilities users. The Labé program focused on information about free health services. In N’zérékoré and Kankan, the programs focused on the supply of medicines to public hospitals and discussed the benefits of pre-natal care and the reasons why some pregnant women do not access it.
➢ Activity 1.2.3: Strengthen the NA media to promote accountability and health reform During this quarter, CIHG worked with Parliamentary Radio to cover two important events to foster government accountability to citizens: the NA Health Commission’s press conference following up on their site visits to health facilities, and the joint NA, MATD and MOH press conference on health decentralization, both discussed above under IR 1.1.
NA Health Commission Press Conference: CIHG helped with the organization of the February 28 press conference, including the participation of NA media. NA media broadcast its coverage of the event the same day. In addition, CIHG also provided technical assistance in Q2 to Parliamentary Radio to produce a full episode of its one-hour radio show “Citizen Space” that airs on Mondays to provide even more in-depth coverage on legislative oversight of health governance.
Health Sector Decentralization Press Conference: In addition to ensuring NA media participation in the Health Decentralization press conference, in Q2, CIHG supported Parliamentary Radio to prepare an edition of “Citizen Space” addressing health decentralization, to be broadcast in April. The show’s working title is “Decentralization of Health: How can it be Achieved?” It will use material from the joint NA-MATD-MOH press conference held at the conclusion of the CIHG-organized Forum on Health Decentralization described above.
➢ Activity 1.2.4: Production and dissemination of health reform focused programming During this quarter, CIHG continued to support radio and print journalism on health governance.
Radio Programming: On January 24-25, CIHG gathered 22 journalists from 11 radio stations for a production planning meeting. This working session had three objectives: 1) to analyze the quality of the programs produced by partner stations to draw lessons for future productions, 2) to identify new themes for future programs, and 3) to provide follow-up coaching for journalists, building on prior training. The participants identified nine topics that the 11 radio partners will address in show that will be broadcast in different local languages. The topics are:
N° Topics of broadcasts
1 The benefits of pre-natal care for pregnant women and their babies
2 Persistent reluctance to vaccinate children: causes and impacts on public health
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 11 of 35 3 The lack of qualified staff in some health centers: measures being taken and additional possible remedies
4 Proliferation of unauthorized private clinics and the risks to patients using them
5 The lack of respect shown to patients at certain facilities: effects on patient care and solutions
6 Proliferation of expired and damaged medical products and the impact on individuals’ health
7 Issues facing the adequate supply of safe blood products to health facilities
8 Modern and traditional medicine: improving complementarity for the well-being of people
9 Challenges facing the management of chronic diseases in Guinea
Online print media production: Following CIHG’s November 2018 training for online journalists, nine journalists produced articles on health governance issues. As these pieces are more in-depth, several journalists decided to work together, as is common practice internationally, to tackle larger subjects and share the workload. The journalists researched and wrote these articles in Q2 while they worked on other pieces as assigned by their respective outlets. They shared the reports with CIHG staff in mid-February. CIHG then worked with the journalists on editing the reports that we expect to be published in the nine media outlets for which the journalists work in April-May). The articles are:
N° Topics Journalists Media Outlet
1 Survey on the effectiveness of free Alhousséïny Camara Santé Plus Info caesarean surgery in Conakry’s medical centers
2 Private health clinics in Guinea Elisabeth Zézé Guilavogui Réussite Ibrahima Kalil Sylla La riposte
3 Citizen participation in the fight against Macky Daff L’observateur malaria in Guinea Fadjimba Kéïta La croisade Conté Mamadouba Africa Média
4 Comparative analysis on the national Agossou Don De Dieu La Nouvelle budget share allocated to health: 2015- Camara Alsény L’indexeur 2019 Oumar Tély Diallo Le Lynx Lance
CIHG-Led Productions: While CIHG media staff focused mostly on training this quarter, work continued on CIHG-led productions as well. The 20 scripts for the TV series Djembe4 that will focus on health and health governance were finalized. CIHG is working with its production vendor and the MOH to secure access to health facilities for the filming. Production will begin next quarter. We anticipate that the episodes will begin airing after June on four CIHG partner
4 Djembe is the name of a very popular traditional musical instrument in Guinea. It is used for calling people together for celebrations and gatherings where information important to the community is shared. The episodes will be 26 minutes each.
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 12 of 35 TV stations (Evasion TV, RTG Koloma, Gangan TV and Faso TV). The shows will also be shared via mobile cinema. CIHG finalized the recruitment for the designer of health reform information products (for example, short, graphic explanations of certain topcis) for low-literacy communities which are to be by July.
➢ Activity 1.2.5: Journalism Awards Competition and a coordinated Media Day on Health Governance In preparation for the awards conference, CIHG did extensive planning in Q2. The awards competition will be paired with a Media Day on Health Governance. CIHG is working with media partners to agree to air the health programming on the same day, likely in August or September. Following the media day, the awards competition will culminate in a two-day, national, peer-learning forum in which journalists from around the country will come together to share their best work and discuss solutions to common challenges. The forum will end with the award ceremony itself. By integrating this combination of activities, we hope to motivate journalists to continue reporting on health governance beyond CIHG and increase audience awareness of their work. The peer- learning forum and the awards ceremony are anticipated for September.
➢ Activity 1.2.6: Increase citizen understanding and discussion of health reforms through community theater CIHG worked with its community theater partners to organize 76 performances for a total of 17,932 people in 76 locations throughout Guinea in Q2. Compared to the first campaign in August-September 2018, this quarter’s campaign demonstrated several improvements in the quality of the shows and audience size, thanks to partners’ willingness to apply lessons learned from the last campaign and CIHG follow-on coaching. Troupes were able to increase their pre- performance community research to better target the performances and their stage plays improved. The themes covered were more varied and performers themselves better understand the health reforms and health governance issues that communities face, enabling the troupes to better translate the themes in their scenarios.
The performances were not only attended by the general public but also by local authorities (such as newly elected mayors and/or their councillors) and public health officials, enabling constructive dialogue among health system users, health professionals and local officials. The performances were well received and resulted, in some cases on commitments on the spot by "I speak on behalf of the members of our center to say officials to take specific actions. For thanks to you and to your group and your donors. The example, in Bordo district activities carried out in our locality support us; it (Kankan), faced with complaints strengthens the bound between the people, the health from citizens about the lack of workers and the health authorities. (...) We are and will reliable electricity for the health always be at your disposal. We can rely on our community health promoters for the dissemination of information and center, the Secretary General of the advice received here." municipality promised on behalf of – Mr. Alhassane Sylla, director of a health center in the Mayor to provide the health Kankan center with solar panel for its
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 13 of 35 electrification by the month of May. In Kobéla, authorities publicly committed to improving citizen involvement in decision making related to health facility governance. In the case of Bordo, the theater troupe has agreed to follow up with the City Council to ensure that the solar panel is indeed procured. CIHG will support these efforts and publicized them if successful.
Following the performances, the troupes surveyed community members regarding the health issues of greatest concern. In all, 3,650 people were interviewed. The key issues raised by respondents are presented in the table below. The information will be shared with CIHG civic and governmental partners.
Theme Common Specific Concerns Access to health - Charges for malaria treatment that should be free care - Charges for cesarean section surgery that should be free - High cost of products and services at health centers - Distance to health centers - Insufficient equipment at health facilities and lack of some supplies to treat common diseases - Treatment of patients according to their social status (affinity treatment) Lack of - Continued reticence of many Guineans to vaccinate children confidence in the - Women’s reluctance to seek prenatal care public health - Reluctance of health facilities to treat patients on credit because of non- system payment of some patients treated on credit in the past Reduced use of health facilities due to fear of Lassa fever infection Health - Poor reception of patients by health workers Personnel - Lack of specialists at health posts - Repeated reassignments of health workers - Lack of medical staff at night - Patient neglect in hospitals and health centers by health workers Repeated absences of staff at the health post - Lack of sufficient medical staff at health centers Other public - Insufficient number of drinking water points; distance to water point services that - Insufficient drinking water especially during the dry season (Guéckédou) contribute to - The high incidence of illnesses such as diarrhea due to the lack of potable public heath water - Insufficient number of latrines and garbage dumps - Inadequate management of water supply and garbage collection Other - Lack of community awareness of COSAHs - Need to encourage couples to seek medical treatment together and support one another’s medical care needs - Proliferation of private clinics and pharmacies center, that may or may not be authorized, draw skilled staff away from public sector job and/or contribute to absence of staff who still work for public health facilities - Use of impregnated mosquito nets in vegetable gardens rather than in rooms
➢ Activity 1.2.7: Support community listening and discussion groups
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 14 of 35 A large share of the Guinean population does not have access to radio, particularly in certain areas. Targets communities were previously selected for listening groups. The groups have been established and equipment distributed. Audio materials will be distributed in next quarter when the groups will begin to meet and discuss.
List of locations of the listening clubs Region Locations Moyenne Guinée Kebaly, Kaala, Bantighel, Donghol Touma, Timbi Madina, Kegneko, Saramoussaya, Poredaka Basse Guinée Bangouyah, Samayah, Sinta, Sikhourou, Tondon, Sarekaly, Kouriah, Kollet Haute Guinée Cissela, Banko, Konindou Guinée Forestière Mawouon, Yomata, Nionsomoridou, Gbackedou, Thuo, Daniné, Sengbédou, Fangamadou, Bolodou
IR 2: More effective civic advocacy for health reform
➢ Activity 2.1: Award and Administration of Sub grants Sub-grants Awarded for Health Reform Research: Implementation continued on the four research sub-awards approved previously by USAID. A summary of the partners’work is presented under Activity 2.2.2. On January 15, USAID approved the fifth research sub-award to the Centre Africain de Formation pour le Développement (CENAFOD or the African Training Center for Development). To allow our local partner time to mobilize for timely startup and given the short period of performance for local sub-awards, FHI 360 and CENAFOD signed the eight-month sub-award on January 28 with a start date of February 1. No more research sub- awards are anticipated at this time.
Summary of USAID Approved Research in the quarter CSO Objective Location Details To assess COSAHs performance and the extent to CENAFOD citizen participation; to identify Time: best practices and other Nationwide USAID approval 8 months recommendations to improve January 15, 2019 the effectiveness of COSAHs and health governance.
Sub-awards for Health Reform Coalition Mobilization: On March 27, USAID approved the first mobilization project that was awarded to the Alliance for the Promotion of Governance and Local Initiatives (AGIL). Similarly, given the lessons learned on partner mobilization for the initial sub-awards, the start date was set for two weeks after USAID approval: April 15.
Summary of USAID Approved 1 Mobilization
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 15 of 35 CSO Objective Locations Details Increase the ownership capacity AGIL of local actors (Territorial 38 urban communes Administrators, Local Elected Time: and 40 of USAID approval Officials, CSOs and Citizens) to 12 months convergences March 27, 2019 adopt the health-decentralization approach
Three other proposals were submitted to USAID for approval this quarter. The proposed CSO partners are: - Association Guinéenne pour l’Implication des Femmes dans le Processus Electorale et la Bonne Gouvernance (AGUIFPEG or Guinean Association for the Involvement of Women in the Electoral Process and Good Governance) - Conseil National des Organisations de la Société Civile Guinéenne (CNOSCG or National Council of Guinean Civil Society Organizations) - Femmes pour le Développment Intégré et la Promotion Humaine (FEDIPHU or Women for Integrated, Human Development)
CIHG is still working with two other partners to finalize their grant packages: - Le Lyceum Groupe (LGL or The Lyceum Group) - Réseau Afrique Jeunesse de Guinée (RAJGUI or African Youth Network of Guinea)
Both projects have particular complexities that have required extensive collaboration to strengthen the project designs. LGL will focus on mobilizing traditional medicine providers and ensuring that health governance reforms better address the reality of Guinea’s large traditional medicine sector. RAJGUI proposed a very ambitious project to mobilize youth and advocate for specific reforms. CIHG staff have worked with these organization to ensure that the proposed activities are within their capabilities to effectively execute and that the budgets are reasonable and sufficient.
Sub IR 2.1: Skills of partner CSOs in advocacy, strategic planning and influencing public officials improved
➢ Activity 2.1.1: CSOs’ business management competencies improved CIHG provided extensive coaching this quarter to CSO sub-awardees to strengthen their grant management skills. CIHG staff visited MSS, CJMAD, AFJ and AIDE-Guinée on January 3-4 to review partner grant management processes, CIHG then prepared a report documenting challenges and providing recommendations to improve financial reporting, record keeping, and compliance with reporting requirements stipulated in Article 7 of the grants. Initial feedback was then provided to partners. More structured feedback was provided to partners after the report was finalized and the review of the first financial reports completed. The summary of the meeting to provide the more detailed feedback is presented late in this section.
Between January 5-10, AFJ, AIDE-Guinée, CJMAD and MSS submitted their first monthly subaward financial reports (SFRs). CIHG staff reviewed the reports, identified issues and then worked with each partner to correct the issues before validating the amended SFRs and issuing the next advances. The same review, coaching and approval process was used for the January
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 16 of 35 and February SFRs. CIHG continued to work with partners on their advance requests, helping them to analyze their implementation plans and performance reports and to identify the funding amounts needed to execute the activities anticipated for the coming 60-day period. Given partners’ capacity levels, the support and coaching needed is labor-intensive. CIHG must visit partners weekly to anticipate corrections and avoid delays in validating SFRs and approving advances.
On January 31, CIHG facilitated a targeted training for staff from CENAFOD and their consortium partners, CECIDE (Centre du Commerce International pour le Développement (Center for International Trade for Development) and INAASPO (Initiatives and Actions for the Improvement of Populations’ Health) since their grant was approved after the first round of sub- awards. The training covered operational implementation planning, communication planning including CIHG’s branding requirements, monitoring and evaluation, required sub-award indicators, and other supporting tools used in project management. Ten people participated in the training that took place at CENAFOD’s office.
Based on issues identified during the partner site visits, the reviews of the SFRs and issues identified when monitoring sub-award activities, CIHG organized a sub-award management meeting with AFJ, AIDE-Guinée, CJMAD and MSS on February 12 to share the main findings and recommendations for improvements. During the meeting, CIHG also provided a review of sub-award grants management procedures, the ethics clause of the grants and code of conduct requirements.
Partners’ first cost-share reports are due in early April. CIHG provided support to CSOs during the quarter to prepare their cost-share reports and ensure that the necessary documentation was in place. Given partner challenges with cost-share reporting, future subawards will require monthly reporting until the CSO demonstrates mastery of the requirements.
➢ Activity 2.1.2: CSOs’ advocacy and strategic planning skills improved This activity will be implemented during the next quarter.
Sub IR 2.2: Increased use of evidence by CSOs to influence public officials on health reform ➢ Activity 2.2.1: Technical assistance to grantees on evidence-based research During this quarter, CIHG staff and the consultant on operational research provided ongoing technical support to the five CSO research partners to ensure sound implementation of their respective health reform research projects.
Review of the sampling strategy in the CSOs’ research protocols: CIHG worked with partners over December and January to further refine the sampling in the research protocols given the labor-intensiveness of qualitative research in all projects and based on feedback from CNERS. The fine-tuning helped partner to enhance the quality of their data collection and analysis, without changing the study objectives and the intended target groups. The sampling changes were then shared with USAID prior to deployment of field researchers. Below is a summary of the research protocol modifications.
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 17 of 35 Sampling Refinements CJMAD AIDE MUTUELLE AFJ Number of locations BEFORE 24 34 12 25 AFTER 24 17 12 15 Number of Focus Groups BEFORE 48 136 24 60 AFTER 48 51 24 45 Number of participants in Focus BEFORE 480 1088 240 480 Groups AFTER 384 408 192 360 Number of individual interviews BEFORE 310 220 50 561 AFTER 258 84 103 488 Number of theatres BEFORE 34 AFTER 17 Number of participants to theatres BEFORE 272 AFTER 68 Total participants BEFORE 790 1580 290 1041 AFTER 642 560 295 848
The one research protocol that required significant change was AIDE-Guinée’s and its sub- partner Nimitè Theater, whose sample and targeted locations were revised significantly downward, not only due to recommendations from the research consultant but also based on feedback from the National Ethics Committee for Health Research (Comité National d’Ethique pour la Recherche en Santé or CNERS) that must approve all health-related research. Because these changes were more significant, CIHG and USAID discussed them at length including during a formal meeting on February 1. The new version of the protocol was then approved by USAID and CNERS.
➢ Activity 2.2.2: CSOs effectively use scorecards and evidence gathering approaches The following is a summary of the activities implemented by CIHG CSO partners during this quarter.
AFJ Sub-award Implementation: The research project examines level of women's access to health care in health facilities in Conakry, Kindia and Boké.
Project Start Up: Following the receipt of CNERS approval, AFJ organized a kick-off for its project on January 9. AFJ also met one-on-one with several key government stakeholders to secure their buy-in: Ministry of Social Action, Promotion of Women and Children, National Institute of Public Health, National Directorate of Family Health and Nutrition, NA Health Commission, and Forum of Women Members of Parliament.
In January, AFJ recruited 25 data-collection agents from the different target locations and three supervisors, eight of which are women. AFJ then trained the data collectors and supervisors in Kindia on January 19-20. Thirty-two people participated: the 25 data collectors, three supervisors and four AFJ project staff. Two FHI 360 representatives also attended. AFJ's
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 18 of 35 Research Consultant facilitated the training, presenting the overall project objective, the research methodology and the data collection tools. Participants were given practical exercises and simulations to master the material presented. The event was also used to pretest of data collection tools, resulting to refinements to the tools.
AFJ staff took advantage of their presence in Kindia to meet with Kindia’s Prefect and DPS to present the project. These officials promised to support the project staff and data collectors once they were deployed in the field. Given media partners’ challenges in accessing health officials and facilities, officials’ support is very important.
Data Collection: From January 28 to February 16, data collectors and supervisors were deployed to collect data in the project's target locations. A sample of 848 people was surveyed through methods of interview collection, in-depth interviews and focus group discussions. Some difficulties were encountered in the field, namely the non-availability of certain TFPs, government officials and CSO key informants.
Data Entry, Analysis and Reporting: During February-March, AFJ focused on data entry, conducting remaining interviews, transcription of in-depth interviews, and analysis of quantitative and qualitative data. Delays in securing interviews and challenges in the transcription process slowed the analysis of qualitative data.
Activities for the Coming Quarter: A draft report of the study will be shared with CIHG staff for initial review. AFJ will share the report with other stakeholders to receive feedback prior to finalizing. The report will be finalized in next quarter and the sub-award closed out.
AIDE-Guinée Sub-award Implementation: AIDE-Guinée is working with Nimitè Theater to analyze the factors that limit citizen participation and access to health services, identify specific solutions to improve health system management, and raise community awareness of the local populations regarding their health rights. The geographic area of focus is the Préfectures of Dinguiraye, Mandiana and Beyla.
Identification of data collectors, supervisors and community theater performers: Project staff worked from January 9-11 to identify data collectors, supervisors and community theater performances in the target prefectures, with support from Prefectural and Sub-Prefectural Youth Directorates. The selection criteria included: level of education, permanent residence in the locality, knowledge of the locality, involvement in community activities, availability during the data collection period and knowledge of the local language. Thirty-four data collectors, six supervisors and 18 actors for participatory theater were recruited.
Training of local project staff: Between February 28 – March 7, AIDE-Guinée trained 34 data collectors and six supervisors from the different urban and rural targeted communes over the course of workshops in Beyla, Mandiana and Dinguiraye. The workshops were also attended by local officials including the general secretaries of prefectures and DPS. These workshops allowed participants to become familiar with the overall project, the concepts and techniques of data collection and to learn about their role and responsibilities when collecting data in the field.
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 19 of 35 In parallel with the training of data collectors and supervisors, three community theater training workshops (six people each, or 18 total) were held in the same locations at the same time to train participants not just on performance but using community theater to collect qualitative information from audiences. Pre-tests were also conducted.
Data collection: Data collection was not completed this quarter as planned due to the time taken to finalize the research protocol as discussed earlier in this report.
Activities for the Coming Quarter: Data collection will continue next quarter followed by data analysis and presentation of the report.
CJMAD Sub-award Implementation: CJMAD, in partnership with the Guinean Center for Training, Research and Development (Centre Guinéen pour la Formation, la Recherche et le Développement or CEGUIFORD) is researching the level of access to malaria prevention and treatment services, the extent of CSO involvement in reducing malaria and depth of citizen knowledge about anti-malaria efforts. They will then to identify recommendations to improve the fight against malaria. The target regions are N’zérékoré and Faranah.
Identification and training of data collectors: Project staff finalized the recruitment of six supervisors and 24 data collectors in Faranah and N’zérékoré having widely advertised the positions in such places as universities and administrative offices in the regions concerned. They then conducted a training in Faranah January 7-10 for the 24 data collectors and six supervisors. Data collection tools were pre-tested in the sub-prefecture of Tindo. The pretest helped to evaluate the capacity of the different data collectors on conducting interviews and focus group discussions and refine the tools.
Data collection: Data collection took place March 12-31 in the six prefectures in the Faranah and N'zérékoré administrative regions. Six hundred forty-two people participated in focus groups and in-depth interviews that were conducted at health centers, with COSAH members and with local authorities. Emphasis was put on the verification of free malaria products.
Activities for the Coming Quarter: The study report will be shared with stakeholders for feedback and then finalized during next quarter.
MSS Sub-award Implementation: The objective of MSS’s project is to assess the involvement of rural communities and their COSAHs in management of the health facilities and to identify recommendations to improve health facility management. The regional focus is the 12 PNACC target communes in N’zérékoré, Kankan, Faranah, Mamou, Kindia, Labé and Boké. MSS and CIHG staff replied to questions from CNERS on the research protocol. CNERS issued their formal approval on January 18.
Identification and training of data collectors: In January, MSS staff recruited 21 data collectors including eight women and seven focal points from the target regions based on pre-defined selection criteria. These individuals were then training during a workshop held January 18-20. Project staff shared the research project’s objectives, expected results and methodology. The
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 20 of 35 training also covered focus group and interviewing techniques and the data collection tools that participants practiced using during simulations.
Pre-testing and validation of data collection tools and data collection: Due to issues that emerged, some of the participants did not participate in the final data collection process. The remaining 14 data collectors were divided into three groups for a pilot survey at three health centers. Corrections were made on the data collection tools based on pre-test findings. In March, the data collection was carried out in the 12 communes of convergence in the administrative regions of Boké, Kindia, Mamou, Labé, Faranah, Kankan and N’zérékoré. Two-hundred ninety people were reached through focus group discussions and interviews.
Activities for the Coming Quarter: Data entry and analysis will be conducted. The report will be drafted and shared with stakeholders prior to finalization. The sub-award will then be closed out.
CENAFOD Award Implementation: This eight-month, nation-wide project seeks to assess COSAHs’ performance and the extent to citizen participation and to identify best practices and recommendations to improve the effectiveness of COSAHs and health governance. The award began on February 1.
Project Start Up: CENAFOD identified and established the project team: the project coordinator, the education coordinator, the training and monitoring officer and the accountant. CENAFOD also signed a collaboration agreement with its partners CECIDE and INAASPO and worked with those partners to clarify the coordination process during project implementation. Also, during the quarter, 70 data collectors and eight supervisors were recruited, data collection tools and training for data collectors were prepared. The data-collection tools developed include the questionnaire for COSAH Members, the questionnaire for in-depth individual interviews for local elected representatives and decentralized authorities and the questionnaire for community focus groups.
Activities for the Coming Quarter: Training of data collectors will be held the first week of April. The tools will be pre-tested and data collection will begin.
➢ Activity 2.2.3: CSOs make effective use of the score card tool and evidence collected
Next quarter, CIHG will begin piloting Good Governance Barometer tools in pilot rural communities after approval of Mobilization Grants.
➢ Activity 2.2.4: Partners effectively collect and use information from health service providers for advocacy
No activities to report this quarter. Four CSOs will publish results of their reseach next quarter and will conduct some advocacy activities.
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 21 of 35 SECTION C: ACTIVITY PERFORMANCE MONITORING, EVALUATION AND LEARNING
In this period, MEL support focused on training partner CSOs, as well as a review of existing MEL documents to further strengthen CIHG internal monitoring systems. In addition, CIHG began planning for a mid-project learning exercise to be carried out in mid-April. The project also received the resignation of the MEL Specialist who chose to move home to be with his family.
➢ MEL Training with CSOs CIHG delivered a training on MEL for CSO partners on January 23-25. The course included 27 participants from 16 CSOs who are current sub-awardees, their consortium partners and prospective sub-awardees. The training had an audience with varied needs and roles in their organizations, from MEL officers or executive directors to program assistants. This was a challenge for the training, but we made that determination that inclusive participation was critical. MEL officers must work with colleagues that are not MEL specialists to collect, review and use data.
For concepts such as the difference between monitoring and evaluation, knowledge of Kobo toolbox, theory of change, and the difference between monitoring and evaluation, participant knowledge improved significantly. These represent important knowledge gains that can help to improve the quality of data being reported into CIHG’s monitoring system. Trainees rated the workshop highly (on a scale of 0-5, negative to positive) on the course’s process and content: “relevance to work” (4.76/5); “new skills applicable in my role” (4.74/5); “objectives are appropriate to my needs” (4.74/5); and overall utility of training (4.74/5), “logical progression of the training” (4.39/5); “balance between presentation and exercises” (4.29/5); and “quality and utility of training materials” (4.39/5).
This training is a first step to support CSO partners to integrate MEL into their advocacy and management. CSOs will require further support to improve their MEL skills in the coming quarters.
➢ Activity Monitoring, Evaluation and Learning Plan (AMELP) Systems Review In March, CIHG reviewed project monitoring systems, specifically assessing the quality of the CIHG tools, alignment with the Kobo database for reporting purposes, and the overall application of data collection tools for the project. The goals of this review were to: a) identify and minimize potential issues related to data collection, entry, aggregation, and reporting by partners reporting into CIHG’s AMELP; b) improve user-friendliness of data collection, entry, aggregation, and reporting quality through monitoring tools and database; c) ensure compliance with approved CIHG AMELP; and d) inform recommendations for changes to the AMELP to further improve MEL efforts. A summary of findings, as well as recommendations for strengthening CIHG MEL systems moving forward, is provided in Table 1 below:
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 22 of 35 Results of Monitoring System Review Review Findings Recommendations Theme o Revise Kobo from a single form to one o While tools capture required data, for each monitoring tool, updating to not all disaggregation or reflect data in tools. supporting material can be o Clarify or re-visit roles and expectations Monitoring captured in Kobo Toolbox. around completing monitoring tools, Tools and o There is a single form for collecting uploading to Kobo, and information to Kobo Toolbox data in Kobo. This creates include (perhaps via a refresher additional time burden in training). responding to questions, as well as o Confirm preferences for Kobo set-up to risks in data entry and reporting. more easily feed into SCS-Global level reporting. o Indicators in the AMELP have varying levels of utility depending o Discuss with USAID either to keep AMELP on relevance to activities and/or context indicators 4 and 5, as well as the CIHG theory of change, timing indicator #13 (Sub IR 1.2). and feasibility of data collection. o CIHG’s monitoring includes several non-indicator activities such as case studies and MSC; o Discuss with USAID reducing non- the previous MEL Specialist indicator monitoring activities to the Qualitative recommended streamlining these essential to focus on a few core Monitoring efforts during his exit interview activities (e.g., Most Significant given their complexity and the Change). interest in hiring a local professional.
Next steps for implementation of the above recommendations include: - Finalize recommendations for AMELP refinements to share with USAID in May. - Update Kobo and refine the advocacy tool as needed based on any USAID approved changes to the AMELP (due date pending possible AMELP changes).
➢ Planning for Learning Exercise In February-March, CIHG began planning the approach and structure for a learning exercise to take place in April. The exercise will gather key CIHG stakeholders and people with expertise in health governance and civic participation to discuss how the project can further strengthen its efforts to improve health governance and service delivery. The structure of the learning exercise will include interactive focus groups tasked with examining a specific set of questions. The focus groups results will be compiled in a report summarizing the findings and key recommendations for next steps and CIHG implementation.
➢ CIHG collaborating, learning and adapting (CLA) and promoting local ownership
Advisory Committee: The advisory committee will meet in early April to help prepare CIHG’s learning exercise planned for mid-April.
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 23 of 35 ➢ Local Ownership and Partnerships During Q2, FHI 360 held meetings and participated in events to strengthen partnership with key stakeholders in health governance.
Presentation of CIHG Project to CNERS: On January 8, CIHG’s project director and health specialist met with ten members of the CNERS. The CNERS members appreciated the project’s inclusion of operational research and especially CIHG on capacity building of CSOs.
Engagement with government partners: CIHG staff met regularly with officials from MATD and MOH to organize the National Forum on Health Decentralization and the Communication Workshop.
Health Technical and Financial Partners: We also engaged with health TFPs to ensure coordination and improve implementation. In addition to formal health TFP meetings, CIHG ensured wide particpiation of partners in the Forum on Health Decentralization, attended by senior officials USAID, the World Health Organization, UNICEF, World Bank, European Union, UNDP, AFD, and several other health projects. During the quarter, several organizations and projects intervening in health sector requested for meetings with CIHG project to explore areas of partnership: Organization for Positive Change (OCP); Association of the Communicators of Guinea; Solidarité Thérapeutique et Initiative pour la Santé) (SOLTHIS); Association of Technicians and Biomedical Engineers of Guinea (ATIB); and the National Network of Guinea Ebola Survivors' Association (ENASEG). These organizations were also invited to participate in CIHG organized activities during the quarter for them to have a better understanding of CIHG's implementation strategy and reinforce the complementarity of actions on the field.
➢ Gender and Youth Reporting Gender and youth issues have been considered at several levels. Among data collectors and supervisors recruited and trained by CSOs, 60% were young people and 24% female, i.e., 51 women out of 215 staff members for four CSOs. In different research protocols, all CSOs have specific plans and targets to engage women.
While women’s participation for the Health Decentralization Forum was a challenge given the nature of the participant list, CIHG ensured that women were represented as expert panelist during each training topic. We included Guinea one female governor (who serves in Kindia) and two civil society activists, the President of the Coalition of Women and Girls of Guinea for Dialogue, Peacebuilding and Development, which is the largest women's platform COFFIG and the President of Guinea's National Coalition for Women's Rights and Citizenship /CONAG- DCF).
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 24 of 35 ➢ Summary of Indicator Tracker Table Please note, CIHG is reviewing targets and their validity, to discuss with USAID.
Frequency
Indicator of Data LOP
FY19Q1 FY19Q2 FY19Q3 FY19Q4
Collection Baseline
FY18Total FY19Total FY20Total #1: Objective Context Indicator: Percentage 80% Baseline/ To be of survey respondents satisfied with health (10/ Actual NA NA NA NA NA NA NA Endline collected
services received 2017)
Pending #2: Objective Context Indicator: Percentage 8.2% N/A
Annually Actual 7.2% 8.2% budget
N/A N/A N/A of national budget allocated to health (2017) N/A vote #3: Objective Context Indicator: Percentage Pending Pending Pending 77% of Ministry of Health annual budget Annually Actual annual NA NA NA NA annual 3rd party NA (2017) disbursed against allocation5 report report report #4: Objective Context Indicator: Pending Percentage change in the availability of Baseline/ 65% Actual NA NA NA NA NA NA 3rd party NA essential elements of sanitation and comfort Endline (2017) report in health facilities in Guinea6 #5: Objective Context Indicator: Percentage change in the availability of standard Pending Baseline/ 67% precautionary elements for infection Actual NA NA NA NA NA NA 3rd party NA (2017) prevention and control in health facilities in Endline report Guinea7 Objective: Improved citizens’ understanding and participation in Guinea’s health system reforms 72% 72% Target NA NA NA NA NA NA (15% (15% #6: Percentage of people who say they feel 57% Baseline/ increase) increase) more informed about the health system in (Oct Endline Guinea 2017) Actual NA NA NA NA NA NA Variance NA NA NA NA NA NA
5 Government annual budget execution report anticipated in June of each year. 6 Baseline report Haute qualité des services de santé pour le Développement (HSD) October 2017, page 26. 7 Baseline report Haute qualité des services de santé pour le Développement (HSD) October 2017, page 32.
SCS-Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 25 of 35
Frequency
Indicator of Data LOP
FY19Q1 FY19Q2 FY19Q3 FY19Q4
Collection Baseline
FY18Total FY19Total FY20Total 47.6% 51% 25% 51% (50% Target NA -- NA NA (40% (50% 34% increase increase) #7: Rate of media coverage on health Biannually increase) increase) (Sept See reform issues (television and radio) (Sept/Mar) Actual NA 52% NA NA 2018) baseline Variance NA NA -- NA NA IR 1: Opportunities Expanded for Elected and Appointed Officials and Citizens to Engage in Constructive Dialogue Target 18,800 8600 8600 8600 8600 34,400 19,000 72,200 #8: Number of people participating in CIHG- sponsored forums promoting health Quarterly NA Actual 13426 645 17932 18,577 32,003 - governance and reforms Variance -5374 +9332 -15823 19,000 -40,197 7955 #9: Number of CIHG-supported public Target 10 0 2 8 10 20 20 50 forums with civil society, government Quarterly NA Actual 16 4 2 6 20 official, and/or citizens promoting health governance and reforms Variance +6 +4 - -16 20 -30 Sub IR 1.1: Government officials prepared for engaging citizens’ in health reform dialogue
#10: Number of new initiatives taken by Target 0 0 1 2 2 5 5 10 GoG officials to promote health reform Quarterly NA Actual 0 0 0 0 0 dialogue as a result of CIHG activity Variance 0 0 0 -5 5 -10 Sub IR 1.2: Improved facilitation of issued based discussion and dialogue by media outlets and community theater troupes 71% 80% 86% 86% #11: Percentage score of health issue 57% Target (25% NA NA NA NA (40% (50% (50% publications/ programming on Objectivity Annually (Sept. increase) increase) increase) increase) Scorecard 2018) Actual NA NA NA NA NA Variance NA NA NA NA NA 84% 90% 90% 25% Target NA NA NA NA (40% (50% (50% 60.4% increase #12: Percentage of media partners increase) increase) increase) Annually (Sept. demonstrating improved management 2018) Actual NA NA NA NA NA capacity Variance NA NA NA NA NA
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 26 of 35
Frequency
Indicator of Data LOP
FY19Q1 FY19Q2 FY19Q3 FY19Q4
Collection Baseline
FY18Total FY19Total FY20Total #13: Number of interactive multi-media Target 4 0 1 3 0 4 4 12 platforms supported to facilitate dialogue Actual 1 0 0 0 1 between citizens and the GoG about health Quarterly NA governance Variance -3 0 -1 -3 4 -11 #14: Number of training days provided to Target 70 0 0 35 35 70 46 186 journalists with USG assistance measured Quarterly NA by person-days of training (Mission PMP Actual 64 146 428 574 638 Indicator) Variance -6 +146 +428 +504 46 +452 IR 2: More effective advocacy for health reform by partner CSOs #15: Number of public policies introduced, Target 1 NA NA NA NA 3 4 8 adopted, repealed, changed or implemented as a result of civil society Actual 0 NA NA NA NA Annually NA organizations (CSOs) receiving USG assistance engaged in advocacy Variance -1 NA NA NA NA 3 4 8 interventions #16: Number of USG-assisted CSOs that Target 4 0 0 4 0 4 0 8 engage in advocacy with national legislature Quarterly NA Actual 0 0 0 0 and its committees Variance -4 0 -4 0 -8 Sub-IR 2.1: Skills of CSOs in advocacy, strategic planning and influencing public officials improved Target 25% NA NA NA NA 40% 50% 50% #17: Percentage of targeted CSOs that Annually NA Actual NA NA NA NA NA show improved advocacy capacity Variance NA NA NA NA NA
#18: Number of civil society organizations Target 0 NA NA NA NA 5 10 15 (CSOs) receiving USG assistance engaged Annually NA Actual 0 NA NA NA NA 0 0 in advocacy interventions (Standard F) Variance 0 NA NA NA NA -5 10 -15 Sub-IR 2.2: Increased use of evidence by CSOs to influence public officials on health reform
#19: Percentage of CIHG partner CSOs Target 0 NA NA NA NA 75% 75% 75% using social accountability tools to advocate Annually NA Actual 0 NA NA NA NA for health reforms Variance 0 NA NA NA NA
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 27 of 35
Frequency
Indicator of Data LOP
FY19Q1 FY19Q2 FY19Q3 FY19Q4
Collection Baseline
FY18Total FY19Total FY20Total #20: Number of action plans implemented Target 0 NA 0 NA 1 1 2 3 Biannually as a result of citizens' use of the social NA Actual 0 NA 0 NA 0 0 (Sept/Mar) accountability tool Variance 0 NA 0 NA -1 2 -3
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 28 of 35 SECTION D: MANAGEMENT AND ADMINISTRATIVE ISSUES
➢ Implementation Challenges Major challenges encountered during this period are as follows: With state structures: - Slowness and delays in event planning, validation of supporting documents of activities and communication
With CSOs partners: - Delays of research CSO partners in submitting technical and financial reports - Low quality of financial reports and insufficient supporting documentation - Lack of rigor and weak capacity of CSOs in developing project proposals and reporting - CSO under-estimation of necessary budget for some planned activities (for example, stipends for data collectors and financing for CSO project staff to monitoring activities) - Low capacity in procurement processes in CSOs
➢ Human Resources This quarter, CIHG finalized its recruitment for the new media team leader who was in turn approved by USAID. The MEL Advisor resigned in January. Vigorous recruitment for this position continued with both FHI 360 and SI advertising locally and internationally. Applications were reviewed regularly. After several rounds of job advertisements and screening of more than 130 application, only a handful of candidates were shortlisted and interviews conducted. CIHG expects to submit the leading candidate to USAID for approval in April.
➢ Security Security remains a matter of concern and requires a fair amount of management attention. A training on civil unrest was organized for the staff with the support of some colleagues from headquarters and in the region. The security plan has been updated, reviewed and validated by FHI 360’s Global Security Department with the support from the Regional Security team. The emergency evacuation plan has been updated, reviewed and validated by Regional Security. To ensure office security, the security contract was renewed through December 31, 2019.
The country continues to experience a rather turbulent socio-political and security climate. A protest organized by civic actors, including the Free Union of Teacher-Researchers of Guinea, prevented by strong presence of the police. Roads were blocked, and tires burned. A case of Lassa fever was recorded in Guinea. Declared in Mamou on January 28, 2019, the patient from Kissidougou died. Confirmation was made as early as February 1, and in response about 100 contacts (Kissidougou and Mamou) were followed without developing the disease. This proved that country surveillance and response to epidemics managed by the National Health Security Agency in Guinea has improved markedly. On March 18, 2019, a deworming campaign at Praziquantel targeting school-age children from three prefectures neighboring Conakry (Coyah,
SCS-Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 29 of 35 Dubréka and Fria) triggered side effects (vomiting, diarrhea, abdominal pain and intense fatigue) at a number of children. This triggered a wave of social movements and false rumors that negatively affected most health activities (vaccinations, distribution of mosquito nets, FP programs). The fact that this crisis happened during the preparations for the workshop on the role of CSOs and the media in the implementation of the communication strategy of the Ministry of Health allowed us to showcase the importance of communication for the MOH.
➢ Financial Management At the beginning of 2019, there was a change in the procedure of paying taxes at the level of the National Tax Direction and at the National Social Security Fund. There has been an increase in the ceiling for social contributions. CIHG project has adjusted the salary mechanism in order to comply with this new procedure for the payment of taxes and this new method of calculating payroll taxes.
- All requests for funds were processed on time. - All payment requests have been processed and classified. - All financial deliverables were processed on time.
The average, minimum and maximum cost matrix table for sub-grants is under review to take into account the lessons learned from the difficulties encountered by Research partners, and to improve documentation of cost-estimates.
A tracking table of activation and expiration dates on SAM for all CSOs in mobilization was developed.
➢ Procurement/Logistics/Information Technology Staff updated the office inventory. A second contract for fuel supply has been signed. Procurement for health insurance for employees and dependents has been finalized and will be effective at the beginning of next quarter. Procurement for internet service for year two has been finalized. All procurements related to the organization of workshops and office operations were completed on schedule. As part of the organization of the National Forum on the Health Sector Decentralization, a procurement process was conducted to identify a CSO vendor to lead the organization of the workshop. The procurement was finalized for a translation vendor as well.
Regular preventive and curative maintenance of IT equipment proceeded at regularly intervals to ensure functionality of printers, scanners, computers and the server room. Maintenance for the update of the Windows 10 operating system and software, Antivirus Bitdefender, Umbrella and other programs was conducted. Individual and collective training of server usage and data sharing was provided.
SECTION E: LESSON(S) LEARNED
The Forum on the Decentralization of Health highlighted the need for a combination of efforts of all actors in order to support the newly elected commune leaders to own the health
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 30 of 35 responsibilities transferred to them through the revised Code de Collectivités Locales (Code on Local Communities).
CSOs have underestimated the time for data transcription and analysis for research. A no-cost extension request process will be initiated in the next quarter to allow CSOs to complete their research projects. Through the review and analysis of financial reports submitted by research CSOs, it was noted that CIHG team should conduct weekly visits to support CSOs to avoid delays in report validation.
SECTION F: PLANNED ACTIVITIES AND EVENTS FOR NEXT QUARTER
IR 1: Opportunities Expanded for Elected and Appointed Officials and Citizens to Engage in Constructive Dialogue
Sub-IR 1.1: Elected and appointed officials better prepared for engaging citizens’ in health reform dialogue
➢ Activity 1.1.2: Strengthening NA Leadership in Health Reform In the next quarter, CIHG will conduct the following activities with the NA: - Training for NA Health Committee members on advocacy - Training for NA staff on legislative reporting - Training on leglisative accountability, transparency and executive oversight
➢ Activity 1.1.3: Strengthening MOH Leadership in Health Reform In the next quarter, CIHG will work on two activities that were postponed due to structural changes in the MOH: - Support the revitalization of two thematic groups on health governance and community health - One press conference on health reform
➢ Activity 1.1.4: Strengthening MATD Leadership in Health Reform In the next quarter, CIHG will organize following activities in partnership with MATD: - Participate in PNACC steering committee meeting. - Establishment of an online platform for citizen feedback/PNACC
Sub IR 1.2: Improved facilitation of issued based discussion and constructive dialogue by media outlets and community theater troupes
➢ Activity 1.2.1: Effective health reform communications and media programming developed - Health communication workshop - Finalization of the communications strategy
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 31 of 35 ➢ Activity 1.2.2: Develop the capacity of local radio stations - Onsite training for five radio stations
➢ Activity 1.2.3: Strengthen the NA media to promote accountability and health reform - CIHG will provide follow up coaching to NA media
➢ Activity 1.2.4: Production and dissemination of health reform focused programming - Broadcast of productions from 30 radio partners on health reform - Production of TV series on health governance continues - Production of information products for low-literacy communities continues
➢ Activity 1.2.6: Increase citizen understanding and discussion of health reforms through community theater - Ten participatory theater performances
➢ Activity 1.2.7: Support community listening and discussion groups - Facilitate listening groups
Sub IR 2.1: Skills of partner CSOs in advocacy, strategic planning and influencing public officials improved
➢ Activity 2.1.1: CSOs’ business management competencies improved - Organize an orientation session on procedures and contractual requirements of the FHI 360 CIHG project with CSOs in Mobilization - Organize a capacity building session on governance, administrative and financial management for CBOs / CSOs with internal expertise
➢ Activity 2.1.2: CSOs’ advocacy and strategic planning skills improved - Organize a CSO training workshop in advocacy - Organization of a two-day training workshop in behavior change communication and communication technology for CSO partners - Training workshop on strategic planning and organizational governance - Coaching sessions on monitoring and evaluation for CSOs
Sub IR 2.2: Increased use of evidence by CSOs to influence public officials on health reform ➢ Activity 2.2.1: Technical assistance to grantees on evidence-based research - Coaching to research grantees to continue
➢ Activity 2.2.2: CSOs effectively use scorecards and evidence gathering approaches • AFJ : - Finalization of the data collection preliminary report - National restitution of the data collection outcomes
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 32 of 35 - Training of journalists in Conakry and Kindia on the dissemination of the results - Advocacy meetings with decision makers
• AIDE: - Conducting data collection in the field - Analysis, interpretation and sharing of data - Drafting the provisional report of data collection and feedback from FHI 360 - Workshop to share report and validation recommendations - Dissemination of the research’s findings
• MSS: - Data entry - Data processing and analysis - Report drafting and feedback from FHI360 - Workshop to share and validate report recommendation - Organization of seven workshops to disseminate the recommendations of the study in seven regions
• CJMAD: - Analysis, interpretation and sharing of data - Report drafting and feedback from FHI360 - Workshop to share and validate report recommendation - Dissemination of the research’s findings
• CENAFOD : - Training of supervisors and data collectors - Training and orientation of Focal Points in Prefectures - Conducting data collections in the field
➢ Activity 2.2.3: CSOs effectively mobilize constituencies for reform • AGIL - Setting up the Project Team - Production of Tools on Health Reforms and Skills Transferred to Communities - Implementation of the Good Governance Barometer in the sub-prefecture of Norassoba, Kankan
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 33 of 35 ANNEX
List of CIHG TV partners TV Station Partners Location Evasion TV Conakry RTG Koloma Conakry Gangan TV Conakry Faso TV Kankan
List of CIHG Radio Station Partners
Name Radio Frequency Location 1. Radio Parlementaire 107.5 Conakry 2. Renaissance 95.9 Conakry 3. Tamata FM 92.6 Conakry 4. Soleil FM 93.5 Conakry 5. RKS 94.9 Conakry 6. Chérie FM 104.1 Conakry 7. Espace Labé 99.7 Labé 8. Kania Zik FM 107.0 Kindia 9. Sabou FM 96.6 Kindia 10. Voix de Fria 92.5 Fria 11. BTA FM Zaly 103.8 N’zérékoré 12. Bolivar FM Mamou 99.4 Mamou 13. Espace Kakandé Boké 99.7 Boké 14. Milo Fm Siguiri 99.6 Siguiri 15. Baobab FM 97.7 Kankan 16. Bambou FM 104.5 Faranah 17. Niandan FM 94.10 Kissidougou 18. Radio rurale Kissidougou 88.3 / 99.9 Kissidougou 19. Radio rurale Macenta 91.7 Macenta 20. Radio rurale Beyla 94.40/98.20 Beyla 21. Radio rurale Guéckédou 104.10 Guéckédou 22. Radio rurale N’zérékoré 92.2 N’zérékoré 23. Radio Rurale de Kouroussa 94.7 Kouroussa 24. Radio Rurale Boké 94.4 Boké 25. Radio Rurale Boffa 95.9 Boffa 26. Radio Rurale Forécariah 89.3 Forécariah 27. Radio Rurale Labé 104.3 Labé 28. Radio Rurale Dalaba 89.9 Dalaba 29. Zaly FM 106.6 N’zérékoré 30. Pacifique FM 106.6 N’zérékoré
SCS-Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 34 of 35
Summary List of Guinean CSO Sub-Awards Sub-grants pending USAID approval Organization name Femmes pour le Développement Intégré et la Promotion Humaine (FEDIPHU) Association Guinéenne pour l’Implication des Femmes dans le Processus Electoral et la Gouvernance (AGUIFPEG) Conseil National des Organisations de la Société Civile (CNOSCG) Sub-grants approved by USAID Organization name Mutuelle de Sante et Service « Mutuelle Guinée » Action et Développement pour la Guinée (Aide Guinée) Comite Jeunes mon Avenir d’Abord (CJMAD) Association des Femmes Journalistes de Guinée (AFJ) Centre Africain de Formation pour le Développement (CENAFOD) Alliance pour la Promotion de la Gouvernance des Initiatives Locales (AGIL)
SCS Guinea: Citizen Involvement in Health Governance FY 2019 Q2 Quarterly Report: January – March 2019 Page 35 of 35