Population Services International (PSI) Cooperative Agreement No.: AID-654-A-17-00003

YEAR 3 QUARTER 2 PROGRESS REPORT

January 1, 2019 to March 31, 2019

Date of Submission: May 15, 2019

Country Representative: Anya Fedorova, email: [email protected]

Chief of Party: Paulo R Proto de Souza, email: [email protected]

Table of Contents

3 Acronym List

5 Background

6 Executive Summary

Malaria

7 Result 1

15 Result 2

25 Result 5

HIV/AIDS

31 Result 3

Sexual and Reproductive Health and Family Planning

39 Result 4

Attachments Attachment 1 – Mentorship Assessment Plan for NMCP Attachment 2 – Performance Management Plan Attachment 3 – Success Story Attachment 4 – Corrective Action Plan: Q2 FY19 Update Attachment 5 – Capacity Development Plan Attachment 6 – List of Health Units in the Six PMI Provinces

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 2

Acronym List

ACT Artemisinin-Based Combination Therapy ADECOS Community Health Workers AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care ART Antiretroviral Therapy ASAQ Artesunate/Amodiaquine DHIS2 District Health Information Software 2 DHS Demographic and Health Survey DNSP National Public Health Department DPS Provincial Health department) FAS Social Support Fund FP Family Planning GEPE Office of Planning and Statistics Global Fund Global Fund to Fight AIDS, Tuberculosis and Malaria GPS Provincial Health Directorate GPSL Health Department of GRA Government of the Republic of GTI Office of Information Technology HF Health Facility HFA Health for All HIV Human Immunodeficiency Virus HMIS Health Management Information System HNQIS Health Network Quality Improvement System HTS HIV/AIDS Testing Services HU Health Unit HW Health Worker iCCM Integrated Community Case Management ICTT Index Case Testing and Tracing INLS Instituto Nacional de Luta Contra a SIDA IPTp Intermittent Preventive Treatment in Pregnancy LLIN Long-Lasting Insecticidal Net IUD Intrauterine Device LD Laboratory Diagnosis LLIN Long-Lasting Insecticidal Net M&E Monitoring and Evaluation MCM Malaria Case Management

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 3

MINSA Ministry of Health MiP Malaria in Pregnancy MSH Management Sciences for Health NGO Nongovernmental Organization NMCP National Malaria Control Programme OM Optical Microscopy PAF Patient Assistant Facilitator PAV Expanded Vaccine Program PEPFAR United States President’s Emergency Plan for AIDS Relief PMI President’s Malaria Initiative PMP Performance Management Plan PSI Population Services International PSM Procurement and Supply Management Project RH Reproductive Health RMA Rede Mulher Angola RDT Rapid Diagnostic Test SBCC Social and Behavior Change Communication TB Tuberculosis UNAIDS Joint United Nations Programme on HIV and AIDS UNICEF United Nations Children’s Fund USAID United States Agency for International Development USG United States Government WHO World Health Organization

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 4

Background

In January 2017, a Population Services International-led consortium signed the Cooperative Agreement No.: AID- 654-A-17-00003 to implement project Health for All from February 2017 to January 2022. HFA includes three health areas: malaria, HIV/AIDS, and sexual and reproductive health and family planning.

The following progress report describes main achievements of the past quarter, achievements and constraints in this reporting period, and proposed recommendations and action plans for the next quarter.

This reporting period is January 1 and March 31, 2019 (the second quarter [Q] of year 3 of fiscal year 2019 [FY19]). The progress report is organized into three primary programmatic-based sections, as indicated below.

1. Malaria prevention and treatment activities (Results 1, 2, and 5)

2. HIV/AIDS continuum of care activities (Result 3)

3. Sexual and Reproductive Health and Family Planning activities (Result 4)

LLIN campaign in Bengo (above); Family planning training in province (top left); Interviewing community health workers (ADECOS) (bottom left)

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 5

Executive Summary

The Health for All (HFA) project continued to expand and provide key services in malaria, HIV/AIDS, and sexual and reproductive health and family planning throughout Angola from January 1, 2019 to March 31, 2019.

Malaria prevention and treatment activities (Results 1, 2, and 5) continued throughout the reporting period. The long-lasting insecticidal nets (LLINs) mass distribution campaign (Result 1) concluded in Q2. It was 17 months in total, running from May 1, 2017 to February 4, 2019. Fifteen provinces were targeted for distribution, but only 13 were covered. and Bie were excluded due to unavailability of LLINs. The final campaign results included total population covered: 12,073,097; number of registered pregnant women covered: 354,444; number of registered children < 5 years covered: 2,031,464; number of registered households covered: 2,379,943; and total LLINs distributed in 13 Provinces: 6,693,503. Universal coverage reached 85.6% of the total estimated population of the 15 target provinces (12,073,097 out of 14,193,030).

Malaria services were also improved throughout the targeted municipalities (Result 2). Health workers were trained in malaria case management of artemisinin-based combination therapy, intermittent preventive treatment in pregnancy, and malaria laboratory diagnostics and use of rapid diagnostic tests. Shifting from mass distribution to supporting the National Malaria Control Program (NMCP) in routine distribution, together with changes to the supervision methodology, required significant changes so the HFA structure was revised accordingly. In addition, formative supervision continued and a new approach to mentoring was developed and is awaiting NMCP approval.

The capacity of municipal and provincial governments to plan, fund, monitor, and supervise health services (Result 5) continues to improve with ongoing support provided to the Ministry of Health (MINSA) on improving data quality and data use for decision-making. In Q2, HFA conducted various activities on routine supervision, data analyses, and technical assistance. Other ongoing activities included routine supervision to municipal health directorates, data analyses meetings with municipal and provincial health staff, monitoring activities, workshop to assess DHIS2 roadmap implementation, and research activities including the Therapeutic Efficacy Study, the LLIN Use and Care Study, the Operational Research-Southeast Asian Migrant Study).

HFA continued providing support to ensure a sustainable model for providing high-quality HIV/AIDS services. During Q2, HFA completed workshops for HIV/AIDS micro-plans for the managers of health facilities. The family planning team Result 4) and the HIV team (Result 3) finished service integration in 22 health facilities (including three selected U.S. President’s Emergency Plan for AIDS Relief [PEPFAR] health facilities assigned to HFA) in .

Several activities took place to strengthen, expand, and integrate sexual and reproductive health and family planning services (Result 4). Key achievements in Q2 included: supported organization of the 3rd Technical Working Group on Sexual and Reproductive Health meeting; assisted in updating lists on DHIS2; provided, through a public and private partnership, a donation of 141,540 cycles of the third-generation oral combined contraceptive pills (Meuri brand) to 92 public health units in Luanda and Huambo; integrated family planning and HIV services in HFA-supported health units in Luanda; and improved social and behavior change communication among clients in HFA-supported health units.

Although HFA faced challenges in project implementation during Q2, as discussed later in the report, the HFA team realized significant achievements during this reporting period and continues to ensure that the project is providing high-quality, expansive health services to the population of Angola.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 6

MALARIA

Result 1: 1 LLIN Access and Use Increased by at Least 30%

1.1 Summary of Past Quarter Achievements (Q1 FY219)

In the first quarter of 2019, a LLIN mass distribution campaign was conducted in , Lunda Sul, and Bengo provinces. The President’s Malaria Initiative (PMI)/United States Agency for International Development (USAID) exclusively supported the campaigns in Bengo and Lunda Sul. Moxico was able to complete universal coverage thanks to an agreement with the NMCP, the Global Fund for to Fight AIDS, Tuberculosis and Malaria (Global Fund), and PMI. During the registration period, it was determined that the initial estimate was insufficient given the population increase; PMI provided additional nets.

HFA demonstrated strong results with universal coverage achieved in the provinces of Moxico, Lunda Sul, and Bengo. A total population of 1,969,151 was reached with distribution of 1,091,031 LLINs of the total 1,114,578 LLINs that were made available for the 3 provinces. The Global Fund contributed with 409,335 LLINs (used in Moxico only) and PMI/USAID contributed with 705,243 LLINs (used in all 3 provinces).

Following the campaigns, LLINs remained in each province: Moxico had 2,285 LLINs in the DPS warehouse for routine distribution; Lunda Sul had 7,020 LLINs in the DPS warehouse for routine distribution; and Bengo had 14,242 LLINs that were returned to the Procurement and Supply Management Project (PSM)’s warehouse in Luanda.

1.2 Targets and Achievements in Reporting Period (Q2 FY19)

Mass Distribution Lunda Norte, the last of 13 provinces to be completed, was not finalized in Q1 due to road accessibility issues during the rainy season. Five municipalities (Capenda-Camulemba, , Xá-Muteba, , and Cuango) were completed by the end of January 2019, and the mass distribution campaign was completed on February 4, 2019. Results are depicted in table 1.

Table 1. LLIN Mass Distribution Results in

Achievement Estimated Target for Achieved (between Q1 Performance Indicators (Q1 and Q2) * Lunda Norte FY19 and Q2) ** FY19 1. Number of LLINs distributed in Q1 and Q2 FY19 540,102 673,316 124% 2. Number of community health workers trained on LLIN use in Q1 and Q2 FY19 595 665 111% 3. Number of households with at least one LLIN for every two people by Q2 FY19 186,867 214,408 114%

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 7

4. Number of children < 5 with LLINs by Q2 FY19 188,409 238,220 126% 5. Number of pregnant women with LLINs by Q2 FY19 24,110 42,482 176% 6. Total number of people with LLIN between Q1 and 1,020,289 1,237,367 Q2 FY19 121%

* The achievements refer to Lunda Norte province (covered from November to January and are being reported under Q2 (not included in Q1). **The estimated population, based on the 2014 census, was lower than the population registered during the distribution. This resulted in achieved results being much higher than anticipated.

1.3 Major Constraints in Reporting Period (Q2 FY19)

Major constraints specific to Lunda Norte included: • Inaccurate 2014 census data: Data from the 2014 census (Instituto Nacional de Estatística/INE) and data provided by local authorities was not accurate leading to a significant underestimation of the population needing LLIN coverage. This resulted in three separate LLIN deliveries to the province which took additional time and increased costs.

• Population migration of population (interprovincial and international): Forced migration of Congolese back to their home country, imposed by the Operação Resgate, resulted in difficulties obtaining accurate population rates due to constant fluctuation.

• Outdated municipality maps: Maps used by local authorities were outdated. The number of inhabitants living in the municipalities was often incorrect, and in some cases, communes were not mapped.

1.4 Proposed Targets and Plan of Action for Q3 FY19

The LLIN mass distribution campaign formally ended in Q2 FY19 so targets and action plans are no longer necessary.

1.5 Final Results Achieved with LLIN Mass Distribution Campaign

The LLIN mass distribution campaign started on May 1, 2017 and ended on February 4, 2019. It was 17 months in total. Fifteen provinces were targeted for distribution, but only 13 were covered. Cabinda and Bie were excluded due to unavailability of LLINs. Coverage rates in the 13 provinces are provided in table 2.

Table 2. Total Quantification Data from LLIN Distribution (2017–2019)

Total Total Total Total Province/ Registered Registered Total LLINs Registered Registered Municipality Pregnant Children Distributed Population Households Women < 5 Years Bengo Ambriz 34,230 785 6,628 7,468 19,300 18,631 518 3,371 3,867 10,348 288,155 9,014 46,188 56,689 159,950 33,729 858 5,800 7,675 19,250 60,041 1,538 10,889 12,989 33,638 Pango Aluquém 9,725 211 1,559 2,566 5,600 Total 444,511 12,924 74,435 91,254 248,086 Cuando Cubango 21,125 335 3,322 5,036 12,194 32,928 946 7,608 7,636 18,797 40,765 982 6,580 9,391 23,193 47,998 1,204 7,320 11,640 27,660 12,566 279 2,588 3,514 7,456 24,406 707 4,447 8,048 14,753 296,687 9,119 60,950 56,966 164,164 Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 8

Nancova 3,460 149 539 1,378 2,176 28,251 723 4,507 6,876 16,150 Total 508,186 14,444 97,861 110,485 286,543 Cunene 77,440 1,306 12,891 13,623 42,610 398,850 10,764 56,028 55,583 213,308 44,935 2,656 6,981 9,391 25,284 84,054 2,836 10,520 15,912 46,500 102,289 4,047 14,874 17,134 55,628 270,672 9,251 38,046 45,230 146,114 Total 978,240 30,860 139,340 156,873 529,444 Huambo 355,093 13,518 51,134 73,439 196,743 Catchiungo 156,760 4,261 23,814 31,348 85,799 Caála 392,037 12,723 71,187 71,162 212,598 120,729 3,834 20,392 25,807 66,919 Huambo 946,916 30,805 151,776 173,978 519,952 Londuimbale 169,290 5,091 29,124 35,762 94,665 120,205 2,948 17,319 25,127 66,460 Mungo 157,699 4,930 23,822 34,137 86,396 Tchicala-Tcholoanga 49,387 1,335 8,237 11,703 27,976 Ucuma 76,927 3,343 13,922 17,413 43,304 Total 2,545,043 82,788 410,727 499,876 1,400,812 Cuanza Norte 76,722 1,897 12,524 15,648 43,343 Banga 11,022 216 1,731 2,357 6,197 12,726 310 2,214 2,769 7,180 Dondo 101,130 3,032 16,942 18,877 58,927 204,058 4,590 27,563 37,794 111,375 31,521 614 4,947 8,187 17,538 27,533 677 4,899 5,712 15,492 6,327 143 945 1,745 3,761 10,124 194 1,664 2,590 5,833 Samba Caju 27,946 945 5,732 7,246 15,606 Total 509,109 12,618 79,161 102,925 285,252 Kwanza Sul Amboim 168,299 4,248 31,534 49,304 107,822 155,293 4,080 25,727 36,283 88,349 Cela 257,896 5,832 36,605 52,782 143,700 Conda 79,245 2,332 13,445 26,767 48,223 Ebo 125,046 3,129 19,996 48,238 73,913 78,520 1,411 10,211 17,896 43,160 80,958 1,972 11,614 18,814 47,050 134,769 2,486 16,160 25,434 75,296 132,334 4,367 20,703 27,884 73,850 66,410 1,574 11,745 17,786 38,676 Seles 157,543 3,039 26,218 40,291 90,620 284,012 7,316 38,108 61,291 159,939 Total 1,720,325 41,786 262,066 422,770 990,598 Lunda Norte Cambulo 194,429 6,775 36,192 32,972 106,048 Capenda- 90,184 3,326 17,161 19,015 49,300 Camulemba Cangula 32,803 775 6,404 5,802 18,000 Chitato 294,645 9,252 59,335 43,764 161,630 Cuango 266,679 10,555 45,448 46,197 142,841 Cuílo 23,660 441 4,529 4,116 12,650 Lóvua 31,540 1,504 8,992 6,292 17,283 24,790 628 5,104 4,984 13,600 196,170 6,689 42,069 34,603 106,412 Xá-Muteba 82,467 2,537 12,986 16,663 45,552 Total 1,237,367 42,482 238,220 214,408 673,316 Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 9

Lunda Sul 31,734 730 6,728 5,841 17,324 Dala 42,934 1,136 10,376 7,879 23,300 55,271 2,031 13,345 9,750 29,965 545,232 18,002 120,408 86,800 294,991 Total 675,171 21,899 150,857 110,270 365,580 Cahombo 28,038 751 5,581 6,317 16,050 Kacuso 95,056 2,293 14,586 19,717 52,600 Kalandula 111,249 2,705 21,113 22,635 61,939 Cambundi-Catembo 49,959 1,146 8,379 10,710 28,414 58,021 1,828 9,896 8,898 30,945 Cuaba Nzogo 19,059 673 3,232 4,373 10,700 Cunda-Dia-Baze 22,483 933 3,297 6,095 13,300 70,444 2,012 11,675 14,845 39,672 Malanje 550,633 13,391 85,967 88,879 295,487 Marimba 37,198 1,072 7,209 6,022 20,100 47,554 1,692 7,924 8,994 26,756 37,485 969 6,527 7,560 21,046 31,733 848 6,159 5,874 17,500 27,246 855 6,300 5,262 15,150 Total 1,186,158 31,168 197,845 216,181 649,659 Namibe 74,811 2,363 12,066 14,784 42,050 Camucuio 69,570 2,806 9,631 10,634 37,850 Namibe 257,546 7,120 36,774 44,621 142,905 50,789 1,607 7,220 9,088 27,850 29,783 1,202 5,457 4,971 16,158 Total 482,499 15,098 71,148 84,098 266,813 Uíge 60,735 1,557 9,885 13,394 33,632 Bungo 41,247 1,142 7,743 8,786 23,441 64,130 2,018 12,146 13,160 35,473 5,418 159 785 1,011 3,009 Puri 43,018 997 7,861 8,808 24,154 37,787 999 6,533 8,244 21,178 82,335 2,493 16,002 15,495 45,464 Total 334,670 9,365 60,955 68,898 186,351 Zaire 62,899 1,196 10,291 16,691 37,100 M'Banza Kongo 199,048 4,661 29,051 38,975 111,489 Nzeto 43,217 880 6,540 7,768 26,685 Nóqui 27,161 682 4,224 5,064 15,086 229,183 5,204 31,713 51,761 117,102 40,841 896 7,407 10,581 26,222 Total 602,349 13,519 89,226 130,840 333,684 Moxico 117,601 3,247 23,310 26,992 65,500 73,660 2,512 14,358 17,587 38,200 47,754 1,320 9,051 9,945 24,665 Cameia 42,092 1,982 8,077 8,795 22,950 27,514 772 5,056 5,300 15,850 Luau 120,985 4,176 25,067 24,711 68,650 17,208 589 3,656 4,239 8,700 Luena 365,664 9,878 63,485 65,786 212,250 Léua 36,991 1,017 7,563 7,710 20,600 Total 849,469 25,493 159,623 171,065 477,365 Grand Total 12,073,097 354,444 2,031,464 2,379,943 6,693,503

Final LLIN campaign coverage results were: 1. Total Population Covered: 12,073,097 2. Number of Registered Pregnant Women Covered: 354,444

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 10

3. Number of Registered Children < 5 Years Covered: 2,031,464 4. Number of Registered Households Covered: 2,379,943 5. Total LLINs Distributed in 13 Provinces: 6,693,503

Universal coverage reached: 1. Total Population of 15 Target Provinces: 14,193,030 people 2. Coverage of 13 Provinces Fully Completed (excluding Cabinda and Bie): 12,073,097 people 3. Universal Coverage Achieved: 85.6% 4. Approximate Cost per LLIN Distributed (excluding net cost and transport to each municipality): US$1.88

1.6 Social and Behavior Change Communication (SBCC) Activities Supporting LLIN Access and Use

Five SBCC activities were developed to support the LLIN mass distribution campaign, and are described in detail below.

Post-Campaign Communication for Promotion and Proper LLIN Use

During Q2 FY19, the SBCC LLIN post-campaign training was completed in: two provinces of phase 3—Cuando Cubango and Moxico—between January 21 and February 7, and 43 malaria and health promotion supervisors were trained in all municipalities; and three provinces of phase 4—Lunda Sul, Lunda Norte, and Bengo—between February 25 and March 20, and 46 malaria and health promotion supervisors were trained in all municipalities. In Q3, PSI plans to support the NMCP in the supervision phase of community leaders who will be trained by the HFA-trained malaria and health promotion supervisors. The supervision will be carried out in the six PMI provinces starting in mid-April based on the activity plan developed jointly with the NMCP SBCC Focal Point, Dr. Fátima Joao. The remaining 4 provinces (excluding Lunda Norte and Lunda Sul) have shared their training plans with HFA and NMCP. Supervision activities for the remaining non-PMI provinces is the responsibility of the NMCP.

Malaria Jingle Promoting LLIN Use

In previous quarters, PMI/USAID and the National Public Health Department (DNSP)/MINSA approved a jingle developed by HFA in partnership with NMCP to be used after the LLIN campaign to promote continuous use of bed nets. The jingle was shared with the Secretary of State for Social Communication, Dr. Celso Malavoloneke, who facilitated jingle placement in the Angolan National Radio on national and provincial radio channels. The approved media plan for the campaign included broadcasting the jingle three times a day—morning, midday, and late afternoon. PSI conducted placement monitoring in the six PMI provinces and on the national level and confirmed that the jingle was aired nationally and across five of the PMI provinces. In Lunda Norte, broadcasting of the jingle did not take place in February, as the provincial station claimed not to have received communication from the Angolan National Radio. PSI worked with the office of the Secretary of State for Social Communication to reinforce the placement of the jingle and, in March, Lunda Norte radio started broadcasting it during the agreed time. PSI also requested an extension of the radio campaign until the end of May (instead of mid-April). The extension was confirmed by the Angolan National Radio and the Secretary of State’s office.

Participation on Inter-Ministerial Working Group

As of January 2019, PSI’s Director of Communications has been a regular member of the Inter-Ministerial Working Group for Social Communication on Cholera and Malaria. Other members of the working group include the UN Children’s Fund (UNICEF), Ministry of Culture, DNSP (represented by the Director of the Department of Health Promotion), the Health Department of Luanda (GPSL), and the Ministry of Social Communication. The working group is chaired by the Secretary of State for Social Communication, Dr. Celso Malavoloneke and co- chaired by Dr. Joseth Rita de Souza, Director of Department of Health Promotion of DNSP/MINSA. In the reporting period, the working group worked on communication materials, including finalization of key messages, revision of printed information, education, and communications materials (i.e., leaflets and posters), revision of radio spots, and development of new communication materials. PSI’s Communication Department was responsible for the malaria artwork revision, while UNICEF worked on cholera.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 11

The communication materials were recently presented to the Minister of Health and Minister of Social Communication and were approved for printing and dissemination. The printing and distribution will be done solely with the Government of the Republic of Angola (GRA) budget.

Development of SBCC Campaign Targeting Pregnant Women to Increase Antenatal Care (ANC) Visits and Intermittent Preventive Treatment in Pregnancy (IPTp) Uptake

A previous study conducted by World Learning1 identified three key barriers to ANC attendance and IPTp uptake: distance to facilities, stockout of sulfadoxine/pyrimethamine, and costs associated with travelling to facilities and purchasing sulfadoxine/pyrimethamine, if it is not available in the public sector. In 2019, HFA conducted an additional study to identify barriers and motivators beyond structural and logistical challenges articulated by World Learning. This study was an exploratory-descriptive study, with a qualitative approach, where information was obtained through semi-structured interviews with 37 pregnant women, aged 18-45. It was conducted in three provinces—Malanje, Uíge, and Zaire. Key findings include: • Identify the factors that discourage active demand for prenatal care throughout pregnancy in health facilities. Findings: negative and judgmental attitudes of providers, long waiting times to receive services, and lack of explanation on the importance of IPTp. • Identify the factors that discourage the search for and the completion of IPTp against malaria in pregnant women. Findings: side effects of the drug, availability of food, and late start of prenatal consultations. The full focus group report will be available in Q3. A second study will be conducted with healthcare professionals to gain a better understanding of behavioral barriers and other issues. It will be semi-structured in-depth interviews.

LLIN Use and Care Study to Support Future SBCC Campaign

Johns Hopkins University issued an ethical approval for the LLIN use and care study on March 11, 2019. Fieldwork will begin in mid-April and will be completed by the end of June in three provinces—Uíge, Cunene, and Kwanza Sul. Joint supervision of field activities is being planned in coordination with the NMCP.

1.6.1. SBCC Achievements in Q2 FY19

Post-Campaign Communication for Promotion and Proper Use of LLINs Results were monitored routinely and are reflected in table 3.

Table 3. Post-Campaign Communication Results Achieved in Q2 FY19

Number of Trainees Province Date of Training Number of Total SPPM SPPS SMPM SMPS Others Municipalities Cuando January 21-23, 2019 9 01 01 12 06 04* 24 Cubango Moxico February 5-7, 2019 8 01 01 09 08 00 19 Lunda Sul February 25-27, 2019 4 02 01 04 04 00 11 Lunda Norte March 4-6, 2019 10 01 00 10 10 00 21 Bengo March 18-20, 2019 7 01 01 06 06 00 14 January 21 to Total 38 6 4 41 34 4* 89 March 20, 2019 *In Cuando Cubango, other representatives who also attended included: 1 TransKunene Malaria Initiative Project representative, 1 provincial supervisor for school health, 1 provincial supervisor for nutrition, and 1 provincial supervisor for environment sanitation.

Jingle Radio Placement Monitoring

1 World Learning. (2017). Eye Kutoloka Project. Oportunidades e Barreiras à um Funcionamento Eficiente do TIP-SP em Angola: A Percepção dos Prestadores de Serviços e das Utente. PowerPoint Presentation.

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Radio campaign monitoring was conducted in all six provinces and at the national level: Luanda (national level), Zaire, Lunda Sul, Lunda Norte, Cuanza Norte, Malanje, and Uíge. Tables 4 and 5 showcase results for the quarter. Table 4. Jingle Monitoring Sheet for Prevention of Malaria on Seven Radio Stations (February 2019)

Mês Fevereiro (entre dia 1 a 28)

Semana Total do mês

# vezes # vezes # vezes # vezes # vezes # vezes o # vezes o # vezes o # vezes o # vezes o # vezes # vezes monitorad monitorada monitorad monitorada monitorad Dia da Semana evento % evento % evento % evento % evento % # vezes o monitoread % # vezes o monitoread % as na s na as na s na as na aconteceu aconteceu aconteceu aconteceu aconteceu evento as na evento as na semana semana semana semana semana aconteciou semana aconteciou semana Dia Calendario 18,20,22,24,26,28 Provincia Rádio Lunda Sul Rádio Zaire Rádio Kwanza Norte Rédio Nacional Rádio Uíge Rádio Lunda Norte Malange Manha (7:25 am) Passou no ar 6 6 100,0% 6 6 100,0% 5 5 100,0% 13 13 100,0% 0 3 0,0% 0 3 0,0% 0 3 0,0% Se faz menção ao Programa 5 6 100,0% 6 6 100,0% 5 5 100,0% 13 13 100,0% 0 3 0,0% 0 3 0,0% 0 3 0,0% Nacional de Controlo de Malária ? Se faz mencão a USAID ? 5 6 100,0% 6 6 100,0% 5 5 100,0% 13 13 100,0% 0 3 0,0% 0 3 0,0% 0 3 0,0% Tarde (14:28 am) Passou no ar 6 6 100,0% 6 6 100,0% 3 3 100,0% 4 4 100,0% 0 3 0,0% 0 3 0,0% 0 3 0,0% Se escuta a mencão ao Programa 6 6 100,0% 6 6 100,0% 3 3 100,0% 4 4 100,0% 0 3 0,0% 0 3 0,0% 0 3 0,0% Nacionald e Controlo de Malária ? Se faz mencão a USAID ? 6 6 100,0% 6 6 100,0% 3 3 100,0% 4 4 100,0% 0 3 0,0% 0 3 0,0% 0 3 0,0% Noite (22:07 am) Passou no ar 5 5 100,0% 6 6 100,0% 3 3 100,0% 0 12 0,0% 0 3 0,0% 0 3 0,0% 0 3 0,0% Se escuta a mencão ao Programa 5 5 100,0% 6 6 100,0% 3 3 100,0% 0 12 0,0% 0 3 0,0% 0 3 0,0% 0 3 0,0% Nacionald e Controlo de Malária ? Se faz mencão a USAID ? 5 5 100,0% 6 6 100,0% 3 3 100,0% 0 12 0,0% 0 3 0,0% 0 3 0,0% 0 3 0,0% Total durante o dia (22:28 am) Passou no ar 17 17 100,0% 18 18 100,0% 11 11 100,0% 17 17 100,0% 0 3 0,0% 0 6 0,0% 0 6 0,0% Se escuta a mencão ao Programa 17 17 100,0% 18 18 100,0% 11 11 100,0% 17 17 100,0% 0 3 0,0% 0 6 0,0% 0 6 0,0% Nacionald e Controlo de Malária ? Se faz mencão a USAID ? 17 17 100,0% 11 11 100,0% 17 17 100,0% 0 3 0,0% 0 6 0,0% 0 6 0,0%

Table 5. Jingle Monitoring Sheet for Prevention of Malaria on Seven Radio Stations (March 2019)

Mês Março (entre dia 1 a 29) Semana Total no mês

# vezes # vezes # vezes # vezes # vezes # vezes # vezes o # vezes o # vezes o # vezes o # vezes o # vezes o monitorada monitorada monitorada monitorada monitorada monitorada # vezes Dia da Semana evento % evento % evento % evento % evento % evento % % s na s na s na s na s na s na # vezes o monitoread aconteceu aconteceu aconteceu aconteceu aconteceu aconteceu semana semana semana semana semana semana evento as na aconteciou semana Dias Calendário monitorado 4,6,8,10,12,14,18,20,24,26, 28, 29 Provincia Rádio Lunda Sul Rádio Zaire Rádio Kwanza-Norte Rádio Luanda Rádio Uíge Rádio Malange Lunda-Norte Manha (7:25 am) Passou no ar 12 12 100,0% 12 12 100,0% 12 12 100,0% 8 12 66,7% 12 12 100,0% 12 12 100,0% 8 12 66,7% Se faz menção ao Programa Nacional de Controlo de 12 12 100,0% 12 12 100,0% 12 12 100,0% 8 12 66,7% 12 12 100,0% 12 12 100,0% Malária ? 8 15 53,3% Se faz mencão a USAID ? 12 12 100,0% 12 12 100,0% 12 12 100,0% 8 12 66,7% 12 12 100,0% 12 12 100,0% 8 15 53,3% Tarde (14:28 am) Passou no ar 12 12 100,0% 12 12 100,0% 12 12 100,0% 7 12 58,3% 12 12 100,0% 12 12 100,0% 8 15 53,3% Se faz mencão ao Programa Nacional de Controlo de 12 12 100,0% 12 12 100,0% 12 12 100,0% 7 12 58,3% 12 12 100,0% 12 12 100,0% 8 15 53,3% Malária ? Se faz mencão a USAID ? 12 12 100,0% 12 12 100,0% 12 12 100,0% 7 12 58,3% 12 12 100,0% 12 12 100,0% 8 15 53,3% Noite (22:07 am) Passou no ar 12 12 100,0% 12 12 100,0% 11 12 91,7% 0 12 0,0% 11 11 100,0% 9 12 75,0% 8 15 53,3% Se faz mencão ao Programa Nacionald de Controlo de 12 12 100,0% 12 12 100,0% 11 12 91,7% 0 12 0,0% 11 11 100,0% 9 12 75,0% 8 15 53,3% Malária ? Se faz mencão a USAID ? 12 12 100,0% 12 12 100,0% 11 12 91,7% 0 12 0,0% 11 11 100,0% 9 12 75,0% 7 15 53,3% Total durante o dia (22:28 am) Passou no ar 36 36 100,0% 36 36 100,0% 35 36 97,3% 15 30 50,0% 35 35 100,0% 33 36 91,7% 24 42 57,1% Se faz mencão ao Programa Nacional de Controlo de 36 36 100,0% 36 36 100,0% 35 36 97,3% 15 30 50,0% 35 35 100,0% 33 36 91,7% 24 42 57,1% Malária ? Se faz mencão a USAID ? 36 36 100,0% 36 36 100,0% 35 36 97,3% 15 30 50,0% 35 35 100,0% 33 36 91,7% 24 42 57,1%

1.6.2. SBCC Proposed Action Plan for Q3 FY19

HFA has developed an action for Q3 FY19 as defined in table 6.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 13

Table 6. SBCC Proposed Action Plan for Q3 FY2019

Result 1: LLIN Access and Use Increased by at Least 30% April May June

Social and Behavior Change Communication

1. Supervision

Supervision for post-campaign communication for the promotion and proper use of 1.1 LLINs in the provinces of Uíge, Zaire, and Cuanza Norte. Supervisors: Fátima X João/NMCP and Alberto Zingany/HFA.

Supervision for post-campaign communication for the promotion and proper use of 1.2 LLINs in the provinces of Malanje, Lunda Norte, and Lunda Sul. Supervisors: Fátima X

João/NMCP and Alberto Zingany/HFA.

Broadcasting on seven radio stations throughout six provinces and at 2. Malaria Jingle: X X national level.

Conduct second part of the study with healthcare 3. Study on Pregnant Women: X professionals.

4. LLIN Use and Care Study X X X

1.7 Environmental Mitigation Monitoring Plan (FY19)

HFA has developed an environmental mitigation monitoring plan for FY19 as defined in table 7.

Table 7. Environmental Mitigation Monitoring Plan (FY19)

Result 1: LLIN Access and Use Achieved Results (FY19) Indicators Q1 Q2 Q3 Q4 Total Number of households receiving messages on appropriate 372,589 214,408 N/A N/A 586,997 use of LLINs Number of activists trained on communicating correct LLIN 1,462 665 N/A N/A 2,127 use messages to populations

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 14

MALARIA

Result 2: Malaria Services Throughout Targeted 2 Municipalities Improved

2.1 Background

USAID initially approved 24 priority municipalities in the six PMI provinces for HFA targeting. However, during FY19 planning, USAID requested that HFA scale-up target municipalities to 60. Three essential activities were also extended due to the scale-up, focusing primarily on the 36 newly included municipalities that were not covered in FY17 or FY18. 1. Training on malaria case management (MCM) and lab diagnosis (LD), targeting 36 municipalities; 2. Formative supervision and on-the-job training on monitoring and evaluation (M&E), knowledge, and practices of health workers (HWs) previously trained by HFA in the 24 priority municipalities; 3. Integrated community case management (iCCM) implemented by community health workers (ADECOS), in cooperation with the Social Support Fund (FAS) of the Ministry of Territory Administration and the NMCP/DNSP in three provinces: Zaire, Lunda Sul, and, more recently, Cuanza Norte.

2.2 Summary of Past Quarter Achievements (Q1 FY19)

2.2.1. Malaria Case Management Training

During Q1, HFA continued working in close collaboration with key partners, including DNSP, NMCP, the provincial and municipal health directorates, Global Fund, the World Health Organization (WHO), and PSM to accomplish many results.

HWs Trained in Case Management with Artemisinin-Based Combination Therapy (ACT) Under the coordination of and close collaboration with the NMCP, HFA conducted HW trainings in Q1 FY19 resulting in 274 HWs (41.6% female and 58.4% male) trained in MCM, with skills to prescribe ACT.

HWs Trained in IPTp During Q1 FY19, in partnership with and under the coordination of the NMCP, HFA conducted HW trainings resulting in 105 trained HWs (72.4% female and 27.6% male), including doctors, nurses and midwives. Training included MCM and ANC skills such as services for prescribing sulfadoxine/pyrimethamine as IPTp.

HWs Trained in Malaria Laboratory Diagnostics (Optic Microscopy) and Rapid Diagnostic Tests (RDTs) During Q1, under NMCP coordination, HFA conducted trainings resulting in 30 laboratory technicians (50% female and 50% male) attending a 10-day training on laboratory diagnosis of malaria, through optic microscopy and RDTs. The training sessions were conducted in Cuanza Norte and Malanje provinces by MINSA- certified trainers, selected by the NMCP.

The HFA target for FY19 is that 1,544 HWs are trained on RDTs. In Q1 FY19, 409 HWs were trained on RDTs, reaching 26.5% of the target to date. By gender, results show that 49.9% of the trained HWs were male (204) and 50.1% female (205).

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 15

2.2.2. Formative supervision

During Q1, formative supervision consisted of monitoring knowledge and practices of HWs, according to national guidelines from the NMCP/DNSP on the correct use of RDTs, ACT treatment, and appropriate administration of IPTp in ANC clinics. Results include a 132 HWs (29.5% male and 70.5% female) supervised through direct observation of their knowledge and good practices in MCM (i.e., ACT, IPTp) and malaria diagnosis with RDTs.

2.2.3. Implementation of iCCM (ADECOS)

During Q1, HFA continued supporting FAS and NMCP in the implementation of the National Program of ADECOS for MCM at the community level. As part of a new approach (described in the Q1 Progress Report), the following activities were implemented: • HFA provided technical support and resources to FAS to implement formative supervision activities at the existing 120 ADECOS (60 in Lunda Sul and 60 in Zaire), helping improve the quality of work related to malaria diagnosis, treatment, and data collection. • In coordination with NMCP and FAS in Zaire and Lunda Sul provinces, HFA started formative supervision activities in ADECOS referral health units (HUs) to strengthen the link between HUs and ADECOS, and ensure that HWs follow-up on artesunate/amodiaquine (ASAQ)/RDT stock control. • HFA supported preparatory activities and coordination to implement ADECOS expansion in two municipalities in Zaire (Cuimba and ), one municipality in Lunda Sul (Muconda), and the expansion to Cuanza Norte province where two municipalities (Quiculungo and Cambembe) will join. • HFA procured the necessary materials and equipment (e.g., computers for supervisors, monitoring forms, smartphones, etc.) for ADECOS and supervisors for fieldwork. To facilitate ADECOS implementation, HFA supported the distribution of supplies and materials to ADECOS and referral HUs, including RDTs and ACTs (ASAQ 25mg/67.5mg, ASAQ 50mg/135mg, ASAQ 100mg/270mg, and paper log forms for registering stock materials and program indicators). In Q1, ADECOS provided services in Lunda Sul and Zaire provinces.

2.3 Targets and Achievements in Reporting Period (Q2 FY19)

Results HFA achieved in Q2 FY19 are provided in table 8.

Table 8. Results Achieved by Key Indicator

FY19 Results Achieved

FY19 % Key Indicators Targets Achieved Q1 Q2 Q3 Q4 Total

1. Number of HW trained in case management with ACT with US Government (USG) funds. 1,129 274 329 N/A N/A 603 53%

2. Number of HWs trained in malaria diagnostics with RDTs with USG funds. 1,544 409 430 N/A N/A 839 54% 3. Number of HWs trained in malaria laboratory diagnostics (microscopy) with USG funds. 161 30 23 N/A N/A 53 33% 4. Number of HWs trained in intermittent preventive treatment in pregnancy with USG funds. 254 105 78 N/A N/A 183 72% 5. Number of HWs who received formative supervision on malaria diagnostics (rapid diagnostic test or 320 132 94 N/A N/A 226 70% microscopy). 6. Number of HWs who received formative supervision in ACT use. 320 132 94 N/A N/A 226 70% Source: M&E HFA Project.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 16

2.3.1. Training on Malaria Case Management and Laboratory Diagnostics

HWs trained in MCM with ACTs Planned and targeted delivery of essential malaria interventions is critical in achieving HFA malaria control objectives. Early diagnosis by testing suspect malaria clients and prompt treatment of confirmed cases with effective ACTs is critical. Under the coordination of and in close collaboration with NMCP, HFA conducted HW trainings in Q2 FY19 as depicted in table 9.

Table 9. Health Workers Trained in ACT by Province and by Sex

Q1 Q2 Q3 Q4 Total

% Target Provinces Achieved/ FY19 M F T M F T M F T M F T M F T Target

Cuanza 169 35 20 55 0 0 0 35 20 55 32% Norte Lunda 140 0 0 0 43 21 64 43 21 64 46% Norte Lunda Sul 105 15 16 31 29 2 31 44 18 62 59%

Malanje 215 58 27 85 24 9 33 82 36 118 55%

Uíge 382 25 32 57 113 13 126 138 45 183 48%

Zaire 118 27 19 46 61 14 75 88 33 121 100%

Subtotal 1,129 160 114 274 270 59 329 430 173 603 53% Source: M&E HFA Project. Note: M = Male, F = Female, T = Total

Results show that a total of 329 HWs (18% female and 82% male) were trained in MCM, with skills to prescribe ACT. The five training sessions were five days each. These trainings were facilitated by MINSA-certified trainers from national and local levels and selected by NMCP. The pre- and post-test evaluations indicated that: 76% (252 trained) improved their knowledge on managing ACTs and 24% (74 trained) left the training with the same level of knowledge. In the second group, 18.5% (61 trained) received less than 50% on both the pre-test and post-test. It is important to include this group of HWs in future HFA trainings and formative supervision activities.

HWs trained in IPTp MINSA has adopted WHO’s recommendation that states to reduce the risk of malaria, all pregnant women must receive at least four doses of sulfadoxine/pyrimethamine, at a minimum of one month apart after quickening. During Q2 FY19, in partnership with and under the coordination of NMCP, HFA conducted HW trainings. Results are reflected in table 10.

Table 10. Health Workers Trained in IPTp by Province and Sex

Q1 Q2 Q3 Q4 Total

% Target Provinces Achieved FY19 M F T M F T M F T M F T M F T / Target

Cuanza 36 1 16 17 9 10 19 10 26 36 100% Norte Lunda Norte 37 5 11 16 0 0 0 5 11 16 43%

Lunda Sul 31 3 16 19 5 5 10 8 21 29 93%

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 17

Malanje 59 9 28 37 2 10 12 11 38 49 83%

Uíge 63 0 0 0 15 22 37 15 22 37 58%

Zaire 28 11 5 16 0 0 0 11 5 16 57%

Subtotal 254 29 76 105 31 47 78 60 123 183 72% Source: M&E HFA Project Note: M = Male, F = Female, T = Total

Results show that 78 HWs (60.2% female and 39.8% male), including nurses and midwives, were trained in MCM and ANC services for prescribing sulfadoxine/pyrimethamine as IPTp. MINSA-certified trainers selected by NMCP facilitated the five days of training sessions. The number of HWs trained in IPTp to Q2 is 183, which represents 72% of the annual goal. Additional results from HWs trained in MiP include:

• 94% (73 trained) improved their knowledge on managing IPTp according to pre- and post-tests. • 3 nurses (technician level) trained scored 100% on the post-test related to managing IPTp. • 6% (5 HWs) retained the same level of knowledge, scoring less than 50% in both pre-and post-tests. This group will be prioritized for future trainings and formative supervision activities. • The Q2 IPTp training process included HWs from 10 priority municipalities with HWs from 50 MINSA health units.

HWs Trained in Malaria Laboratory Diagnostics (Microscopy) and RDT Conventional microscopy is the established method for laboratory confirmation of malaria. Careful examination by an expert microscopist of a well-prepared and well-stained blood film currently remains the “gold standard” for detecting and identifying malaria parasites. Another important diagnostic method currently used is the RDT, which is based on the detection of antigens derived from malaria parasites in lysed blood, using immune chromatographic methods. Both methods are critical to ensuring that early diagnostic testing of malaria happens before treatment is provided. In Q2 FY19, under NMCP coordination, HFA conducted trainings of laboratory technicians and achieved the results detailed in table 11.

Table 11. Lab Technicians Trained in Laboratory Diagnosis (OM and RDT) by Province and Sex

Q1 Q2 Q3 Q4 Total

% Target Provinces Achieved FY19 M F T M F T M F T M F T M F T / Target

Cuanza 37 9 9 18 7 2 9 16 11 27 73% Norte Lunda 34 0 0 0 0 0 0 0 0 0 0% Norte Lunda Sul 12 0 0 0 0 0 0 0 0 0 0% Malanje 34 6 6 12 0 0 0 6 6 12 35% Uíge 32 0 0 0 12 2 14 12 2 14 44% Zaire 12 0 0 0 0 0 0 0 0 0 0%

Subtotal 161 15 15 30 19 4 23 34 19 53 33% Source: M&E HFA Project. Note: M = Male, F = Female, T = Total

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 18

Results showed that a total of 23 HWs (17% females and 83% males) were trained during the 10-day training on laboratory diagnosis of malaria through optic microscopy (OM) in Q2 FY19. Additionally, these lab technicians were trained in RDT. Q2 microscopy-trained HWs is 53, which represents 33% of the annual goal. Additional information on HWs trained in lab diagnostics include: • As a result of the pre- and post-test, 96% (22 trained) improved their knowledge on malaria diagnosis. Only one HW (4%) kept the same low level of knowledge (less than 50%). • The training sessions included HWs from 16 municipalities from 20 MINSA health units.

HWs Trained in Malaria Diagnostics with RDT HFA assumes that every HW trained in MCM (i.e., ACT, IPTp, and OM) is also trained in the use of RDT. The NMCP curricula and training plans include specific sessions on malaria diagnosis with RDT. The HFA FY19 target is 1,544 HWs to be trained on RDTs. In Q2 FY19, 430 HWs trained on RDTs, and 409 were trained in Q1. HFA has already reached 54% of the FY19 goal. During Q2 FY19, under NMCP coordination, HFA conducted HW trainings and the results are depicted in table 12.

Table 12. Health Workers Trained in RDTs by Province and Sex

Q1 Q2 Q3 Q4 Total % Target Provinces Achieved FY19 / Target M F T M F T M F T M F T M F T

Cuanza 242 45 45 90 16 12 28 61 57 118 49% Norte Lunda 211 5 11 16 43 21 64 48 32 80 48% Norte Lunda Sul 148 18 32 50 34 7 41 52 39 91 61%

Malanje 308 73 61 134 26 19 45 99 80 179 58%

Uíge 477 25 32 57 140 37 177 165 69 234 49%

Zaire 158 38 24 62 61 14 75 99 38 137 87%

Subtotal 1,544 204 205 409 320 110 430 524 315 839 54% Source: M&E HFA Project. Note: M = Male, F = Female, T = Total

In Q2 FY19, HFA trained 329 HWs in ACT, 78 HWs in IPTp, and 23 HWs in OM. In total, 430 HWs were trained. By gender, results show that 74.4% of the trained HWs were male (320) and 25.6% female (110). Results by professional category included: 14 nurses, 387 nurse technicians, 6 nurse-midwives, and 23 lab technicians.

2.3.2. Formative Supervision

Formative supervision in Y2 (FY18) included M&E of knowledge and practices of HWs according to national NMCP/DNSP guidelines on correct use of RDT, treatment with ACTs and appropriate administration of IPTp in ANC clinics.

Formative Supervision Methodology The methodological approach of supervision activities was developed by PSI’s short-term technical advisor Victor Lara. It is a quick assessment of the knowledge and ability for HWs to handle MCM. Supervision activities were conducted using a checklist tool comprised of three sections: ANC services (e.g., MiP); pediatrics; and adult medicine and the emergency room. Evaluation was conducted through observing key aspects of malaria diagnosis and timely treatment of clients.

In each province, HFA formed one supervision team with the following members: the provincial malaria official, the provincial malaria supervisor, and the municipal malaria focal point. The objective is that all HWs trained should be supervised by someone from the provincial and the municipal level, while services are provided, including during client care.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 19

At the end of each supervision activity, the supervisors conduct a short meeting with each supervised HW to provide feedback on compliance with national and other standards and protocols, difficulties, and any work- related challenges. The supervisors also list their findings and observations during the services provided by the HW and discuss solutions and best practices for overcoming identified issues. During Q2 FY19, under NMCP coordination, HFA supported formative supervisions as depicted in table 13.

Table 13. Health Workers Supervised in Malaria Case Management by Province and Sex

Q1 Q2 Q3 Q4 Total % Provinces Target Achieved/ FY19 Target M F T M F T M F T M F T M F T

Cuanza 45 0 0 0 0 0 0 0 0 0 0% Norte Lunda 31 0 0 0 10 20 30 10 20 30 96% Norte Lunda Sul 39 0 0 0 0 0 0 0 0 0 0%

Malanje 66 0 0 0 0 0 0 0 0 0 0%

Uíge 97 78 28 106 21 15 36 99 43 142 146%

Zaire 42 15 11 26 9 19 28 24 30 54 128%

Subtotal 320 93 39 132 40 54 94 133 93 226 70%

Source: M&E HFA Project. Note: M = Male, F = Female, T = Total

Results indicate a total of 94 HWs (42.5% male and 57.5% female) were supervised through direct observation of knowledge and good practices in MCM and malaria diagnosis with RDTs. During Q2, 45 health units were supervised: 18 in Uíge, 18 in Zaire, and 9 in Lunda Norte.

2.3.3. Routine Distribution

Routine distribution falls under the scope of formative supervision. HFA will provide technical assistance to NMCP in the development of a detailed distribution plan for each of the six PMI provinces (Zaire, Malanje, Uíge, Cuanza Norte, Lunda Sul, and Lunda Norte), a monitoring and supervision plan on service provision and stock management, and weekly/monthly reporting of health units that have ANC and expanded vaccine programs (PAVs), to provincial and national health authorities (see attached list of all HUs with these services in the six PMI provinces). The technical assistance also includes training and supervision of healthcare providers, supporting the Provincial Health Directorate (GPS) in implementing an effective stock management system, and improving communications with beneficiaries.

Revision of Current HFA Structure Shifting from mass distribution to supporting NMCP in routine distribution, together with changes to the supervision methodology, required significant changes within the existing HFA structure. In January and February several internal meetings were held to discuss the best approach to meet the objectives outlined above. The proposed organigram is depicted in figure 1.

Figure 1. Proposed HFA Organogram

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 20

In the revised organogram, it is proposed that each province will have an HFA Provincial Coordinator to provide support in the implementation of MCM, iCCM, and MiP activities. In March, the vacancies were published, candidates were interviewed, and new staff were onboarded. It is an ongoing process, with the first training with new provincial staff scheduled for the first week in May.

2.3.4. Implementation of iCCM (ADECOS)

During Q2 FY19, HFA continued supporting FAS and NMCP/DNSP in the implementation of the National Program of ADECOS for MCM at the community level. According to a new mentoring approach, HFA intends to strengthen malaria services at HUs to which ADECOS refer beneficiaries (i.e., families covered in the community). Once the NMCP/DNSP approves the implementation of the mentoring approach with ADECOS, trained HWs from the reference HUs will contribute to strengthen performance of ADECOS, aiming to contribute to the reduction of child morbidity and mortality caused by: diarrhea, pneumonia, and malaria. As part of this new approach, the following technical support activities were implemented in Q2 FY19:

1. HFA supported FAS and MINSA (DPS) in the ADECOS expansion to one new municipality in Zaire (Cuimba) and two new municipalities in Cuanza Norte (Quiculungo and Cazengo). Additionally, 30 new ADECOS from the municipality of Muconda in Lunda Sul were selected to join the program. During Q2, HFA supported MCM training in the community for 30 new ADECOS in the municipality of Cuimba, Zaire. 2. Supporting FAS in the ADECOS information system implementation has been a challenge, however, in Q2 the HFA team obtained significant advances including: a. Supported FAS and MINSA/DPS in KoboCollect training workshop for provincial managers in Zaire. b. Worked closely with FAS IT team in the development of a platform for data analysis intended to improve the current version of KoboCollect to enable interoperability and networking with DHIS2. c. HFA supported FAS and MINSA (DPS) in a KoboCollect training workshop in two municipalities of Lunda Sul for 60 ADECOS to start information collection by ADECOS at the community level. 3. In coordination with NMCP and FAS in Zaire and Lunda Sul, HFA continued supporting activities of ADECOS data collection, and following up on ASAQ/RDT stock control in Lunda Sul and Zaire. 4. Following modifications requested by PMI during Q2, HFA focused on supporting preparatory activities and coordination among partners to expand to 60 additional ADECOS in Zaire (Soyo, Cuimba), 30 in Lunda Sul (Muconda), and 60 in Cuanza Norte (Quiculungo, Cazengo). Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 21

5. HFA continued supporting ADECOS and supervisors with materials and equipment (computers for supervisors, monitoring forms, smartphones, etc.) to help facilitate fieldwork. During Q2, HFA delivered 4 new computers to ADECOS supervisors, 60 smartphones, and solar energy devices to support ADECOS data collection. 6. HFA continued supporting the distribution of supplies and materials, including RDT kits and ACTs (ASAQ 25mg/67.5mg, 50mg/135mg and 100mg/270mg), paper log forms for registering stock materials, and program indicators to ADECOS and referral HUs. The services ADECOS provided during Q2 FY19 in Lunda Sul and Zaire provinces are detailed in table 14.

Table 14. ADECOS Performance in Lunda Sul, Zaire, and Cuanza Norte Provinces

FY19 % # Indicator Q1 Q2 Q3 Q4 Total Target Achieved Number of new ADECOS trained in 1 malaria case management at the 150 0 30 30 20% community level Number of ADECOS supervised in 2 malaria case management at the 270 120 120 120 44% community level 3 Number of fever cases reported by 3 12,782 3,505 3,226 6,731 52% ADECOS at the community level Number of fever cases tested with RDT 4 12,782 3,505 3,226 6,731 52% by ADECOS at the community level Number of confirmed malaria cases 5 reported by ADECOS at the community 6,391 1,855 2,243 4,098 64% level Number of confirmed malaria cases 6 6,391 1,855 2,243 4,098 64% treated with ACT reported by ADECOS Number of confirmed malaria cases 7 referred to health units by ADECOS 639 401 634 1,036 162% Number of ADECOS who received 8 refresher training in MCM at community 150 0 0 0 0% level Source: M&E HFA Project.

2.4 Major Constraints in Reporting Period (Q2 FY19)

2.4.1. Malaria Case Management Trainings • Delayed approval of MCM annual training plan: At the beginning of 2019 (non-fiscal year), the National Directorate of Public Health asked PSI to request approval of the MCM annual training plan. The approval was not received until mid-March, limiting implementation of training activities, as well as causing delays. • Administrative issues in ensuring participation of health personnel: This year, HFA is focused on working with HUs in municipalities with less management capacity, as well as geographic distance from the provincial capital. It has been particularly challenging to ensure participation of health technicians given the lack of identification, bank accounts, and sending information from the provinces to HFA. Consequently, there have been delays in some training activities. • Low willingness of some national trainers: Key challenges include lack of encouragement by national trainers, who prefer to work in easy-to-access locations with better conditions. There were also difficulties related to transportation of national trainers, who do not appear to be eager to conduct trainings in more difficult provinces. 2.4.2. Formative Supervision • Review and approval on formative supervision methodological approach: As mentioned in previous quarterly reports, the supervision guides developed and used by NMCP are very long and cumbersome, with many sections that need to be filled in, resulting in supervisors spending a few hours completing a single form. These supervision guides are being reviewed and updated, in partnership with NMCP, and should be ready for use in the next supervision stage.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 22

HFA developed a more user-friendly proposal for MCM, which can be used during formative supervision, upon NMCP approval. A similar proposal is being developed for laboratory supervision. Both proposed supervision guides are being shared and discussed with NMCP and WHO. • Low willingness or capacity to solve recurrent problems identified in supervision activities. Issues identified during supervisions, such as the lack of malaria registry books and the lack of supplies in HUs, are not routinely addressed in GPS, despite frequent HFA effort and advocacy.

2.4.3 ADECOS Implementation

The key constraints faced with the implementation of ADECOS at the community level include: • Lack of link between HWs/HUs and ADECOS: Lack of follow-up from GPS to HUs supporting ADECOS activities presents a real challenge. HWs do not recognize ADECOS in malaria activities and do not support ADECOS in MCM. The consequences include weakness in ASAQ/RDT stock control follow-up, lack of referrals and counter-referrals link, and information sharing. • ADECOS municipal supervision activities delayed: Supervision activities that were supposed to be conducted by ADECOS municipal supervisors are delayed in all four municipalities of Zaire and Lunda Sul. Although ADECOS municipal supervisors from Soyo have received the motorcycles, these are not being used due to lack of fuel. • Poor capacity for management and maintenance of ADECOS information system: Technical assistance is provided by HFA, but ADECOS supervisors have low proficiency in using MS Office tools (e.g., Excel and Word). In addition, ADECOS often have smartphones for data collection, but lack communication subsidies compromising the upload of data into KoboCollect. These constraints compromise ADECOS activity reports. • Limited resources in some local governments: Subsidies from ADECOS and municipal supervisors from Zaire are delayed. Three ADECOS have never received subsidies, while others experience a 2- month delay. In addition, lack of funds from local administrations for this financial year continue to be a constraint for providing supervisors and ADECOS with key supplies (e.g., fuel and paper forms for registering data). • FAS delays in delivery of equipment and some supplies: Although HFA provided a total of eight motorcycles in Zaire and Lunda Sul provinces to facilitate ADECOS municipal supervisor tasks, so far, FAS continues to hold six motorcycles in a warehouse awaiting local administration approval for formal delivery. Delivering computers for ADECOS supervisors has also been delayed by FAS, compromising ADECOS supervisor performance. Lack of key supplies (e.g., backpacks and gloves) for ADECOS can lead to safety issues in the field.

2.5 Recommendations for Next Quarter (Q3 FY19)

• Involve local counterparts in monitoring HFA result: This will include improving relationships with local partners and local governments by establishing regular planning meetings and joint HFA progress monitoring. The expected outcome is that HFA provincial teams will achieve quality improvement in daily work helping them more effectively overcome challenges listed previously. • Provide continuous support in implementation and expansion of ADECOS: • Continue to support FAS in KoboCollect improvement and statistical implementation. The introduction of new digital tools is a major improvement to data reporting. These tools have the potential to provide quicker—and better—data analysis and visualization dashboards that can ultimately help in targeting activities. However, such analysis and use require data sharing mechanisms to trigger prompt action. • Improvement of supply chain and stock control of ASAQ/RDT to ADECOS and referral HUs. HFA will coordinate activities with PSM to improve the stock distribution and control in referral HUs. • Share ADECOS reporting with DPS. HFA will continue to be proactive in identifying an interoperability solution to fulfill the expectation of FAS and MINSA, and to link information collected through Open Data Kit and KoboCollect with DHIS2. • Training 90 new ADECOS. HFA will support training of 90 new ADECOS in the following municipalities: Muconda (30) in Lunda Sul, and Golungo (30) in Cuanza Norte, and Noqui (30) in Zaire. The remaining 60 new ADECOS will be trained in Q4.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 23

2.6 Proposed Targets and Action Plan for Next Quarter (Q3 FY19)

HFA has developed an action plan for Q3 FY19 as defined in table 15.

Table 15. Result 2 Action Plan.

Activity April May June

Malaria in Pregnancy Training Training of HWs in MiP: IPTp, diagnosing and treating, LLIN use X X X Formative supervision Start formative supervision of HWs in 274 HUs with ANC on MiP: IPTp, diagnosing and treating, X X LLIN use Malaria Case Management Training

Training of HWs on MCM with ACTs X X X Formative supervision X X Implement new approach on formative supervision of HWs on MCM with ACTs and RDT use Laboratory diagnosis (RDTs and microscopy) and quality control Training X X Training of lab technicians on microscopy test (six PMI provinces) X Formative Supervision

Formative supervision of lab technicians on microscopy (paper forms) X X iCCM Training

Training new ADECOS on MCM X X Formative Supervision Formative supervision of ADECOS on MCM X X

2.7 Environmental Mitigation Monitoring Plan (FY19)

HFA has developed an environmental mitigation monitoring plan FY19 as defined in table 16.

Table 16. Environmental Mitigation Monitoring Plan

Achieved Results Key Indicators Q1 Q2 Q3 Q4 Total # of training-of-trainers trained on lab waste management 0 0 # of HWs trained in waste management 409 430 # of ADECOS trained in waste management 0 30 # of bio waste boxes provided to ADECOS 0 0 # of Therapeutic Efficacy Study (TES) personnel trained in N/A 15 waste management

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 24

MALARIA

Result 5: Capacity of Municipal and Provincial Governments to Plan, 5 Fund, Monitor, and Supervise

Health Services Improved

5.1 Summary of Past Quarter Achievements (Q1 FY19)

HFA made significant progress toward DHIS2 consolidation in the six PMI provinces. Q1 achievements included: • Target indicators: 94.6% of HUs were updated in DHIS2 organizational tree, 72.5% of DHIS2 malaria quarterly reports were submitted, and 78.4% of expected municipal authorities were meeting quarterly to analyze DHIS2 data. • Data analyses meetings: NMCP and HFA personnel conducted workshops in 4 provinces to increase awareness on data quality and to improve dashboard analyses (i.e., Lunda Sul, Lunda Norte , Uíge, and Cuanza Norte). Results were shared and discussed by NMCP with GEPE, Epidemiological Surveillance, and Sexual and Reproductive Health Department. • MINSA endorsement of DHIS2: Minister of Health issued written request to provincial governors to adopt and start reporting data using DHIS2, starting in Q1.

5.2 Targets and Achievements of Reporting Period (Q2 FY19)

5.2.1. DHIS2

HFA continues to provide support to MINSA to improve data quality and data use for decision-making. In Q2, HFA conducted various activities on routine supervision, data analyses, and technical assistance that are summarized in table 17. Results show achievements toward targets: 84.1% of DHIS2 malaria quarterly reports were submitted on the platform (versus 21.1% in non-PMI provinces), 82.4% of expected municipalities were represented in quarterly meetings to analyze DHIS2 data (42 out of 51), and 50% of the target was achieved for providing DHIS2 refresher training or on-the-job coaching. Although other indicators show a slower pace of achievement, progress is still underway over the course of the year: 37.5% of quarterly data revision meetings were held, 35% of quarterly meetings led by NMCP took place, and 37.3% of routine visits to municipalities took place.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 25

Table 17. Health Systems Strengthening Results for FY19 Targets

Achievements % Total Achiev- Non-PMI FY19 Target ed Provinces Indicators for 6 PMI / (For Provinces Q1 Q2 Q3 Q4 Total Target Compar- FY19 ison Only)

1. % of health units updated in 100.0% 94.6% 94.6% 94.6% 94.6% N/A

organizational DHIS 2 tree 2. % of DHIS2 malaria 85.0% 72.5% 84.1% 84.1% 98.9% 21.1% quarterly reports submitted 3. % of historical data (2017) entered in DHIS2 for six PMI 85.0% 40.5% 40.2% 40.2% 47.3% 6.2% provinces, in non-PMI provinces β * 4. # of municipal authorities meeting quarterly to review > 51 40 42 42 82.4% N/A DHIS2 data and provide feedback** 5. # quarterly data consolidation and revision 24 4 5 9 37.5% N/A meetings *** 6. # of quarterly meetings in 3 4 which NMCP led DHIS2 > 20 7 35.0% N/A

analyses for decision-making 7. # of supervision visits implemented to Municipal > 528 89 108 197 37.3% N/A Directorate of Health by HFA-MINSA personnel **** 8. # of Health Information 2 (Open In In Systems interoperable with LMIS, Kobo- progre progre N/A N/A N/A DHIS2 Connect) ss ss 9. # of MINSA staff trained or refreshed (at national and 56 - 28 28 50.0% N/A provincial levels) ***** * Reporting values for non-PMI provinces on selected indicators will depend on MINSA (GEPE/GTI) facilitating such information to HFA. N/A: Not applicable because activity might not be happening in non-PMI provinces or not under control of HFA to collect evidence data. β Last measured in April 2019. A decrease in value could be explained due to an update on organizational units and on the linkage between these and data entry forms. ** Calculated as the total number of municipalities per 85% (60 x 0.85=51). Includes the number of municipalities represented in meetings, since there is always more than one person per municipality. Precise number varies due to factors outside HFA control. For Q2 FY19, 42 municipalities were represented with a total of 109 participants—81 at municipal level and 28 at provincial level. *** Assumes six provinces x four quarterly meetings per province equals 24 meetings per year. Also assumes that NMCP will lead/participate in at least 80% of meetings (24 meetings x 80% = 20). **** 528 supervisions to Municipal Directorate of Health assumes that at least 80% of 60 municipalities are visited by HFA-MINSA personnel every month to ensure no issues with DHIS2. Also assumes such supervisions take place 11 months a year: 80% x 60 municipalities x 11 months = 528. ***** Assumes 20% of currently trained personnel in six PMI provinces will need refresher training or will be replaced by new personnel who require training (20% x 280 MINSA staff = 56 staff to be [re]trained or receive on-the-job coaching).

5.2.2. Routine Supervision to Municipal Health Directorates

This activity works: to ensure recent and historical paper-based forms are input into DHIS2 correctly, to periodically update the HU list, and to provide IT maintenance. During Q2, the HFA staff and municipal and provincial staff also visited HUs with reporting rates challenges. The team observed registry books and provided feedback to health personnel. These visits are expected to raise awareness on the importance of properly registering information and sending it to municipalities in a timely manner. The results of routine supervision are expressed in the relatively high reporting rates (table 18). The past quarter has seen an increase in reporting rates across the six PMI provinces from 72.5% in Q1 to 84.1% in Q2.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 26

Due to the high reporting rates in the six PMI provinces, GEPE/GTI has requested HFA to provide support in training and supervision in at least four provinces (i.e., Huila, Cuando Cubango, Luanda, and Bengo). Discussions are underway with USAID determine a path forward. To have a fully integrated national DHIS2, it is essential that it is successfully implemented in all provinces.

Table 18. Malaria Reporting Rates for Different Time Periods in Six PMI Provinces Versus Non-PMI Provinces DHIS2

Malaria Reporting Rates * Provinces Jan.-Dec. 2017 Jan.-Jun. 2018 Jul.-Sept. 2018 Oct.-Dec. 2018 Jan.-Mar. 2019 Zaire 26.6% 89.7% 95.7% 94.3% 96.2% Lunda Sul 36.7% 59.1% 69.0% 79.1% 84.4% Malange 32.8% 67.7% 75.1% 75.4% 84.7% Cuanza Norte 52.0% 70.4% 79.2% 75.3% 86.6% Lunda Norte 3.4% 66.1% 70.3% 69.2% 84.5% Uíge 54.5% 67.1% 73.1% 63.3% 79.5% Total PMI Provinces 40.2% 69.0% 75.9% 72.5% 84.1% Total Non-PMI 6.2% 6.1% 5.05% 5.2% 21.1% Provinces National Average 16.2% 24.9% 26.2% 25.3% 39.6% * Reporting rates for January to December 2018 were measured in January 2019; reporting rates for January to March 2019 and for January to December 2017, were measured in April 2019.

5.2.3. Data Analysis Meetings with Municipal and Provincial Health Staff

This activity aims to improve data quality and the skills of MINSA staff in data analysis for decision-making. In Q2, NMCP officers (i.e., epidemiologist Fernanda Guimaraes and M&E specialist Mario Hossi) gained confidence in leading the activity and traveled alone to 4 out of 5 provinces were data analysis meetings took place—Malange, Zaire, Cuanza Norte, Lunda Norte. In Lunda Sul, NMCP officials traveled with the M&E advisor Ricardo Yava. Meeting participants included an average of two staff members from the municipal level and two staff members from the provincial level (e.g., municipal chief and municipal statistician, provincial malaria supervisor and provincial statistician). Results show that IT (how to deal with hardware or software) or DHIS2 problems (how to work specifically with DHIS2 platform) have reduced since the HFA DHIS2 team in provinces provide routine support. However, structural problems continue, including lack of electricity, lack of payment, and lack of full-time contracts for health personnel in HUs or to MINSA staff trained on DHIS2. These issues result in other concerns, including demotivation.

In March 2019, a meeting was held by NMCP to share and discuss results of the visits to the provinces. Participants were primarily NMCP staff, as staff from the Sexual and Reproductive Health and the Epidemiological Surveillance departments did not attend. Table 19 summarizes identified issues and association actions taken.

Table 19. Summary from Data Analysis Meetings with Municipal and Provincial Staff to Improve Data Quality and Data Use for Decision-Making

Issues Encountered Actions Taken Actions Taken Level (Q4 FY18 to Q1 FY19) (Q1 FY19) (Q2 FY19) Health Units Poor quality data and delayed Preparation of agenda and HFA staff and municipal and reports to municipalities due curricula for training of six HFA provincial supervisors initiated to bad road conditions and staff on HU forms and supervision visits to HUs to HU staff not willing to work monitoring processes to start improve quality of data and due to months of no payment. supervision with MINSA reporting rates. staff. Training took place in early January 2019. Municipal Level Lack of electricity Electricity problem was Unitel and HFA worked on (generators are off when presented to GEPE and NMCP. improving connectivity by DHIS2 data should be Action is needed. identifying exact locations of input). Unitel (mobile phone company) Municipal Directorate of Health and HFA tested DHIS2 platform and adjusting connectivity around Poor internet access in some to assure that no airtime was those areas. Work in progress. municipalities. consumed during data uploads. Fixed in most cases, but testing HFA distributed 30 modems to

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 27

DHIS2-trained staff not paid continues. Unitel continues to municipalities with worst internet regularly and on non- have issues importing modems, connection. permanent so HFA bought 30 modems of contracts. alternative brand in Q1 to be distributed in Q2. DHIS2 Level Need to update HUs in GEPE/GTI and HFA Continuous work on linking HUs DHIS2. regularly updated HUs under with electronic sheets. DHIS2. Electronic sheets Electronic sheets of some linked to HUs. Formulas Continuous work on formulas. programs are not always revised per request linked to DHIS2. (ongoing).

Electronic sheets sometimes have errors in formulas (reproductive health and contraceptive stock levels).

Data Analyses Incoherence of data Validation rules were revised, HFA staff and municipal and reported by some health and current errors corrected. provincial staff initiated units: # of clients Continuous work is done as supervision visits to HUs to tested with RDT versus problems are identified and improve quality of data registration # of RDT used; # of LLIN reported by users. and reporting rates. distributed versus # of beneficiaries.

Difference in data reported using the NMCP form vs. epidemiological surveillance (malaria cases and deaths) or SRH (i.e., IPTp).

Some data input were out of feasible range (e.g., 13 million tested cases with RDT by a HU in Cuanza Norte).

5.2.4. Workshop to Assess DHIS2 Roadmap Implementation

In February 2019, GEPE/GTI conducted a workshop with support from HFA to assess the implementation of the DHIS2 roadmap. Financial support was provided by the World Bank and USAID. Participants included representatives from the National Institute Against HIV/AIDS, NMCP, public health organizations, as well as international partners (e.g., ICAP, European Union, UNICEF, WHO, and PSM). Participants presented achievements in each health area against the DHIS2 roadmap and challenges encountered. Table 20 summarizes key results.

Table 20. DHIS2 Roadmap: Achievements, Challenges, and Proposed Solutions

Achievements Challenges Proposed Solutions Free Connectivity MINSA managers and governors still Greater advocacy with governors and implementation through Unitel. need to appropriate and validate data of a DHIS2 electronic approval system for municipal in DHIS2. and provincial managers. MINSA endorsement Lack of data harmonization and Integrated supervision in municipalities and provinces of DHIS2 and Open- coherence. (unique process and instruments for supervision). LMIS. Interoperability Lack of awareness of importance of Training on importance of data quality to HU staff and workshop on DHIS2 quality data in most HU health staff. close supervision of data registration. and Open-LMIS. Over 500 health Delays in payments and job instability Advocacy to enroll health technicians and statisticians technicians trained on among health technicians and as full-time MINSA employees. DHIS2 in 18 provinces. statisticians.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 28

5.2.5. Monitoring Activities with NMCP/MINSA

The HFA M&E adviser supported NMCP on a wide range of activities during Q2, including: 1. DHIS2 data quality and data analysis meetings in five provinces (i.e., Malanje, Cuanza Norte, Lunda Norte, Lunda Sul, and Zaire) from January to March 2019. 2. Continued technical support in revision of Global Fund Concept Note on Health Systems Strengthening (last revision March 2019). 3. Held internal NMCP working session with NMCP coordinator, MCM focal point, M&E officer, epidemiologist, and M&E Adviser. Presented DHIS2 data quality and analysis provincial reports (March 15, 2019). 4. Worked with national NMCP trainers (i.e., Dr. Elisa Miguel, Dr. Marilia Afonso, Dr. Arlindo Miranda) to update contents of MCM and IPTp training modules, providing data trends, graphics, and tables (March 2019). 5. Trained 28 hospital, municipal, and provincial focal points, in conjunction with NMCP epidemiologist (Dr. Fernanda Guimarães) on malaria early warning system in (calculation of epidemic threshold from third quartile). Identical training also held in by NMCP M&E officer and WHO Angola national program officer.

5.2.6. Research Activities

• Therapeutic Efficacy Study: Training and fieldwork of this study initiated in late January 2019. Given the stockout of dihydroartemisinin/piperaquine, the study is being conducted with only two antimalarials— artemether/lumefantrine) and ASAQ. No major incidences were observed during Q2 fieldwork implementation. • LLIN Use and Care Study: In the first week of March, the Johns Hopkins University’s ethics committee approved the study. The approved questionnaire was configured on Survey to Go by the research agency in charge of implementation and logistics were arranged for training and for fieldwork (commencing in April 2019). • Operational Research–Southeast Asian Migrant Study: The Angolan Institutional Review Board (IRB) approved the study in January 2019 and the U.S. Centers for Disease Control and Prevention (CDC) approved it in February 2019. During March, PSI identified key personnel for conducting the study (i.e., general research coordinator, Luanda supervisor, interviewers, and RDT specialist). Training and fieldwork are planned to start in May, after preliminary work identifies the best locations for Asian immigrants.

5.3 Major Constraints in Reporting Period (Q2 FY19)

• Many activities occur at the same time, and NMCP has a small M&E department. This makes it difficult to coordinate all planned DHIS2 and M&E activities. HFA will advocate for MINSA to allocate funds for hiring additional personnel. • Numerous municipalities need to be routinely supervised. Hiring two additional on-call DHIS2-IT staff for Uíge and Malanje was initiated in Q2 to help resolve this ongoing challenge. • There is an ongoing need for free airtime to upload information into the DHIS2 platform. During Q1 and Q2, Unitel and HFA worked to test the platform to ensure that airtime consumed was not charged. This is a work in progress.

5.4 Recommendations for Next Quarter (Q3 FY19)

Recommendations reported in previous progress reports remain valid. There is the need for HFA to work with MINSA to identify a mechanism within its own monitoring and supervision plan to improve the completeness and quality of data registration in HUs. HFA has already taken a preliminary step in that direction through the expansion of current routine supervision activities to review data registration in HUs. Further actions are needed to ensure MINSA personnel can eventually conduct supervision independently.

Taking advantage of the increased DHIS2 interest by the Minister of Health, advocacy should be placed at provincial and municipal levels to ensure electricity for effective use of DHIS2. Recommendations should also be

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 29 made to offer full-time contracts to HU health personnel and to municipal staff trained on DHIS2, in order to reduce delays in data submission.

5.5 Proposed Targets and Action Plan for Next Quarter (Q3 FY19)

According to the approved FY19 workplan, a series of activities are planned for Q3 to improve data quality and analyses. Details are provided in table 21.

Table 21. Proposed Activities for Q3

Q3 FY19 Activity April May June

DHIS2: Data Quality and Data Analyses for Decision-Making

HFA and MINSA staff to conduct joint, routine supervision of municipal health officers to assure data is entered in DHIS2 and platform X X X 1 problems solved. Includes supervision at key HUs to improve data (6 provinces) (6 provinces) (6 provinces) registration. Quarterly meetings held—one per province—convening municipal X X X 2 staff for training in data analysis and decision-making. (2 provinces) (2 provinces) (2 provinces) Monthly meetings with NMCP and GEPE/GTI to analyze malaria X X X reporting rates, data analysis, and decision-making 3 (Luanda) (Luanda) (Luanda) Enter historical data after revising data formats and reviewing X X X 4 information available from previous periods. (6 provinces) (6 provinces) (6 provinces)

Implementation of Health Network Quality Improvement System (HNQIS) for Malaria/ADECOS/FP

5 Configuration on tablets (checklist and HUs). X X X 6 Training supervisors on system use. X

Southeast Asian Migrants Study

7 Training. X 8 Fieldwork. X X

Therapeutic Efficacy Study with Antimalarials

9 Fieldwork. X X X

ADECOS Monitoring 10 Supervision visit to collect data from ADECOS. X X Program a software to automatically extract data from 11 KoboCollect/Open Data Kit and link to DHIS2. X X X

LLIN Use and Care Study

12 Conduct training. X X

13 Fieldwork. X X X

5.6 Environmental Mitigation Monitoring Plan (FY19)

Health systems strengthening activities under result 5 have a status of categorical exclusion and do not require reporting.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 30

HIV/AIDS

Result 3: Sustainable Model for Providing High- 3 Quality HIV/AIDS Services Established

3.1 Background

HFA’s goal is to transform USAID Angola partnerships to strengthen the effective use of GRA’s resources to meet the country’s development needs. Management Sciences for Health (MSH), a member of the HFA consortium led by PSI, is responsible for establishing a sustainable model for providing high-quality HIV/AIDS services.

3.2 Summary of Past Quarter Achievements (Q1 FY219)

In Q1, HFA collaborated with Instituto Nacional de Luta Contra a SIDA (INLS) and GPSL to accomplish several major achievements in the seven PEPFAR-selected health facilities (HFs): • At the beginning of Q1: PEPFAR’s new indicators (HTS_INDEX/HTS, Recent/TX_ML) were received, TX_Current and TX_TB were updated, and TB_ART and TB_STAT were moved from annual to quarterly. • The annual testing target is 43,845 people and 20,425 people were tested in Q1, resulting in 47% of the target met. • The annual target for identifying HIV-positive people through testing is 5,843 and 1,400 were identified in Q1, resulting in 24% of the target met. • Achievement of TX_NEW (828) during Q1 is around 50% of the Q1 target; almost all HFs increased performance, with the exception of Hospitals Esperança and Pediátrico. • At the end of Q1, 17,011 adults and children were receiving ART (the target was 22,003), indicating a 77% achievement of the TX_CURR target. • HFA identified 1,931 new and recurring clients with tuberculosis (TB), which is 41% of the annual target. Of these clients, 1,788 knew their serological status (45% of the annual target) and 228 were HIV-positive (30% of the annual target). Of the 228 HIV-positive clients, 121 started ART (18% of the annual target). This target was not met because the remaining clients did not complete the two-week treatment required for TB Treat First because TB medication was not available at HFs. • HFA continued to improve the index case testing and tracing (ICTT) strategy through exceptional work of community counselors and effective coordination with HF staff, including patient assistant facilitators (PAFs) and case managers (CMs) supported by the project. The ICTT strategy continues to demonstrate excellent and consistent results. • HFA found a significant percentage of positive cases through ICTT (22%) and a high number of positive cases linked to ART (76%). • In Q1, HFA started using the new PEPFAR 2.3 indicator HTS_INDEX. Of the 638 tests offered, all were accepted (638 cases), and all individuals received their results (638 cases). • For contact cases of individuals younger than 15 years, 84% of parents were positive and 35% of the extramarital contacts of the adults were also positive. • The number of clients who had a viral load (VL) test (11,345) met 99% of the annual target (11,513 clients); 8,519 clients were virally suppressed and represent the 93% of the annual target (9,206 clients). Most HFs are close to the annual target, except Hospital Pediátrico at 43% (annual target of 80%) because many clients are orphans and do not receive proper treatment.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 31

3.3 Targets and Achievements in Reporting Period (Q2 FY19)

3.3.1. Health Facility Micro-Plans

During Q2, HFA completed workshops for HIV/AIDS micro-plans for the managers of the seven HFs with the participation of the four municipality health directors from Luanda province (table 22). The micro-plans for each of the seven HFs were elaborated, and will be implemented in Q3.

The overall objective was to strengthen municipal and district management capacity coupled with HIV interventions developed in the seven HFs. The specific objectives were to: 1. Test the development process of interventions and articulated plans at the municipality and district levels. 2. Test the development process of the municipal and district health systems. 3. Test the process of setting up the HIV care network at municipality and district levels (taking into account the TB and family planning integration processes). 4. Test the process of strengthening HIV skills and human resource management at municipality and district levels. 5. Support municipalities and districts for implementation of planning and learning cycles, as well as in the appropriation of techniques for training supervisors and those providing services. 6. Support municipalities and districts in achieving goals of the accelerated HIV reduction plan and the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 targets. 7. Support municipalities and districts in achieving goals related to family planning for reducing maternal and infant mortality.

Table 22. Health Facility Workshops on HIV/AIDS Micro-Plans

Dates Health Facilities Number of Participants March 12-13 Pediátrico and Dispensario 15 March 14-15 Kilamba Kiaxi and Divina 16 March 18-19 Esperança and Rangel 20 March 20-21 Viana 18 TOTAL 7 HFs 69

3.3.2. Family Planning and HIV/AIDS Service Integration

The family planning (FP) team (HFA Result 4) and the HIV team (HFA Result 3) finished service integration in 22 HFs (including three selected PEPFAR HFs assigned to HFA) in Luanda province. The strategy includes three scenarios depending upon HF services: • Scenario 1: HF provides both FP and HIV/AIDS services • Scenario 2: HF provides only FP services • Scenario 3: HF provides only HIV/AIDS services In scenarios 2 and 3, clients are referred to the nearest HF that provides the service. The 44 staff (including 10 PAFs from HIV/AIDS services) were trained in both FP and HIV/AIDS. Three HFs (Viana, Rangel, and Kilamba Kiaxi) reflect scenario 1 and the other four reflect scenario 3, but with trained activists to refer clients to the nearest HF that provides FP. The next step is to complete the provision of equipment necessary in the polyvalent rooms where both HIV and FP services are provided.

3.3.3. Pilot Project

Following the Q1 visit to Mozambique (with a delegation from INLS, civil society, PSM, and HFA) to exchange knowledge information on HIV control strategies, the INLS director commissioned HFA to design the pilot project for prevention and treatment of HIV/AIDS. HFA presented the pilot project to INLS in February 2019 for analysis and approval. The overall objective was to implement a pilot project on differentiated care models to improve adherence and retention of HIV-positive clients on ART by more involvement of the clients themselves, and by creating a community-based platform for strengthening adherence. The three proposed models are: support groups and community adhesion (e.g., Grupos de Apoio e Adesao Comunitária), quarterly rapid flow (providing clients with 3-month ART supplies); mentoring mothers. The specific objectives were to:

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 32

• Improve access to ART, client retention, and adherence. • Reduce work overload and improve quality of follow-up care for HIV-positive clients. • Promote active client participation in collection and distribution of ARTs, including increased ART adherence. • Establish early warning system for screening of various diseases (e.g., TB, malaria, malnutrition, acute diarrhea, infectious respiratory diseases). • Identify faults and report to HF. • Reduce burden of frequent visits to HF. • Ensure psychosocial support among ART clients. • Improve bond between HF and community.

3.3.4. Main Results

Key results are highlighted in the figures below.

Figure 2. Analysis of Tested, Positives, TX_New, and TX_Curr (Q2 FY19)

50,000 94% 100% 45,000 90% 77% 40,000 80% 35,000 70% 30,000 60% 48% 25,000 50% 20,000 40% 15,000 24% 30% 10,000 20% 5,000 10% 0 0% HTS_TST HTS_TST POS TX_NEW TX_CURR Annual Target 43,845 5,843 7,543 22,003 2019 Q1 20,425 1,400 828 17,011 2019 Q2 20,837 1,385 976 16,997 2019 Q1-Q2 41,262 2,785 1,804 16,997 % of Target 94% 48% 24% 77%

Source: Register Books and Clinic Process of the HIV Services in the HFs - Elaboration: HFA

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 33

Figure 3. HIV and TB Testing and Treatment (Q2 FY19)

5,000 100% 88% 4,500 83% 90% 4,000 80%

3,500 61% 70% 3,000 60% 2,500 50% 2,000 35% 40% 1,500 30% 1,000 20% 500 10% 0 0% TB_STAT Den TB_STAT Num TB_ART Den TB_ART Num Annual Target 4,682 4,005 750 673 2019 Q1 1,931 1,788 228 121 2019 Q2 1,962 1,746 231 114 2019 Q1-Q2 3,893 3,534 459 235 % of Target 83% 88% 61% 35%

Source: Register Books and Clinic Process of the HIV Services in the HFs - Elaboration: HFA

Figure 4. TB_PREV (Q2 FY19)

20,000 160% 138% 139% 18,000 140% 16,000 120% 14,000 100% 12,000

10,000 80% 59% 8,000 60% 6,000 40% 4,000 25% 20% 2,000

0 0% TB_PREV Den TB_PREV Num TX_TB Den TX_TB Num Annual Target 2,836 1,954 18,615 918 2019 Q1 3,922 2,717 11,021 229 % of Target 138% 139% 59% 25%

Source: Register Books and Clinic Process of the HIV Services in the HFs - Elaboration: HFA

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 34

Figure 5. Index Case and HTS_INDEX (Q2 FY19)

1000 97% 100% 100% 900 86% 90% 800 82% 81% 85% 80% 700 74% 70% 600 60% 500 50% 400 39% 40% 300 30% 22% 21% 22% 200 16% 19% 20% 100 15% 10% 0 0% CS Ana Paula CS Rangel Dispensario H Divina H Kilamba H Pediatrico Grand Total Offered Index Case 130 96 164 154 84 102 730 Accepted Index Case 123 94 160 154 82 102 715 Realized Index Case 122 90 152 138 81 80 663 Identified Contacts 179 127 196 197 102 134 935 Tested Contacts 128 88 171 170 97 108 762 Positives 28 14 33 36 15 42 168 Linked 23 12 32 29 15 31 142 % Positives 22% 16% 19% 21% 15% 39% 22% % Linked 82% 86% 97% 81% 100% 74% 85%

Source: Register Books and Clinic Process of the HIV Services in the HFs - Elaboration: HFA

Figure 6. TX_PVLS (Q2 FY19)

14,000 106% 104% 12,000 104% 10,000 102% 8,000 100% 6,000 98% 98% 4,000 2,000 96% 0 94% TX_PVLS Den TX_PVLS Num Annual Target 11,513 9,206 2019 Q1 11,345 8,519 2019 Q2 12,026 9,008 2019 ANNUAL 12,026 9,008 % of Target 104% 98%

Source: Register Books and Clinic Process of the HIV Services in the HFs - Elaboration: HFA

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 35

Figure 7. TX_PVLS (Q2 FY19)

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% H H CS Ana CS Dispens H H Esperan Pediatri Total Paula Rangel ario Divina Kilamba ça co Not Traced 0 0 0 0 0 0 0 0 Traced and Not Located 888 271 281 134 786 350 149 2859 Traced and Located 22 77 56 34 16 42 43 290 Silent Tranfer 1 1 1 0 1 0 0 4 Died 2 2 0 0 0 0 0 4

Source: SEGEP appointment system, consultations and drug delivery registries and tracing form of each health facility with HFA.

3.4 Major Constraints in Reporting Period (Q2 FY19)

In Q1, the major constraint was linking HIV-positive clients to ART and maintaining their adherence and retention to treatment. There has been an improvement in linkage to treatment, but adherence and retention to ART continues to be an issue. HFA has implemented the following activities to address this constraint:

1. Reinforce active search by PAFs for a client on the same day that appoint is missed to ensure adherence to ART. 2. Continue use of tools created to identify all clients lost to, or that abandoned, ART. 3. Continue to improve reference health system with navigators or activists who physically accompany HIV- positive clients to reference HF to initiate ART.

During Q2, after the Country Operational Plan 19 meeting in Johannesburg, South Africa, HFA was informed that the PEPFAR strategy for Year 4 (2020) is shifting, and HFA result 3 must closeout by September 30, 2019. The transition will start in April and will include documenting experiences and lessons learned during the last three years to be shared with GRA.

3.5 Recommendations for Next Quarter (Q3 FY19)

Key recommendations for Q3 include:

• Continue working with the National Programme of TB Control on all activities to improve the diagnosis (through GeneXpert) and treatment of TB/HIV co-infected clients. Key issues to consider include: TB drug resistance and the provision of isoniazid and second line TB medicaments. • Advocate to INLS to implement a pilot project on differentiated models of care to improve adhesion and retention of HIV-positive clients on ART. • Provide FP equipment to HFs that provide both HIV and FP services. • Design and implement activities plan for the transition with the seven HF managers.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 36

3.6 Proposed Targets and Action Plan for Next Quarter (Q3 FY19)

HFA developed proposed targets and an associated plan for action for Q3, as outlined in table 23.

Table 23. Proposed Targets and Action Plan (Q3 FY19)

Activities April May June 1 2 3 4 1 2 3 4 1 2 3 4 w w w w w w w w w w w w Refresher training in screening and diagnosis of sexually transmitted infections according to technical note 04/18 X National Institute of Faith Again AIDS in the seven health facilities. Refresher training in tracing HIV-positive children co-infected X with TB. Training in identifying and managing therapeutic fails and the X viral load cascade in the seven health facilities. Training in reinforcing adhesion for health staff (nurses, X medical doctors, and psychologists). Refresher training in counselling and testing for HIV/AIDS (National Institute of Faith Again AIDS, National Programme of X TB Control, Provincial Health Cabinet of Luanda, SRH, Municipal District of Health). Workshop for quarterly evaluation of micro-plans of needs in X X the seven health facilities Refresher training in early infant diagnosis for National Institute of Faith Again AIDS, SRH, Provincial Health Cabinet X of Luanda, Municipal District of Health. Refresher training to improve quality of data register in the seven HFs and National Institute of Faith Again AIDS, National X Programme of TB Control, SRH, Provincial Health Cabinet of Luanda, Municipal District of Health. Monthly data feedback for decision-making. X X HFA integrated supervision with national health staff (National Institute of Faith Again AIDS, National Programme of TB X X X Control, Provincial Health Cabinet of Luanda, and Municipal District of Health) in the seven health facilities.

3.7 Environmental Mitigation Monitoring Plan (FY19 Q2)

The number of facility staff trained by HFA was 246, which is the number of staff that training was planned for in the seven HFs during Q2 (table 24). Trainings were conducted on the following topics.

Table 24. Health Facility Staff Trained

Themes Number of Participating Staff Feedback from M&E indicators (seven meetings) 168 Micro-planning for quality improvement of HIV services (8 workshops) 78 Total 246

The senior HIV adviser and the PAF/community counselor coordinator supervised all staff providing HIV services. Supervision details are included in table 25.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 37

Table 25. Supervision Activities

Number of HFs Number of Staff Involved Activity Involved in Supervision Supervision/mentoring for nurses at HIV testing points. 7 44 Supervision/mentoring for technicians (HIV focal points and clinicians) 7 7 responsible for care of co-infected TB/HIV clients. Supervision/mentoring for technicians (HIV focal points and clinicians) 7 7 working in HIV services. Supervision of active search conducted by PAFs of clients who 7 16 abandon treatment. Supervision of ICTT strategy implementation conducted by case 6 (Esperança has managers and coordinator responsible for activities. not implemented 10 ICTT) Supervision of data analyst. 7 9 Total 93

3.8 Sustainable Model Providing High-Quality HIV/AIDS Services (Q2 FY19)

HFA identified indicators to help ensure sustainable high-quality HIV/AIDS services. The indicators are outlined in table 26.

Table 26. Indictors for Provision of High-Quality HIV/AIDS Services

Indicators Achieved Q1 Q2 Q3 Q4 1. Number of facility staff trained on biological waste management while working in 10 10 the community. 2. Number of staff trained at facility level by HFA on use of standard operation 51 84 procedures for HIV/AIDS services, including biological waste management. 3. Number of trained staff supervised by HFA on use of standard operating 88 67 procedures for HIV/AIDS services.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 38

SEXUAL AND REPRODUCTIVE HEALTH AND FAMILY PLANNING

Result 4: Strengthened, Expanded, and Integrated Sexual Reproductive 4 Health and Family Planning Services at the Provincial and

Municipal Levels

4.1 Summary of Past Quarter Achievements (Q1 FY219)

The main achievements in Q1 included securing sexual and reproductive health and family planning (SRH/FP) services in the 44 USAID-supported HUs in Luanda and Huambo provinces. Considerable results were demonstrated through advocacy, gender-based violence (GBV) interventions, quantification of contraceptives, improved supportive supervision, and activities toward SBCC.

HFA directly supported a delegate from MINSA and a delegate from PSI to attend the 5th International Conference on Family Planning in Kigali, Rwanda. During the conference, Angolan delegates learned best practices in SRH/FP from other countries. A meeting between the Angolan Minister of Health, Dr. Silvia Lutukuta, and the FP2020 Committee was coordinated by the United Nations Population Fund (UNFPA), and supported by PSI and PSM. It helped raise awareness of the advantages of FP2020 participation.

PSI, through international partnerships, facilitated a donation of 130,000 doses of Sayana Press, a hormonal, injectable birth control option that lasts for three months. This donation to MINSA was a result of a coordinated work between PSI and UNFPA. These contraceptives were funded by the United Kingdom’s Department for International Development.

To address GBV, Rede Mulher Angola, in coordination with the Ministry of Social Action, Women, and Family and partners led radio debates, public sessions, and round table meetings to discuss topics such as the GBV consequences, support for survivors, sexuality and human rights, SRH, and gender.

PSI and PSM worked together to update the national reproductive health commodities quantification (2017-2021). The updated version was sent to DNSP for approval, and included a more realistic forecast of long- and short- term contraceptives.

HFA also achieved success in supportive supervision. The number of USAID-supported HUs was reduced to benefit from an intensive intervention package, and 22 HUs were selected in Luanda and 20 HUs in Huambo. The HUs were assigned quality control supervisors to ensure quality and provide on-the-job coaching.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 39

Another key achieve in Q1 was qualitative research among adolescents. This research—part of the operationalization of the National Communication Strategy for Ideal Moment and Healthy Spacing of Pregnancy/Family Planning—helped collect insights on Angolan adolescents aged 15-19. The qualitative research included observation at 22 urban and peri-urban areas and 56 small group interviews (two to five participants). The result of this study will help inform which channels to use to provide SRH/FP information and promote behavior change among teenagers.

4.2 Targets and Achievements in Reporting Period (Q2 FY19)

In Q2, several activities were conducted to support the implementation of HFA. Key achievements included: • Supported DNSP to organize the 3rd Technical Working Group on Sexual and Reproductive Health meeting. • Assisted Office of Planning and Statistics (GEPE) and DNSP in updating SRH lists on DHIS2. • Provided, through a public and private partnership, a donation of 141,540 cycles of the third-generation oral combined contraceptive pills (Meuri brand) to 92 public HUs in Luanda and Huambo. • Integrated FP and HIV services in HFA-supported HUs in Luanda. • Improved SBCC among clients in HFA-supported HUs.

Table 27. Performance Monitoring Table

Indicator Performance % Total Achieved (Q1+Q2)/ Baseline FY18 FY19 Target Total Achieved (Q1 + Q2) Level Indicator Target FY19

N=22 N=20 N=42 N=22 N=20 N=42 N=22 N=20 N=42 N=22 N=20 N=42 Luanda Huambo Total Luanda Huambo Total Luanda Huambo Total Luanda Huambo Total Activity A4.1 Percentage of 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% US Government- assisted service delivery points offering FP/reproductive health counseling or services Numerator 22 20 42 22 20 42 22 20 42 / / / Denominator 22 20 42 22 20 42 22 20 42 / / / A4.2 Percentage of 95.5% 100.0% 97.6 86.4% 90.0% 88.1 95.5% 100.0% 97.6 90.5% 90.0% 90.2 US Government- % % % % assisted service delivery points that experienced a stockout at any time during reporting period of a contra- ceptive method that the service delivery point is expected to provide Numerator 21 20 41 19 18 37 21 20 41 / / / Denominator 22 20 42 22 20 42 22 20 42 / / / FEMALE 86.4% 100.0% 92.9 77.3% 90.0% 83.3 95.5% 100.0% 97.6 81.0% 90.0% 85.4 CONDOM % % % % Numerator 19 20 39 17 18 35 21 20 41 / / / Denominator 22 20 42 22 20 42 22 20 42 / / / MALE CONDOM 45.5% 50.0% 47.6 36.4% 40.0% 38.1 40.9% 95.0% 66.7 88.9% 42.1% 57.1 % % % % Numerator 10 10 20 8 8 16 9 19 28 / / / Denominator 22 20 42 22 20 42 22 20 42 / / / IUD 36.4% 85.0% 59.5 27.3% 75.0% 50.0 22.7% 90.0% 54.8 120.0 83.3% 91.3 % % % % % Numerator 8 17 25 6 15 21 5 18 23 / / / Denominator 22 20 42 22 20 42 22 20 42 / / /

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 40

IMPLANT 31.8% 100.0% 64.3 22.7% 90.0% 54.8 31.8% 100.0% 64.3 71.4% 90.0% 85.2 % % % % Numerator 7 20 27 5 18 23 7 20 27 / / / Denominator 22 20 42 22 20 42 22 20 42 / / / INJECTABLE 31.8% 85.0% 57.1 22.7% 75.0% 47.6 31.8% 70.0% 50.0 71.4% 107.1% 95.2 % % % % Numerator 7 17 24 5 15 20 7 14 21 / / / Denominator 22 20 42 22 20 42 22 20 42 / / / ORAL 9.1% 15.0% 11.9 4.5% 10.0% 7.1% 4.5% 0.0% 0.0% / / / CONTRACEPTI % VE PILL Numerator 2 3 5 1 2 3 0 0 0 / / / Denominator 22 20 42 22 20 42 22 20 42 / / / EMERGENCY 77.3% 15.0% 47.6 68.2% 10.0% 40.5 50.0% 100.0% 73.8 136.4 10.0% 54.8 PILL % % % % % Numerator 17 3 20 15 2 17 11 20 31 / / / Denominator 22 20 42 22 20 42 22 20 42 / / / A4.3 Couple years 17.600 8.000 18.480 8.400 36.758 40.09 198.9 39.7% 149.1 protection in US 25.60 26.88 3.332 0 % % Government 0 0 supported programs A4.4 Percentage of 40.9% 40.0% 40.5 40.9% 40.0% 40.5 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% HFs whose % % providers reported a Quality of Care score >= 80% for management of FP services (+) Numerator 18 16 34 18 16 34 0 0 0 Denominator 44 40 84 44 40 84 44 40 84 A4.5 Number of HWs 280 280 200 100 300 0 0 0 0.0% 0.0% 0.0% who successfully completed service training program A4.6 Number of 4 4 3 3 0 0 0.0% 0.0% protocols finalized and approved A4.7 Number of 400 400 250 150 400 30 0 30 12.0% 0.0% 7.5% people trained with US Government funds A4.8 Number of US 30 30 44 40 84 30 0 30 68.2% 0.0% 35.7 Government- % assisted community HWs providing FP information. referrals. and/or services during the year

Strengthen Advocacy with MINSA and Partners

3rd Meeting of the Technical Working Group on Sexual and Reproductive Health HFA has been a strong advocate for the reactivation technical working group, and supported DNSP in organizing the 3rd meeting which took place on February 14, 2019 in Luanda. The main objective was to discuss DNSP’s SRH Department 2019 workplan. The meeting was led by Dr. Henda Vasconcelos, Head of SRH Department. There were about 30 participants from MINSA and representatives of local and international organizations based in Angola, namely RMA, ADDRA, JICA, People in Need, PSI, PSM, UNICEF, World Bank, and World Vision International.

Angola’s Engagement on FP2020 Initiative PSI and PSM supported UNFPA in engaging with MINSA and discussing a pledge to FP2020. UNFPA engaged with the FP2020 Committee through emails, and PSI and PSM focused on advocacy activities to DNSP, local,

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 41 and international partners. On January 6, 2019 the Angolan Minister of Health expressed interest in pledging to FP2020 through a letter to UNFPA stating the reduction of maternal and infant mortality as a key motivator. The Secretary of State for Public Health, Dr. José Vieira Dias da Cunha, was appointed as the MINSA focal point.

Introduction of Sayana Press to MINSA Given the re-introduction of Sayana Press (depot-medroxyprogesterone acetate) into Angola, it was necessary to inform MINSA departments, such as the National Department of Medicine and Equipment, the entity that regulates use of medicines and medical equipment. HFA supported DNSP in writing a letter to present Sayana Press as an alternative to Depo-Provera (medroxyprogesterone acetate) and, consequently, decrease the unmet need among women that choose injectables as the preferred method of choice. The letter presented the advantages and chemical composition of this method.

Donation of Oral Contraceptive Pill to 92 HUs in Luanda and Huambo Through a public-private partnership, PSI advocated for a donation of 150,072 cycles of Meuri (a third-generation oral combined contraceptive method of 28 pills). All these contraceptives were donated to 68 public HUs in Luanda and 24 HUs in Huambo. All the HFA-supported HUs benefited from the donation. Given the population size, 136,032 cycles were distributed in Luanda and 14,040 were distributed in Huambo. Distribution was made according to the type of HU and the number of FP clients. Thus, hospitals benefited from a larger amount of oral contraceptive pills than HFs. This donation will contribute to delaying the stockout of oral contraceptives in these provinces.

Update of SRH/FP DHIS2 Lists The use of DHIS2 has been growing considerably in malaria and HIV programs across Angola. HFA continues to work with DNSP, GEPE, and Office of Information Technology (GTI) to promote the use of DHIS2 within SRH/FP programs. As a result, PSI, GEPE, and DNSP worked together to update five of the seven SRH/FP data collection tools that already exist on the national DHIS2 platform (i.e., pre-natal consultation, childbirth, post-partum, infant care, FP). With the support of PSI, a DHIS2 training is being coordinated with GEPE and GTI for the provinces of Luanda and Huambo. This training will include SRH/FP data collections tools.

Integration between FP and HIV Programs During Q2, HFA started to strengthen FP and HIV integrated services in the 22 HFA-supported HUs in Luanda. A group of 34 activists and 10 PAFs are working in these HUs to refer women from FP to HIV services and vice- versa. In FP HUs, women receive HIV counseling and testing, when available. If a woman tests positive, she will be navigated (accompanied by an activist) to a PEPFAR facility for HIV treatment and follow-up consultation. In HIV HFs, HIV-positive women receive FP counseling and are referred to FP services. This model is already being used in Luanda and will be replicated in in Q3.

A referral system was created to facilitate the integration of services. Three scenarios were created to accommodate different types of HUs: HUs that have both FP and HIV services at the same site; HUs with only HIV services; and 3) HUs with only FP services. The referral processes are presented in figures 8, 9, and 10.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 42

Figure 8. Referral Process for Health Units with HIV and Family Planning Services

Figure 9. Referral Process for Health Units with only HIV Services

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 43

Figure 10. Referral Process for Health Units with only Family Planning Services

Improved Supportive Supervision HFA continues to support monthly meetings with the municipal FP focal points in Luanda and Huambo. PSI’s quality assurance team is responsible for assisting GPSL and the Provincial Health Cabinet of Huambo in organizing the meetings. In Luanda, topics include: municipal FP focal points supervision plans; PF refresher training schedule; distribution of Meuri in Luanda HUs; and operation of DHIS2 in the municipal level. In Huambo, topics include: FP refresher training; joint supervision between HFA and GPSL; and FP and HIV service integration. The 22 selected HUs in Luanda continue to receive visits from the quality assurance team to assure quality of FP services. Each quality assurance member was assigned specific HUs, as shown in table 28.

Table 28. Assignment of Health Units to Quality Assurance Staff

Health Unit Responsibility by Quality Assurance Team Member Anaisia Octávio Marisa Júnior Maria de Carvalho Health Center Kididi CS Ramiros Hosp. M CS Chimbicado CS Benfica CS Funda CS Mbondo chapeu CS Viana l CS Vila da Mata Hosp. Especializado K.K. CS Bairro Operário Hosp. Cajueiros Health CS Palanca ll CS Samba Hosp. Icolo Bengo Units CS Cabo Ledo Hosp. Mae Jacinta CS Catinton CS Viana ll Mater. L. Paim CS Rangel CS 4 de Fevereiro Total 9 6 7

Social Behavior Communication Change (Adolescent Research) In-depth qualitative data collection continued during Q2 in support of the National Communication Strategy for the Healthy Timing and Spacing of Pregnancy/Family Planning. In Q1, the first phase of the qualitative analysis included direct observations of youth in their usual contexts. Fifty-five group interviews were conducted by 12 trained interviewers and two field coordinators. Phase I started December 15 and finished January 6. Phase 2 involved in-depth interviews with 32 youth—ensuring gender balance—with 16 female and 16 male youth aged 15-19 (see figure 11).

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 44

Figure 11. Youth Distributed by Age Group

15-16 17 18-19

28% 44%

28%

Data collection took place from January 14 to February 10 and was conducted by the same interviewers trained in Phase 1. Thirty-two youth were interviewed in three separate in-depth interviews at three distinct moments. This facilitated the empathy building process allowing youth to speak more openly and encourage youth-centered and youth-powered design processes. The youth were from different neighborhoods in Luanda, ensuring a balance between socio-economic levels and urban, peri-urban, and rural locations.

The first interview focused on broad themes around social and support networks; the second interviewed focused on FP, contraception, sexuality, and pregnancy—and maternity emerged as a topic. The third interview was communications oriented and identified brands, campaigns, and videoclips that youth enjoy. In the third interview, data was captured on their insights on participation in the overall process.

All three interviews used empathy building techniques, part of the Keystone framework that uses elements of human-centered design. Interactive, dynamic exercises to facilitate discussion of personal topics were consistent though all the processes: sharing photos from their own lives and personal objects to enable storytelling; building a daily journey by drawing on paper or creative design through collages; and information source constellations. These techniques allowed for more in-depth insights and allowed participant to be actively engaged.

The preliminary data was analyzed in February by the interviewers, the consultant, and the Direcção Nacional de Saúde Pública representatives from SRH department and Health Promotion Department. Together, nine key findings were identified and empathy maps developed. The key observations were: 1. Youth are often surprised by their body transformations. Information about puberty and body changes is received superficially and they do not fully understand the changes or how to prepare. 2. Youth do not feel like they have enough people to with whom they can speak freely about SRH and other personal issues. They tend to rely on information from peers, which is often inaccurate. 3. Youth have a superficial understanding about contraceptive methods. Misconceptions around hormonal contraception and their association with future fertility are common. 4. Youth consider the condom as the only suitable method. However, they report inconsistent use and misconceptions regarding side effects. The male decision on whether to use a condom or not is also present. 5. Female youth do not feel supported when an unexpected pregnancy occurs. They report it happens frequently, and typically results in family conflict especially in situations where the boyfriend is not supportive. 6. Young girls report social stigma associated with looking for FP services, and it is uncommon to seek FP services prior to having a first child. Adolescent boys report that FP services are for girls. 7. Youth do not typically use HFs or health services unless they are sick—and when they go, they report not going along and not being satisfied with the services provided. 8. Youth show gender unbalanced perspectives that condition their ability to negotiate protected sex. Multiple references indicated that women are expected to do what the men say. 9. Youth expressed a desire for autonomy, yet had no plans in place. Youth expressed wanting to gain independence—often to escape from violence contexts. However, they did not have life plans or, in many cases, the skills to develop a life plan. Pregnancy often occurs as a result of searching for autonomy. Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 45

Analysis of the preliminary information allowed for the development of empathy maps to better understand, youth in terms of: what to youth hear, see, say, and do. Figures 12 and 13 are examples of preliminary empathy maps and family and gender perceptions and sexuality perceptions.

Figure 12. Empathy Map: Family and Gender Perceptions Figure 13. Empathy Map: Sexuality Perceptions

Circles of trust were also used as a tool. This exercise looks for a visual representation of people and channels, and the level of trust from a youth perspective. Preliminary information shows: • Peers are the first resort when youth are looking for SRH information, followed by girlfriends/boyfriends if the conversation is contraception related. Teachers were mentioned as a third source. • School books, YouTube, and Google were identified as the primary channels youth use to find information. Three Angolan YouTubers who make their own videos—Pedro Atormentado, Dora Figueiredo, and Luana Santos—were also mentioned.

Once the information from Phases 1 and 2 has been fully analyzed, the empathy workshop will take place (i.e., Q3) convening: MINSA staff (SRH department and Health Promotion Department), USAID, PSI, Rede Mulher Angola, and youth. This group will jointly do a deep-dive on the background information to identify the first step of the Keystone framework, DIAGNOSE.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 46

During the 3-day workshop, the group will advance the process through the Keystone DECIDE and DESIGN phases. It is expected that in the end of the workshop there will be at least one prototype of what the communication campaign should look like, so that this prototype can be pre-tested and evolved, always in a youth-centered and inclusive approach. The empathy workshop will be led by Mathias Pollock, SBCC technical advisor from PSI’s headquarters team, who will bring his expertise to facilitate this process and improve outcomes expected for the workshop. His visit was supposed to take place during Q2 but due to health reasons, it was agreed with USAID that Mathias Pollock could come in the beginning of Q3.

Social Behavior Communication Change (Health Units) Recruitment of New Supervisors, Activists, and PAFs – RMA released a public tender to recruit activists and supervisors to better serve the target audience (adolescents). Nearly 70 candidates applied for the position in Luanda. All applicants were screened to confirm eligibility criteria (aged 18-30). The SBCC campaign focus is adolescents and youth, RMA felt it important that the activists are young and can conduct peer education in the facilities. After the screening, eligible candidates were on communication skills. Among the candidates tested, 38 were approved. All of the approved candidates demonstrated a reasonable experience in social work as well as technical knowledge on FP and HIV/AIDS. The candidates with the higher scores were interviewed for the position of supervisor. Four candidates were selected as supervisors (one woman and three men). For the position of activists, 34 young people were selected (nine men and 25 women). In addition, 10 PAFs were integrated to complete the desired number of activists (44 activists for 22 health units). Some PAFs already had training and were referred to RMA to conduct SBCC in HIV-specialized HUs.

SBCC Training – To assure the quality of SBCC services, activists, PAFs, and supervisors (48 participants in total) received training on communication techniques, FP, and HIV counseling and voluntary testing in Luanda. The purpose of the training was to build the capacity of supervisors, activists, and PAFs in interpersonal communication on FP and HIV. During the two-day training, activists discussed topics related to the concept of FP, FP myths, SBCC, contraceptive methods (natural, hormonal, and non-hormonal), concept of HIV, HIV counseling and testing, HIV transmission, and HIV prevention. A full list of the topics is presented in table 29.

Table 29. SBCC Training Topics

Trainer’s Name & Institution Topics Jandira de Melo, PSI • Family planning goals • Concept of family planning • Myths about family planning • Activist role in communication for behavior change • Communication activities for behavior change Helena Bungo, PSI • Success stories of communication activities that changed behavior • Presentation of routing vouchers and explanation of process • Contraceptive methods, advantages, and side effects - Natural methods Anaisia Octávio, PSI - Barrier methods - Hormonal methods - Surgical contraception Thiago Costa, MSH • HIV concepts • Voluntary counseling and testing • HIV transmission pathways Vita Vemba, MSH • HIV prevention • ART

Values Exploration Training – PSI conducted a values exploration training with RMA field team. The objective was to explore personal values and understand how personal values can affect the professional environment. All activists, supervisors, and the RMA communication team (53 participants in total) attended the training. The training was divided into two groups (26 and 27 participants each) to ensure a more conducive training environment. Following the discussion on the importance of values for individuals, communities, and professionals, each person was asked to share five personal values. To help the participants, a list containing 38 values was presented (figure 14). Besides the values displayed, participants could add other values.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 47

Figure 14. Values Slide Used in Training

The most common value selected was “belief in God” (23 participants in room A and 23 participants in room B). The second most common values were "respect for women" and "love." Table 30 shows the most common values selected by the two groups.

Table 30. Most Common Values by Room

Most Voted Values - Room A (N=27 participants) # Value # of Votes 1 Belief in God 23 2 Collaborative Spirit 17 3 Treat Others with Dignity 15 4 Love 13 5 Courage 12

Most Voted Values – Room B (N=26 participants) # Value # of Votes 1 Belief in God 25 2 Love 20 3 Respect for women 19 4 Honesty 18 5 Strength 11

Participants were asked to think how their personal values could positively or negatively affect their behavior while providing sexual and reproductive health information to the clients in HUs.

SBCC in Health Units – At the beginning of February, PSI’s Quality Assurance team introduced the activists to the 22 HFA-selected HUs in Luanda. Each HU was assigned two activists or two PAFs. Their main tasks were to provide the correct information about FP and HIV, and to generate demand for FP services and adherence to contraceptive methods, as well as HIV voluntary testing. The supervisors were responsible for evaluating their interpersonal communication skills, ensuring compliance with standards (informed choice), ensuring the collection and correct handling of vouchers, and developing a weekly plan. Each supervisor was assigned a set of five or six HUs to supervise (table 31).

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 48

Table 31. List of Health Facilities and Activist Supervisor

Supervisor’s Name Health Facilities

Health Center Bairro Operário Health Center of Sequele Augusto Quintas Health Center 4 of Fevereiro Health Center of Sequele Health Center of Rangel Municipal Hospital of Cacuaco Health Center of Cassequel Health Center Vila da Mata Fulgêncio da Rocha Health Center Mãe Jacinta Paulina Health Center of Cajueiros Health Center of Viana 1 Municipal Hospital of Catete Health Center of Benfica Health Center of Samba Alda Muongo Health Center of Mbondo Chapeú Health Center of Cabo Ledo Health Center of Ramiros Health Center of Kilamba Health Center of Chimbicato Timóteo Sampaio Health center of Palanca 2 Health Center Viana 2 Hospital of Kilamba Kiaxi

During Q2, the activists conducted interpersonal communication as well as small group counseling on FP and sexual and reproductive health in the selected 22 HUs. Male and female youth and adult were reached. In general, the number of people receiving the counseling and services is growing. In total 13,795 people were reached. Among them, 11,756 were adults (aged 20-49) and 2,039 were adolescents and youth (aged 15-19). Although the number of adolescents is increasing, it is still lower compared to adults (figure 15).

Figure 15. Adolescents vs Adults Reached

11,756 11,756

2,039 2,039

ADOLESCENTS AND YOUTH (<15- 19 YEARS ADULTS (20- 49 YEARS OLD) OLD)

More people were reached in March, compared to February (figure 16). The difference is likely attributed to few days of field work in February (10 days) compared to March (19 days). Activists would also be more experienced in March after practicing in February.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 49

Figure 16. People Reached by SBCC Activities in 22 Selected Health Units in February and March 2019

February March

4,412

4,137

1,780

1,427

732 732

669 669

337 337 301 301

MALE ADOLESCENTS (15- 19 FEMALE ADOLESCENTS WOMEN (20- 49 YEARS MEN (20- 49 YEARS OLD) YEARS OLD) (<15- 19 YEARS OLD) OLD)

More women were reached (7,198 both adolescents and adults) than men (6,597), as shown in figure 17. However, compared to the previous year, the number of men reached has grown significantly. This is likely because men are being referred for condoms.

Figure 17. Total Women and Men Reached During SBCC Activities in Q2

7,198

6,597

WOMEN (<15- 49 YEARS OLD) MEN (15- 49 YEARS OLD)

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 50

4.3 Major Constraints in Reporting Period (Q2 FY19)

Major constraints faced during Q2 include: • Inconsistent distribution of contraceptive methods in HUs are causing a stockout of the most popular contraceptive methods (i.e., implants and injectables) in some HUs. • Lack of HIV rapid tests in FP HUs is creating difficulties in having integrated FP and HIV services. • Change of GPSL director delayed many of activities that were planned for Luanda province. According to the new director, GPSL departments are not allowed to prepare any activities with partners until further notice. • Continuous misunderstanding about USAID policies regarding non-payments for MINSA staff created difficulties in preparing FP refresher training, including Sayana Press. Other donors (e.g., European Union and Japan International Cooperation Agency) provide incentives to MINSA staff to facilitate training, so USAID trainings are given less priority than training provided by other donors.

4.4 Recommendations for Next Quarter (Q3 FY19)

Recommendations for Q3 include: • High-level interventions to disseminate USAID policies to MINSA, in particular, the DNSP Reproductive Health Department. • Schedule meeting with new GPSL director to present HFA and it achievements from inception to present date. • Cascade FP refresher training, including Sayana Press training, to municipal level.

4.5 Proposed Targets and Action Plan for Next Quarter (Q3 FY19)

Specific targets and an associated action plan have been developed for Q3 (table 35).

Table 32. Q3 Targets and Action Plan

Result 4: Strengthened, Expanded, and Integrated SRH and Family Planning Services at Provincial and Municipal Levels Reproductive Health and Family Planning Activity Schedule Q3 Q4 1. Co-organize monthly technical working group meeting with Department of Reproductive X Health. 2. Involve Ministry of Youth and Sports, Ministry of Education, and Ministry of Social Action, X Family, and Promotion of Women in Family Planning Technical Working Group Meetings. 3. Advocate to secure funding for procurement of contraceptive methods and support implementation of multi-year Contraceptive Security Plan in cooperation with PSM and X UNFPA. 4. Media integration advocacy through training journalists and TV hosts on how to report on X gender and FP. 5. Train Provincial Health Department staff and FP focal points in using DHIS2 dashboards for X decision-making and support DHIS2 implementation. 6. Rollout DHIS2 in Huambo. 7. Integrate FP and HIV services. X 8. Integrate youth-friendly health services in selected FP facilities. X 9. Launch SBCC campaign. 10. Implement SBCC activities reaching youth in social media and other channels (e.g., school X activations, information, education, and communication materials).

4.6 Environmental Mitigation Monitoring Plan (FY19)

Activities under result 4 have a status of categorical exclusion and do not require reporting.

Health for All Progress Report: Year 3, Quarter 2 (January 1 to March 31, 2019) 51

HEALTH FOR ALL PROJECT

HEALTH FOR ALL PROJECT (ANGOLA)

MENTORSHIP ASSESSMENT PLAN FOR NMCP

Indicator Achieved FY19 Annual Favourable Target Achieved Performance Target Performance Frequency Comments Trend FY18 FY18 FY18 FY19 (Total Achieved / Q1 Q2 Q3 Q4 Total Description Target FY19)

Number of NMCP M&E staff (2), provincial focal points (3 per In 2018, two NMCP M&E staff had demonstrated skills to produce tables / graphics of malaria key indicator. In 2019, another Number of NMCP staff with demonstrated skills to produce DHIS2 tables / 1 province) in the six provinces covered by HFA with demonstrated Annual ↑ 2 2 100% 2 0 0 0 0.0% additional 2 NMCP staff will be trained and able to create DHIS2 tables/graphics. NMCP will determine who the new staff should be graphics on malaria key indicators skills to produce DHIS2 tables / graphics on malaria key indicators trained.

Number of monthly malaria reports checked for internal coherence Number of DHIS2 malaria electronic reports revised by NMCP staff along year In 2018, not applicable. 2 and against malaria data from other MINSA departments Trimestral ↑ NA NA NA 18 0 5 5 27.8% with M&E Advisor In 2019, it is expected to check for internal coherence of at least 18 malaria reports in the six provinces covered by HFA. (Epidemiological Surveillance, Sexual and Reproductive Health)

In 2018, the M&E Adviser visited 4 provinces of the 6 covered by HFA for analysis of malaria data reported on the DHIS2 platform by Number of provincial DHIS2 supervisions performed by NMCP M&E staff for Number of malaria data monitoring visits reported on the DHIS2 3 Trimestral ↑ 6 4 67% 24 0 5 5 20.8% DHIS2 municipal users (in the fourth quarter of year 2). In 2019, it is expected that 24 DHIS2 supervisions will take place (6 data analysis platform conducted in the provinces covered by HFA supervisions per quarter). In Q2 this activity took place in: Cuanza Norte, Malange, Lunda Norte, Lunda Sul, and Zaíre. In 2018, not applicable. In 2019, three meetings are planned. In Q2 (March 15, 2019), a meeting was held on the analysis of malaria Number of meetings where data reported on DHIS2 platform data reported on the DHIS2 platform, with the Coordinator of NMCP (Dr. Franco Martins), the case management focal point (Dr. Number of meetings at central level of DHIS2 data analysis balance between 4 analysis findings are presented to NMCP and other public health Trimestral ↑ NA NA NA 4 0 1 1 25.0% Elisa Miguel), the M&E Officer (Dr. Mario Hossi), the NMCP Epidemiologist (Dr. Fernanda Guimarães), and the M&E Advisor (Dr. NMCP and other health departments led by NMCP under M&E Advisor departments Yava Ricardo). Despite being invited, staff from the other public health departments did not attend (i.e., Surveillance and Reproductive Health). In 2018, the M&E Advisor participated in the elaboration of several strategic and technical documents of the malaria program, such as: i) M&E 2018-2020 plan, ii) Updating of data forms of all levels (national, provincial, and municipal); iii) Updating of training manual for provincial focal points on M&E ; iv) Malaria commodities quantification document for 2019 ; v) Updating of MEWS training manual Number of strategic and technical documents prepared by NMCP staff with the Effective participation of M&E Advisor embedded in NMCP to 5 Annual ↑ 5 5 100% 2 0 1 1 50.0% (statistics part). technical assistance of M&E Advisor embedded in NMCP produce strategic and technical documents of NMCP In 2019, The NMCP need to develop: i) Annual Operational Plan ; ii) Malaria commodities quantification document for 2020; in Q2 FY19, the M&E Advisor worked with the national NMCP trainers (Dr. Elisa Miguel, Dr. Marilia Afonso, and Dr. Arlindo) to update the contents of MCM , IPTp, and other, training modules, providing data trends, graphics, and tables. In 2018, the M&E advisor embedded in NMCP trained a total of 38 NMCP M&E focal points from national (2) and provincial levels (36) on M&E and HMIS (new malaria database by municipalities, updated M&E and supervisions, etc.). In 2019, additional training will take place, including training 76 provincial and municipal malaria focal points on MEWS (Malaria Early Warning System) in the four Number of NMCP technicians from national, provincial, or municipal level Number of NMCP technicians who directly benefited from transfer 6 Annual ↑ 38 38 100% 76 0 28 28 36.8% southern epidemic prone provinces, 28 of whom were trained in February 2019 in the NAMIBE and CUNENE provinces. In Q2 trained on M&E (transfer of competences) by M&E Advisor embedded in the of competences related to M&E and HMIS from M&E advisor FY2019, the M&E Advisor embedded in NMCP (Dr. Yava Ricardo) and NMCP Epidemiologist (Dr. Fernanda Guimarães) carried out a NMCP embedded in NMCP training on MEWS in the province of Namibe. A total of 28 provincial, municipal, and hospital focal points were trained on the calculation of epidemic threshold from the third quartile. Performance Monitoring Plan - Results 5 Indicator Definition and Unit of Performance Indicator Disaggregation 2018 Achievements 2019 Achievements Level Measure FY17 Baseline Values FY18 Achieved / Achieved / Baseline Year Targets Q1 Q2 (***) Q3 Q4 Total FY19 Targets Q1 Q2 Q3 Q4 Total (*) Targets Target (%) Target (%) (**)

Long-term result 5: National Health Information System Strengthened

Activity

Objective 5: Capacity of national, municipal, and provincial governments to plan, fund, monitor and supervise improved health programs

Numerator: # existing health units listed in DHIS2 for PMI A5.1 Percent of health units updated in DHIS2 organizational tree (new indicator in FY 2019) provinces By province / N/A N/A N/A n/a n/a n/a n/a n/a n/a 100.0% 94.6% 94.6% 94.6% 94.6% Routine data Quarterly Denominator: all health units existing in 6 provinces

Number of MINSA A5.2 Number of DHIS2 users trained within MINSA with USG assistance personnel trained in By province / N/A N/A 278 n/a 2 93 187 282 101.4% N/A N/A N/A N/A N/A Routine data Annual DHIS2 with USG funds

Numerator: # reports submitted before Percent of quarterly reports submitted in DHIS2 (will be compared with non-PMI designated day A5.3 By province / N/A N/A 70.0% n/a n/a n/a 70.1% 70.1% 100.1% 85.0% 72.5% 84.1% 84.1% 98.9% Routine data Quarterly provinces) Denominator: # of reports expected to be submitted Numerator: # reports Percent of historical data (2017) entered in DHIS2 for 6 PMI provinces (will be compared submitted / # reports A5.4 By province / N/A N/A N/A n/a n/a n/a n/a n/a n/a 85.0% 40.5% 40.2% 40.2% 47.3% Routine data Quarterly with Non-PMI provinces) (+) expected to be submitted Number of municipal authorities / Number of municipal authorities meeting quarterly to review HMIS/DHIS2 data and representatives meeting A5.5 By province / N/A N/A 43 n/a n/a n/a 45 45 104.7% > 51 40 42 42 82.4% Routine data Quarterly incorporate feedback in reports quarterly to review HMIS data and incorporate feedback in reports # meetings with A5.6 Number of data consolidation / revision meetings (+ +) municipal authorities to By province / N/A N/A N/A n/a n/a n/a n/a n/a n/a 24 4 5 9 37.5% Routine data Quarterly #analyse of data DHIS2 analyses data Number of quarterly meetings in which NMCP officials lead DHIS2 analyses for decision A5.7 meetings with municipal By province / N/A N/A N/A n/a n/a n/a n/a n/a n/a > 20 3 4 7 35.0% Routine data Quarterly making ( +++) authorities led by NMCP # of visits or routine supervision by HFA- Number of routine supervision visits / meetings implemented to DMS by HFA-MINSA A5.8 MINSA staff into By province / N/A N/A N/A n/a n/a n/a n/a n/a n/a > 528 89 108 197 37.3% Routine data Quarterly personnel (&) municipalities to solve DHIS problems Information between Number of health information systems interoperable with DHIS2 (OpenLMIS, DHIS2 and OpenLMIS, A5.9 national / N/A N/A N/A n/a n/a n/a n/a n/a n/a 2 in progress in progress in progress In progress Routine data Annual KoboCollect) KoboCollect can be linked # staff trained or re trained in DHIS2 with on A5.10 Number of MINSA staff trained or refreshed (at national and provincial level) ( && ) By province / N/A N/A N/A n/a n/a n/a n/a n/a n/a 56 N/A 28 28 50.0% Routine data Quarterly job coaching or tailored training Number of Quarterly # of quarterly meetings in which NMCP officials lead DHIS2 analyses for decision making A5.5 Meetings for Data By province / N/A N/A 4 n/a n/a n/a 4 4 100.0% > 20 travel reports Quarterly (new indicator) Analyses (*) Baseline figure not available; (**) Program kick off with activities focused on staff recruiting, selection of municipalities, coordination for DHIS2 road map development.

(***) Value from Q2 changed from 8 to 2, per request of USAID: the 6 HFA ITs were excluded for not being MINSA staff.

( + ) A slight decrease in % of historical data 2017 (40.5% in Q1 to 40.2% in Q2) can be due to an update in number of forms linked to the health units (some forms originally were not adequately linked).

( + + ) It assumes 6 provinces * 4 quarterly meetings = 24 meetings.

(+++) It assumes at least 80 % * 24 meetings = 19 or more meetings.

( & ) 520 supervisions to DMS, assumes that at least 80% of 60 municipalities are visited/supervised by HFA/MINSA personnel to identify problems and solutions with DHIS2.

( && ) It assumes 20% of currently trained personnel will need refreshment or will be substituted by new personnel (20% * 280 = 56 personnel to be [re] trained in DHIS2 or receive on job coaching).

Notice: Targets for some indicators changed with respect to original PMP, to go in line with developments of DHIS2 RoadMap, HFA plans, and conversations with GEPE/GTI . n/a: These indicators are meant to be measured after DHIS2 training is fully implemented in six PMI provinces.

success story

USAID’s Health for All project empowers health workers across Angola to successfully deliver malaria case management.

Meet Anacleto Francisco Muondo. He is a nurse at Kota Communal Nurse Anacleto, trained by Health Center, nearly 100 km from the Angolan provincial capital of USAID’s Health for All Malanje. It’s here in a rural area that Anacleto works daily to help those in his community. And it’s also here that he’s making a significant project, demonstrates impact in the diagnosis and treatment of malaria for his clients. exceptional malaria case Nurse Anacleto was recently a recipient of malaria case management management skills in remote training provided by USAID’s Health for All project. It was the skills he area of Angola. learned here that are supporting him in delivering exceptional care to those in his community. The Health for All project team provides regular supervision to health workers such as Nurse Anacleto, to ensure ongoing learning and feedback to help health workers better serve their clients and communities. In February 2019, Health for All project team representatives—people from the National Malaria Control Programme, the President’s Malaria Initiative, the Health Department of Malanje’s Malaria Provincial Supervisor, and Health for All’s Provincial Malaria Officers (OPM) — visited three health units in the municipality of Kalandula, , one of which was Kota Communal Health Center. It was here they met Nurse Anacleto who, together with four other health technicians, provides services to the Kota community. During the supervision visit, the team was fortunate enough to observe Nurse Anacleto in action. He had a client with fever, and administered a rapid diagnostic test. The result was negative so the client was Nurse Anacleto Francisco Muondo responsible for prescribed antipyretic and told that if the fever persisted, he should Kota Communal Health Center. Kalandula Municipality, Malanje Province, Angola. Photo: return to the health center the following day. Health for All Project – USAID / Angola Nurse Anacleto demonstrated impressive capacity in handling not only simple and severe cases of malaria, but also malaria in pregnancy. He correctly diagnosed malaria and prescribed the correct treatment in all “I was trained by the Health for cases, and his record-keeping was exemplary—his records included All Project. It helps me complete names of patients, registration numbers, dates of correctly handle malaria case consultation, records of signs and symptoms, results of examinations made (microscopy and rapid diagnostic tests), diagnosis, and the management.” correct treatment.

Nurse Anacleto’s excellent technical performance in malaria care — Nurse Anacleto service delivery is simply one of many transformational experiences for Francisco Muondo health workers across Angola who are benefiting from training, supervision, and capacity building provided by USAID’s Health for All project.

Attachment 4: Corrective Action Plan Q2 FY19 Update

Issue Description: USAID requested PSI to present a Corrective Action Plan outlining areas of improvement.

Desired Outcome: Improved performance of the Health for All Project.

Action Plan Sponsor: PMI /USAID.

Strategic Action / Party Resources Activities Responsible R equired Stakeholders Constraints Date Due Update for Q1 FY19

Malaria Case Management Training

Review job aids and HFA R2 Staff Short-Term NMCP NMCP training (Q2 – Q3) Job aids and technical manuals technical manuals Technical Global Fund manuals require are being updated in for accuracy, up-to- Assistance WHO updates to accordance with WHO and date information, Consultant ensure quality NMCP guidelines. Revised and presentation of (STTA) improvement. versions will be submitted for technical material Victor Lara approval to PMI and NMCP in and suggest Q3. improvements, including advocacy for improvements.

Review NMCP HFA R2 Staff STTA Victor NMCP NMCP training (Q2 – Q3) Review of training manuals and Angola training Lara Global Fund manuals and job job aids are being reviewed in manuals and job WHO aids in MCM accordance with WHO and aids in malaria case require updates NMCP guidelines. Revised management. to ensure quality versions will be submitted for improvement. approval to PMI and NMCP in Q3.

Attend MCM Global Fund Global Fund NMCP (Q2 – Q3) Global Fund officials have been trainings to assess staff Global Fund invited to attend MCM trainings quality of trainers to WHO implemented by NMCP with improve technical HFA support in Q3 to assess competency and quality of trainers. Results of training delivery. assessment should be available in Q4. Develop provider- HFA R2 Staff STTA Victor NMCP National malaria (Q2 – Q3) Both STTA consultants (Victor client Lara and Global Fund trainers (training Lara and Mathias Pollock) are communication Mathias WHO of trainers) also working on proposals for skills training to Pollock need improvement of provider-client include in provider communication skills through job aids and other case management skills training. tools. Proposed tools will be training (R2). presented in Q3.

Formative Supervision

Review supervision HFA R2 Staff STTA NMCP NMCP (Q2 – Q3) Proposed revised supervision plan, supervision Victor Lara Global Fund supervision plan and tools were submitted tools, and WHO tools are not and approved by NMCP; are supervision skills of user-friendly. being field tested in some PMI HFA staff and provinces during Q3. Once this propose process is completed, the improvements. Formative Supervision Plan and respective tools will be applied in all six PMI provinces. Elaboration of HFA R2 Staff STTA Victor NMCP NMCP’s (Q2) With technical support from integrated training Lara Global Fund supervision tool STTA, and in close and formative WHO was identified as collaboration with NMCP, HFA supervision manual. too long and developed integrated training cumbersome. and supervision manual; will be field tested in one PMI province (Zaire) in May. Final version will be used in similar trainings in other PMI provinces during Q3 and Q4.

Evaluate HFA R2 Staff STTA Victor NMCP NMCP’s (Q2 – Q3) NMCP supervision tools revised formative- Lara Global Fund supervision tool in collaboration with NMCP. supportive WHO was identified as Field testing in one PMI supervision tool too long and province (Zaire) begins in May. (NMCP). cumbersome. Once finalized, rollout will be in all PMI provinces.

Improve supervision HFA R2 Staff STTA Victor NMCP (Q2 – Q3) Recently revised formative skills and outcomes, Lara Global Fund supervision tools being field train, and provide WHO tested in Zaire in May are also on-the-job coaching being used to improve skills of to HFA and HFA staff and some NMCP stakeholder personnel. Once initial process personnel. is finalized, it will be replicated to all PMI provinces.

Train provincial and HFA R2 Staff STTA Victor NMCP NMCP’s (Q3) Same comment above. municipal Lara Global Fund supervision tool supervisors and WHO was identified as malaria focal points too long and on formative cumbersome. supervision. Identify and train HFA R2 Staff STTA Victor NMCP (Q1 – Q4) Some national malaria trainers master supervisors, Lara Global Fund are being evaluated during or trainers-of-trainers WHO trainings they conduct to (TOTs) who will identify those that can become continue building TOTs in formative supervision. capacity of supervisors.

Assess capacity of HFA R2 Staff STTA Victor NMCP (Q2 – Q4) Once a cadre of well-trained supervisors to Lara Global Fund supervisors is formed, some will perform supportive WHO become master supervisors for supervision. NMCP.

Advocate for use of HFA R2 Staff STTA Victor NMCP (Q1 – Q4) HNQIS use will be advocated for HNQIS as a Lara Global Fund with DNSP/MINSA once the supportive WHO revised supervision plan and supervision tool. tools are field tested (Q3). Tools will initially be paper-based and later migrated to electronic versions.

iCCM (ADECOS)

Review current set- HFA R2 Staff STTA Victor NMCP FAS (Q1 – Q4) Implementation of ADECOS in up of iCCM activities Lara World Vision Lunda Sul and Zaire started in through ADECOS UNICEF Q3 FY18. PSI has been and suggest gathering lessons learned by opportunities to Mentor other ADECOS partners, but improve, including information sharing is a advocacy with continuous challenge. NMCP and FAS (if required). Evaluate iCCM HFA R2 Staff STTA Victor NMCP FAS (Q1 – Q4) Data collected by ADECOS in implementation Lara World Vision two municipalities in Zaire and results from PSI UNICEF two in Lunda Sul is manual and stakeholders (family notebooks). PSI conducts and develop an Mentor monthly supervisions of all four improvement work municipalities and collects data plan. from ADECOS. Once the simplified KoboCollect app is approved by FAS and used by the ADECOS, it will speed up the process of analysis and evaluation of results.

Develop HFA R2 Staff STTA Victor NMCP FAS Recurrent lack of (Q1 – Q4) PMI, NMCP, PSI, and FAS recommendations Lara World Vision communication continue meeting on regular for better UNICEF and coordination. basis to improve coordination communication and between the Mentor coordination of activities. ministries (MINSA and FAS/MAT) and stakeholders. Evaluate iCCM HFA R2 Staff STTA Victor NMCP FAS Resistance by (Q1 – Q2) Supervision activities focus on supervision Lara World Vision FAS to manually collecting data from activities and UNICEF change the ADECOS. PSI has been develop data collection advocating with FAS to improve recommendations Mentor process with process by utilizing a simple and for improvement. ADECOS. modified KoboCollect app, “Statistics.” Review data HFA R2 Staff STTA Victor NMCP FAS (Q1 – Q2) Same comment as above. collection tools, Lara World Vision supervision tools, UNICEF and job aids, and propose Mentor improvements. SBCC: Malaria

LLIN Use Quantitative and HFA Staff STTA NMCP PSM Institutional (Q1 – Q3) As of May 12, the study is under qualitative Suse Emiliano Mathias Global Fund Review Board for way. Expected completion is end assessments will Pollock UNITEL the study was of May. Flash report will be be conducted in VectorWorks only granted by submitted by end of June and three provinces to Johns Hopkins workshop is planned for first evaluate net use International week in July. and care practices (JHI) in March so PSI communication team has after mass LLIN it delayed field been participating in the inter- campaign (Q2- work. ministerial SBCC working group Q3). Results will to support development of be analyzed in malaria campaign. Q3. Based on results, a costed communication plan will be developed using a participatory approach with stakeholder inclusion (Q3-Q4).

Malaria in Pregnancy Review HFA Staff STTA NMCP (Q2 – Q3) Completed. assessment by Suse Emiliano Mathias PSM VectorWorks and Pollock Global Fund World Learning’s UNITEL additional qualitative study.

Qualitative study HFA Staff STTA NMCP (Q2 – Q3) Focus group research among designed to Suse Emiliano Mathias Reproductive clients of MiP services was validate findings Pollock Health/DNSP conducted and results shared with of literature review RMA PMI/USAID. In-depth interviews in Angolan among providers will be environment. conducted in Q3 to inform workshop scheduled for first week in July.

Design appropriate HFA Staff STTA NMCP (Q2 – Q3) Scheduled for first week in July. communications Suse Emiliano Mathias Reproductive strategy (potentially Pollock Health/DNSP performed via UNFPA interpersonal UNICEF communication) in UNITEL participatory manner. Testing and Treatment Behaviors Behavior change will HFA Staff STTA NMCP NMCP (Q2 – Q3) Job aids for formative focus on providers Suse Emiliano Mathias Reproductive Reproductive supervision are being revised to through improved Pollock Health/DNSP Health/DNSP be more user-friendly and supervision and include tips on communication STTA World Learning World Learning training on client CENFFOR between health providers and communication skills Victor Lara CENFFOR clients. Training manuals also (part of MCM STTA). include communication tips for provider- client communication.

SBCC: Family Planning

Review and HFA Staff STTA Reproductive (Q2 - Q3) Ongoing. Research strategy is participate in Eva Fidel Mathias Health/DNSP completed. Research is under development of Suse Emiliano Pollock UNFPA way. Based on research results, SBCC strategies in UNICEF workshop is planned for Q3 to SRH, with a focus on develop campaign strategy, youth. tools, and messages.

Qualitative study HFA Staff STTA NMCP (Q2 – Q3) Qualitative research is (focus groups and Eva Fidel Mathias Reproductive completed; results will be in-depth interviews) Suse Emiliano Pollock Health/DNSP presented in workshop in Q3. among adolescents. RMA UNFPA UNICEF

Workshop to HFA Staff STTA NMCP (Q2 – Q3) Workshop scheduled for Q3. analyze the Eva Fidel Mathias Reproductive qualitative study Suse Emiliano Pollock Health/DNSP findings and develop UNFPA SBCC campaign UNICEF plan, including messages’ Youth Health effectiveness and Providers sustainability of Unitel SBCC interventions.

Campaign and HFA Staff NMCP (Q2 – Q3) Campaign will be developed in a approval. Eva Fidel Reproductive workshop planned for Q3 and Suse Emiliano Health/DNSP prototyped immediately. RMA UNFPA UNICEF Campaign launch. HFA Staff NMCP (Q2 – Q3) Campaign will have soft launch Eva Fidel Reproductive after workshop in Q3. Prototype Suse Emiliano Health/DNSP phase is included in the RMA UNFPA campaign launch. UNICEF Youth Health Providers Unitel Campaign HFA Staff Eva STTA NMCP (Q3 – Q4) Scheduled for after the implementation and Fidel Mathias Reproductive workshop in Q3. continuous Suse Emiliano Pollock Health/DNSP monitoring. RMA UNFPA UNICEF Youth Health Providers Unitel

Attachment 5: Local NGO Capacity Development Plan (update)

Background Capacity building of local NGOs has always been a crucial component of HFA. In Q1 FY19, Rede Mulher Angola (RMA) received technical support and on-the-job training as part of the ongoing capacity development plan. The support training focused on: finance, human resources, information technology, procurement, and programs. The primary activities in Q1 were related to: • Finance – Hired experienced finance manager. • Human Resources – Revised organogram and assessed human resources in need. • Information Technology – Analyzed existing Finance and Security structure. • Procurement – Implemented procurement manual. • Programs – Updated capacity building plan and started qualitative study among adolescents.

Monitoring of Capacity Building Plan During Q2, PSI provided technical support and on-the-job training to the RMA team, as planned in the FY19 workplan. Each department previously mentioned has an assigned person from the PSI office who was responsible for conducting on-the-job trainings, as well as monitoring progress. Likewise, RMA has also assigned individuals from each department as focal points. The table below identifies the PSI and RMA representatives by department.

Departments PSI Team RMA Focal Points Finance Rafael Pedro Henriques Sungeti Human Resources Carla Barcelos Luís Daniel Information Technology Amélia Pinheiro Hélio Lima Procurement Adelino da Costa Marcolino Programs Eva Fidel Marcolino Cambumba

Results Achieved During Reporting Period (Q2 FY19)

To monitor progress of the capacity building plan, an Excel spreadsheet is used to calculate achievements according to targets. The chart displayed below shows the status of the capacity building plan in Q2.

ACTIVITIES PROGRESS

Concluded 16% 4 16% 0% Not Concluded 0% 0 16% Rescheduled 16% 4 72% In Progress 72% 18

At the end of Q2, 16% of the activities were concluded, 16% of the activities were rescheduled to Q3, and 72% of the activities were in progress (ongoing). Main achievements include:

Finance • Finance Procedure Manual Revised and Updated – RMA received support from PSI’s finance department to revise and update the most recent version of the Finance Procedure Manual to reflect on donor policies. It still requires approval and signature by RMA director. • Primavera Software Training – RMA’s finance department has received training on Primavera (finance software). This software will help RMA develop a more precise accounting system and avoid accounting errors.

Human Resources • RMA’s New Organogram Finalized – New staff were recruited, and existing staff were promoted and shifted from one department to another according to organizational needs and capacity of existing staff. The new organogram reflects three main departments: (1) human resources, (2) program (including SBCC and Monitoring & Evaluation), and (3) finance and operations.

IT • Installation of Primavera Software – PSI’s IT department helped RMA install Primavera Software in the finance and operations department. The vendor provided training for the department, which was successfully completed. However, the finance and operations department is in need of one additional training on the accounting system. • Data security – Data security was improved by implementing automatic password change functionality. Every 120 days (three months) the system will automatically remind users to change passwords. This system increases data security among users.

Procurement • Implementation of Quarterly Purchase Plan – Each department makes a list of needs for the upcoming quarter. The procurement staff then follow the necessary procedures to provide the service or good in the identified timeframe. • Security Committee Created – The security committee will ensure a healthy and safe work environment at RMA’s office. Further training on fire extinguisher use and fire evacuation will be conducted in Q3.

Programmatic • Workplan Updated – The integration of family planning and HIV/AIDS services required updates to the existing workplan. To assure effectiveness in the integration, a training was conducted by PSI and MSH staff. HIV trainings included information related to stigma, discrimination, and HIV counseling. • Technical Training Manager for Partner Development Hired – PSI hired an experienced manager to lead RMA’s capacity building plan. The new manager, who has a background in human resources, is developing a training plan tailored to RMA staff needs.

Health for All Project Health Facilities by Provinces and Municipalities

Provinces Municipalities Total Health Units

Cuanza Norte Ambaca 13 Banga 6 Bolongongo 8 Cambambe 25 Cazengo 31 Golungo Alto 10 Gonguembo 7 Quiculungo 9 Lucala 8 Samba Caju 9 Subtotal 126 Lunda Sul Cacolo 13 Dala 23 Muconda 21 Saurimo 43 Subtotal 100 Lunda Norte Cambulo 13 Capenda-Camulemba 8 13 Chitato 12 Cuango 6 Cuílo 2 Lubalo 4 Lucapa 10 Xá-Muteba 7 Lóvua 1 Subtotal 76 Malanje Cangandala 11 Caculama 6 Cacuso 6 16 Quela 8 Cahombo 5 Cambundi Catembo 6 Marimba 6 Massango 8 Luquembo 6 Quirima 8 Kiwaba Nzogi 14 Kunda Dia Baze 7 Malanje 39 Subtotal 146 Uíge Uíge 46 Ambuíla 16 Bembe 19 Buengas 15 Bungo 14 Cangola 13 26 23 14 Mucaba 15 27 Puri 15 13 Quitexe 16 Sanza Pombo 19 Songo 22 Subtotal 313 Zaire Kuimba 16 Mbanza Congo 32 Noqui 12 Tomboco 19 Nzetu 19 Soyo 31 Subtotal 129

Total 890 Health for All Project Map of Facilities Province: Cuanza Norte

Municipality Health Unit # HU

HM de Ambaca 1 Hospital Regional da Camabatela 2 PS 3 PS Tango 4 PS Cazua 5 PS Maua 6 Ambaca PS Longa 7 PS Canguimbi 8 PS Cole 9 PS Cahima 10 PS Canacanjungo 11 CS Bindo 12 PS Bindo Sector 13 CS Municipal da Banga 14 PS Caculo Cabaça 15 PS Caboco 16 Banga PS Sector Caculo Cabaça 17 PS Bessenguele 18 PS Quinzuamba 19 CS Bolongongo 20 PS Calemba 21 PS 22 PS Quiquemba 23 Bolongongo PS Kiboto 24 PS Quindunguo 25 PS Pimbi 26 PS Manguengue 27 HM Cambambe 28 PS Dange-Ya-Menha 29 PS Cassoalala 30 PS São Pedro da Quilemba 31 PS Canguenhe 32 CS Mucoso 33 PS Pamba da Curva 34 PS Brigada Desminagem do Cambambe 35 PS Beira Alta 36 PS Desminagem do Zenza 37 PS 38 PS Alto Dondo 39 Cambambe PS Alto Fina 40 PS 11º Brigada de Desminagem 41 PS Nhangue-Ya-Pepe 42 PS Ngola Ndala 43 PS Missão Católica 44 PS Madre Afonso Maria (Privado) 45 PS Sector do Zanga 46 PS Quiombe 47 PS Maculumbi 48 PS Caxissa 49 PS Cafuma 50 PS Sonefe 51 PS Unidade da polícia Sonefe 52 HM Cazengo 53 HP Kwanza Norte (HMI) 54 CS Sassa 55 CS Polícia Nacional 56 HP "A.A.N" Kwanza Norte 57 PS Cariambo 58 PS Catome de Cima 59 CS Municipal de Cazengo 60 PS Canhoca 61 PS Quissecula 62 PS Kipata 63 PS Tombó Tombó 64 PS Camuaxi 65 PS Quirima do Meio 66 P.S Canzondo 67 Cazengo PS Zanga 68 HP Sanatório 69 PS Km 13 70 PS Zavula 71 PS Canhoca 72 PS Catamba 73 PS Irmão Panza 74 PS Catari 75 PS Cariango 76 PS Lucala II 77 CS Comarca Cazengo 78 CS Cazengo (ICCT) 79 PS 29 de Novembro 80 PS Km 11 (Sanatório) 81 PS UPIP 82 CS 8ª Região Militar 83 HM Golungo Alto 84 PS Quiluanje 85 PS da Polícia 86 CS 87 PS Cabinda 88 Golungo Alto PS Açude 89 PS Malesso 90 PS Cacanza 91 PS Calunga 92 PS 93 HM Gonguembo 94 CS 95 PS Mussosso 96 Gonguembo PS 97 PS Cafuta 98 PS Lundo 99 PS Velho Yango 100 HM Kiculungo 101 PS Zambi-Quiama 102 PS Tita 103 PS Cacoxi 104 Kiculungo PS Bonzo 105 PS Kapata 106 PS Kianvu 107 PS Kibonda 108 PS Ngongolo 109 Hospital Municipal do Lucala 110 PS CTT 111 PS Coio 112 PS Kiangombe 113 Lucala PS Hala 114 PS Hanga 115 PS Kigia 116 PS Dualumbi 117 CS Samba Cajú 118 HM Samba Cajú 119 PS 120 PS Pambos de Sonhi 121 Samba Cajú PS Cazombo 122 PS Muloco 123 PS Kidiulo 124 PS Mussabo 125 PS Kilemba 126

Summary

Municipalities Total HU

N'dalatando Ambaca 13 Banga 6 Bolongongo 8 Cambambe 25 Cazengo 31 Golungo Alto 10 Gonguembo 7 Quiculungo 9 Lucala 8 Samba Caju 9 Total 126 Health for All Project Map of Facilities Province: Lunda Sul

Municipality Health Unit # HU

HP Lunda Sul 1 HM Saurimo 2 CS Mulombe (14) 3 CS Guadalupe 4 CS Txizainga 5 CMI Saurimo 6 CS Mona Quimbundu 7 CS Manalto 8 PS Carteira 9 Hospital Pediátrico de Saurimo 10 Hospital Psiquiátrico Lunda Sul 11 PS Itengo 12 PS Sueja 13 PS Muono Waya 14 PS Muandondji Barragem 15 PS Txanguilo 16 PS Luari 17 PS Penitenciária Luzia 18 CS Sombo 19 PS Samupafo 20 PS Samulambo 21 Saurimo PS Muambumba 22 PS Camundambala 23 PS Txapoji 24 CS Pedro 25 PS Mombo Calunga 26 PS Nzaje 27 PS Ngando 28 PS Muatoyo Sacaxima 29 PS Nanguanza 30 PS Sacambundji 31 PS Txipamba 32 PS Luachimo Sambuambua 33 PS Sambau 34 PS 1 Lar de Dezembro 35 PS Ngambo Chimuanga 36 PS Peso Velho 37 CS IEIA 38 PS Sacazanga 39 PS MINARS 40 PS Lar da 3ª Idade 41 PS Camanhinga 42 CS IEIA 43 HM Cacolo 44 CS Cucumbi 45 CS Muatxissengue 46 PS Txitala 47 PS Samuquixi 48 CS Chassengue 49 Cacolo PS Camba Txilonda 50 PS Txizeca 51 CS Alto Chicapa 52 PS Muatxinongue 53 PS Alto Cavemba 54 PS Muhesse 55 PS Zovo 56 HM Dala 57 CS Luma Cassai 58 PS Luele 59 PS Biula 60 Maternidade Católica Dala 61 PS Mahamba 62 CS Cazaji 63 PS Ngua 64 PS Mualengue 65 PS Cuzuma 66 PS Samuhini 67 Dala PS IEIA Luma 68 PS Cazoa 69 PS Bando 70 PS Mombo 71 PS Luachimo 72 PS Mucuamuilo 73 PS SAMESSIA 74 PS Txissombo 75 PS Cavuma 76 PS Samugimo 77 PS 11 de Novembro 78 PS Samahina 79 CMI Muconda 80 CS Cassai Sul 81 HM Muconda 82 CS Muriege 83 CS Chiluage 84 PS Tambue 85 PS Muatxikuata 86 PS Txicundo 87 PS Txitende 88 PS Tchivundo 89 Muconda PS Sengo 90 PS Cabo Catanda 91 PS Dala-Chiluage 92 PS Muene Txokue 93 PS Txoji 94 PS Ndondji 95 PS Cambongo 96 PS Sacaluila 97 PS Muazanza Chihumbue 98 PS Muanzanza Luembe 99 PS Sacambundji 100

Summary Municipalities Total HU Cacolo 13 Dala 23 Muconda 21 Saurimo 43 Total 100 Health for All Project

Map of Facilities 0 Province: Lunda Norte

Municipality Health Unit # HU

CH Cassanguidi 1 CM Fucauma 2 PS 3 PS Maludi 4 CM Sacandjandja 5 PS Cachimo 6 Cambulo PS Luia 7 PS Luaco 8 PS Cossa 9 PS Canzar 10 CM Canzar 11 PS Cambulo Sede 12 PS Caquenha (Txina) 13 HM Capenda Camulemba 14 CS Muxinda 15 CS Xamiquelengue 16 Capenda Muhongo 17 Camulemba PS Muanamena 18 PS Xinge 19 PS Calucuta 20 PS Muatxihunga 21 CS Caungula 22 PS Camaxilo 23 PS Tximbonji 24 PS Naumba 25 PS Muieu 26 PS Sacoji 27 Caungula Txipanda 28 PS Mutia 29 PS Chifapu 30 PS Tximbuambua 31 PS Nguba 32 PS Muana Mema 34 PS Xinganhima 36 PS Gasolina 37 PS Sachindongo 38 PS Taxa-Barragem 39 CMI Caxinde 40 PS Ritenda 41 PS Estufa 42 Chitato PS Camatundo 43 HM Chitato 44 PS 4 de Abril 45 PS Cacanda 46 PS Candjamba 47 PS Txamba 48 HG de Cafunfo 49 HM Cuango 50 CS Luremo 51 Cuango PS Fernando 52 CS Cuango 53 PS Kambala Kangando 54 HM 55 Cuilo PS Caluango 56 CS Lubalo 57 PS Calola 58 Lubalo PS Muvulege 59 CS Luangue 60 HM Lucapa 61 CS Chilumbica 62 HM Calonda 63 PS Camissombo 64 HG Lucapa 65 Lucapa PS Capaia 66 PS Chapa Luó 67 PS Xa-Cassau 68 PS Mutoa 69 PS Camba caia 70 Lóvua CS Lóvua 71 CS Xá - Muteba 72 PS Samba 73 CS Domingos Vaz 74 Xá - Muteba PS Môngua Quinguri 75 PS Mulo 76 PS Iongo 77 PS Cangongo 78

Summary Municipalities Total HU Cambulo 13 Capenda-Camulemba 8 Caungula 13 Chitato 12 Cuango 6 Cuílo 2 Lubalo 4 Lucapa 10 Xá-Muteba 7 Lóvua 1 Total 76 Health for All Project Map of Facilities Province: Malanje

Municipality Health Unit # HU

HM Caculama 1 PS Caxinga 2 PS Muquixe 3 Caculama PS Catala 4 PS Damba 5 PS Missão Católica de Caculama 6 HM Cacuso 7 PS Lombe 8 Cacuso PS Matete 9 PS Queximenha 10 PS Kingles 11 PS Zanga 12 HM Cahombo 13 PS Cambo Sunjinji 14 Cahombo PS Micanda 15 PS Cambo Camama 16 PS Banje Angola 17 HM Calandula 18 PS Missão Católica Calandula 19 PS Cota 20 PS Kapele 21 PS Caxito 22 PS Kuale 23 PS Cabaça 24 Calandula PS Cateco Cangola 25 PS Santa Maria 26 PS Quitumbo 27 PS Quinje 28 PS Kibanga 29 PS Kingongo 30 PS Bango Azenga 31 PS Amaral 32 PS Quimbanda 33 HM Cambundi Catembo 34 PS Dumba Cabango 35 PS Tala Mungongo 36 Cambundi Catembo PS Mussolo 37 PS Quipingui 38 PS Muieba Tuto 39 HM Cangandala 40 PS Cuanza 41 PS Tamba 42 CS Bembo 43 PS Kipacasa 44 Cangandala PS Caribo 45 PS Kulamagia 46 PS Bola Casaxe 47 PS Njio 48 PS Cuque 49 PS Kimuezo 50 HM Kiwaba Nzogi 51 PS Mufuma 52 PS Lutau 53 PS Quiifucuça 54 PS Cambo Cafuxi 55 PS Quissua 56 Kiwaba Nzogi PS Medile 57 PS Mola 58 PS Quirima-caxi 59 PS Ngongui Nzambo 60 PS Ndonga Izambo 61 PS Mangumbola 62 PS Tunda dia Mola 63 PS Ngonga Nhongo 64 HM Kunda Dia Base 65 PS Issanga Teca 66 PS Milando 67 Kunda Dia Baze PS Máquina 68 PS Lemba 69 PS Quixinga Bambi 70 PS Kibau 71 HM Luquembo 72 PS Capunda 73 Luquembo PS Rimba 74 PS Dombo 75 PS Quimbango 76 PS Kunga Palanca 77 Maternidade Provincial Malange 78 HM de Malange 79 CS Cahala 80 CS Maxinde I 81 CS Vila Matilde 82 CS Ritondo 83 CS Maxinde II 84 PS Quêssua 85 HP Malange 86 CS Canâmbua 87 CS Catepa 88 CS Cangambo 89 CM Infantil 90 CS Capuchinhos 91 PS Quissol 92 PS Gaiato 93 PS Quissaco 94 PS Cambondo Malanje 95 CS Cambaxi 96 Malanje PS Cangando 97 PS Kimbamba 98 PS Vula Ngombe 99 PS Ngola Luige 100 PS Tuinge Ngondo 101 PS Cambundi do Quije 102 CS Quizanga 103 PS Bambi 104 PS Kamatende 105 PS Suinge 106 CS Carreira de Tiro 107 CS Sagrado Coração 108 CS Catepa II 109 PS Dori Lombe 110 PS Muhemba 111 PS Carianga de Baixo 112 PS Quibinda 113 PS Cassussina 114 PS Penitenciária 115 PS Policia Nacional 116 HM Marimba 117 PS Chifuita 118 PS Cabombo 119 Marimba PS Tembo-a-Luma 120 PS Mangando do povo 121 CS Cabombo Sede 122 HM Massango 123 PS Kihuhu 124 PS Quimbungo Thunda 125 PS Luzitamo 126 Massango PS Kitalabanza 127 PS Macongo 128 PS Quinguengue 129 CMI Massango 130 HM Quela 131 PS Bundo 132 PS Xandel 133 PS Quinguri 134 Quela PS Bangalas 135 PS Moma 136 PS Caturi 137 PS Mufuma 138 HM Quirima 139 PS Cameme 140 PS Saca 141 PS Chindingo 142 Quirima PS Mussongo 143 PS Caiuma 144 PS Sautar 145 PS Sandala 146

Summary

Municipalities Total HU

Malanje Cangandala 11 Malanje Caculama 6 Malanje Cacuso 6 Calandula 16 Quela 8 Cahombo 5 Cambundi Catembo 6 Marimba 6 Massango 8 Luquembo 6 Quirima 8 Kiwaba Nzogi 14 Kunda Dia Baze 7 Malanje 39 Total 146 Health for All Project Map of Facilities 0 Province: Uige

Municipality Health Unit # HU

HP DO UiGE 1 HM do Uige 2 CMI PEDREIRA 3 CMI BEMVINDO 4 CMI DO CEMITERIO 5 CMI CANDOMBE (NOVO) 6 PS TANGE 7 PS do Paco e Benze 8 CMI CANDOMBE (VELHO) 9 Hospital Geral do Úige 10 Uige Maternidade Municipal do Uíge 11 PS do Cavunga 12 CMI do Casseche 13 PS do Quituma 14 PS Culo 15 CMI Casseche 16 PS Papelão 17 PS SENGA 18 PS SALA DE PARTOS PERIFÉRICOS - U 19 PS Quivita 20 PS Povo Mateus 21 PS Quiongua 22 PS MBANZA QUINGUANGO 23 PS do Dambi 24 CMI Casseche 25 PS do Catambi Iº 26 PS Quilevo 27 PS Muenga 28 PS Gunza Cruz 29 PS Mutai 30 PS Catuhula 31 PS Henda 32 PS Calumbo 33 PS Quimanga 34 PS do Gundo 35 PS KISSANGA 36 PS do Sangui 37 PS Camancoco 38 PS Ninho 39 PS KIBIANGA 40 PS Quica 41 PS Cambila 42 PS DA Policia 43 PS Catumbo 44 PS do Bem Vindo 45 PS Povo Luanda 46 Centro de Saúde Municipal 47 CS Quipedro 48 PS Bela Vista Econgi 49 PS Kissengi 50 PS Mayanga 51 PS Lambo 52 PS Kissalavua 53 PS Kibalakata 54 Ambuíla PS Kaniki 55 PS Mbanza Ambuíla 56 PS Luegi 57 PS Nsembo 58 PS Muingo Ambuela 59 PS Kikayi 60 PS Kimutango 61 PS Kindaka 62 CS Municipal do Bembe 63 CS Lukunga 64 CS Vale de Loge 65 CS Nsangi 66 CS Kimaria 67 PS Nlanda 68 PS Zunga 69 PS Gole 70 PS Bonde 71 Bembe PS Mpambo Nsinga Nzambi 72 PS Mpambu Matombe 73 PS Kulu 74 PS Kiloge 75 PS Mabaia 76 PS Tôto 77 PS Kizele 78 PS Nsumba 79 PS Kiziza Kibela 80 CMI Bembe 81 CS Quipanda Bunga 82 HM Buengas 83 PS Quilulendo 84 CS Buengas Sul 85 PS Mbanza Cuimi 86 PS Quissembo 87 CS Quibengui Teca 88 Buengas PS Quituia 89 PS Quingumba 90 PS Quinanga Zulo 91 PS Lema 92 PS Quinioca 93 PS Quiteca Panzo 94 PS Quimalungo Capela 95 CS Cuilo Cambozo 96 HM Bungo 97 CMI Bungo 98 PS Gombe 99 PS Mbanza Lucunga 100 PS Quipaxe 101 PS Hinda 102 PS Kiputo 103 Bungo PS Kiukeke 104 PS Quimuluge 105 PS Quiombo 106 PS Mulubai II 107 PS Zuloe Zundo 108 PS Quitocama 109 PS Calanda 110 CS Cangola 111 CS Caiongo 112 PS Kaka Luiti 113 CS Bengo 114 PS Wemita 115 PS Marinda 116 Cangola PS Kizaúca 117 PS Kibunga Muzombo 118 PS Cawessa 119 PS Chiquita 120 PS Miguel 121 PS Gunza 122 PS Henda 123 HM Damba 124 CS Nsosso 125 PS Lemboa 126 PS Nkama Ntambu 127 HM Infantil Rainha Santa 128 PS Mbanza Damba 129 CS Nkusso Pete 130 PS Nkaindo 131 PS Kokilo 132 PS Tema 133 PS 14 de Abril 134 PS Mukungulu 135 PS Luzuanda 136 Damba PS Paza Madimba 137 PS Nzunga 138 PS Soba Nanga 139 PS Mpelo 140 PS Missão Ndemba 141 PS Kazumbi 142 PS Maxinge 143 PS Songe Baka 144 PS Nkela 145 PS Mafuangui 146 PS Yokola 147 PS Kazuangongo 148 PS Makanda 149 HM DO MAQUELA DO ZOMBO 150 PS CUXIMANA 151 PS Sacandica 152 CS KIBOCOLO 153 PS KIMBATA 154 PS CUILO FUTA 155 CS BÉU 156 CS NDOMBA TADILA 157 CS MASSEQUE 158 CS KINZAU 159 PS Nzadi 160 Maquela do PS MAVOIO 161 Zombo PS VALODIA 162 PS TAIA 163 PS LUCOLO 164 PS QUIVEMBA 165 PS NSOLE 166 PS MBANZA NSOSSO 167 PS MALELE 168 PS KIMANGUMBO 169 PS KIVEMBA 170 CMI DE MAQUELA DO ZOMBO 171 PS KINTINO 172 CS Milunga 173 CS 174 CS Massau 175 PS Kimongo 176 PS Quicoxi-ngundo 177 PS Kiluvualo 178 PS São Paulo 179 Milunga PS Quimbuanji 180 CS Macolo 181 PS Quinzevo 182 PS Tsamba-ndeleji 183 PS Rossio (Viana) 184 PS Marioco 185 PS Quissosso 186 HM Mucaba 187 PS Mussenge 188 PS Caondo 189 PS Quiniambi 190 CS Wando Mucaba 191 PS Lutando 192 PS Quipumba 193 PS Quimbala 194 Mucaba

PS Quieca 196 CMI Mucaba 197 PS Mpêlo 198 PS Quimuzembo 199 PS Mucongue 200 PS Quilumbo 201 PS Katambi 202 HM NEGAGE 203 PS ALDEIA DA MISSÃO - NEGAGE 204 CS Caua-Feira 205 CS CANGUNDO 206 CS QUITUÍA 207 PS Banza Negage 208 PS QUISSEQUE 209 CS BAMBA MATAMBA 210 CMI CAUA GRANDE 211 CS LONGE ZECA 212 CS DIMUCA 213 CS KINDANDO 214 CS QUINDINGA 215 Negage PS TERRA NOVA - NEGAGE 216 PS CANGULO 217 CM do Cahiri 218 PS CAUENDA 219 PS Canzundo 220 PS DALA - NEGAGE 221 CS CABALA 222 PS CATUMBO DO PUMBA 223 PS PUMBA 224 PS TEMA 225 PS ZANDA 226 PS CAZANGA 227 CMI NEGAGE 228 PS Vunge 229 HM Púri 230 CMI Púri 231 PS Quisseque Bembo 232 PS Caxinga 233 PS 11 de Novembro 234 CS Quifutila 235 CS Quibaba 236 Puri CS Malunda Cassumba 237 CS Quinzemba 238 PS Quimuinga 239 PS Calumbo 240 CS Quizemba 241 PS Bengo 242 CS Quisseque lulovo 243 PS Cusso lulovo 244 HM Quimbele 245 CS Alto zaza 246 PS Kindalulu 247 CS Icoca 248 PS Bula calonge 249 PS Quimbanje 250 Quimbele CS Kibocolo 251 PS Quimefoto 252 PS Bula Malungo 253 PS Cassanda 254 CS Kuango 255 PS Icanga 256 PS Canambua 257 CS QUITEXE 258 PS VISTA ALEGRE 259 CS ALDEIA VISOSA 260 CS de Cambamba 261 PS Cambeje 262 PS Quitoque 263 PS ZALALA 264 PS Quimassabi 265 Quitexe PS Catulo 266 PS Mufeque 267 PS Quihinga 268 PS Gama 269 PS Quipossa 270 PS Cólua 271 PS Cuale 272 PS Cahunda 273 HM SANZA POMBO 274 CS WAMBA 275 CS SANZA POMBO 276 CMI SANZA POMBO 277 CS CUILO POMBO 278 CS ALFÂNDEGA 279 PS QUISSALA 280 PS MONGO VUNDA 281

PS QUITUNGO 282 Sanza Pombo PS QUINGOMBO 283 PS QUIANGA 284 PS QUIZULO 285 PS QUIFUAXE 286 PS PANDA MENANGA 287 PS QUIFUTILA CABENGA 288 PS QUICOXE BUNGA 289 PS MAQUILA 290 PS QUICOXE MUENGA 291 PS BANZA LUANDA 292 HM Songo 293 CS Quivuenga 294 PS Zulumongo 295 PS Bau II 296 Banza Luanda II 297 PS Kicuva 298 PS Kimalalo 299 PS Mayengo 300 PS Denga 301 PS Kilemba 302 PS BANZA LUANDA 303 Songo PS Demba 304 PS Tenda 305 PS Kinzambi 306 PS Kavunga 307 PS Kimacuma 308 PS Kitala 309 PS Dia dia 310 PS Matenda 311 PS Pombo 312 PS TEMA 313 PS Kimussungo 314

Summary

Municipalities Total HU

Uíge 46 Ambuíla 16 Bembe 19 Buengas 15 Bungo 14 Cangola 13 Damba 26 Maquela do Zombo 23 Milunga 14 Mucaba 15 Negage 27 Puri 15 Quimbele 13 Quitexe 16 Sanza Pombo 19 Songo 22 Total 313 Health for All Project Map of Facilities Province: Zaire

Municipality Health Unit # HU PS Terra Nova 1 HM Cuimba 2 CS Luvaka 3 CS Buela 4 PS Luangu 5 PS Ngombe ya Ngombe 6 PS Diádia 7 CS Kikongo 8 Kuimba PS Ngódia 9 PS Kinkuvila 10 PS Nsambo 11 PS Tavudi 12 PS Mpangala 13 PS Lunguezi 14 CMI Cuimba 15 PS Belo Horizonte 16 PS Kiowa Madimba 17 PS Ngoma 18 PS Sumpi 19 HM Mbanza Congo 20 HP Maria Eugénia Neto 21 PS 11 de Novembro 22 CM Infantil 23 CS Luvo 24 CS Kianganga 25 CS Nsumpi 26 CS Nkoko 27 CS Nkiende 28 PS Martins Kiditu 29 CS Kaluca 30 PS Mbanza Mazina 31 PS Bela Vista 32 Mbanza Congo PS Mbumbuzi 33 PS Kamba 34 PS Ave Maria 35 CS Nkalambata 36 CS Mbanza Mbamba 37 PS Kuna Paza 38 PS Dobo 39 PS 4 de Fevereiro 40 PS Nkiende II 41 PS Bela Vista 42 PS Sangi 43 CS Madimba 44

PS Wolongo 45 PS Nkoko (Madimba) 46 PS Kaluka Ave Maria 47 PS Kiowa (Sede) 48 PS Lulemba 49 PS Lusemo 50 PS Nsanzi 51 HM Noqui 52 CS Menkonzi 53 PS Mpala 54 Noqui CS Lufico 55 PS Balu 56 CS Manoki 57 PS 42ª B. Militar FAA 58 PS Benfica 59 Maternidade Noqui 60 PS Kingombo 61 PS Santa 62 PS Monga 63 PS Mafinda 64 HM Tomboco 65 CS Kinzau 66 PS Kiowa 67 PS Kiaya 68 PS Kinsimba 69 tomboco PS Kacongo 70 PS Kingombo 71 CMI Agostinho Neto 72 PS Mvuma 73 PS Nkembo 74 PS Yenga 75 PS Kenguele 76 PS Casa de Telha 77 PS Mukula 78 PS Lumbi 79 CS Mambo Mampa 80 CS Berço IEA 81 Centro Materno Infantil 82 PS Divino 83 HM Nzeto 84 CS Kindege 85 PS Kimakuku 86 CS Musserra 87 PS Mboca 88 Nzetu CS 11 de Novembro 89 PS Seke 90 PS Nsanda 91 CS Kinsimba 92 PS Diádia 93 PS Lué 94 CS Kibala Mbuezu 95 PS Loge Pequeno 96 PS Kinsukulo 97 CS Mongo e Tombe 98 HM Soyo 99 PS Binga 100 PS Bungu 101 PS Nenga 102 PS Chinde 103 PS Kimvemba Nzinga 104 PS Lunuangu 105 PS Wondo Tari 106 CS Mongo Soyo 107 CS 1º de Maio 108 CS Kukala Kiacu 109 CS Sumba 110 CS Santo Anselmo 111 CMI Mpinda 112 CS General Ndozi 113 Soyo PS Tombe 114 CS Quimpondo 115 PS Kitona 116 PS Kungu 117 PS Lulombe 118 CS Kelo 119 Instituto Médio Politécnico do Soyo 120 PS Pangala 121 PS Lukata 122 PS Mangue Grande 123 CS Kelo 124 CS Santana 125 PS KIifuma 126 PS Mbinga 127 CS Pedra do Feitiço 128 PS Mpuelo 129

Summary

Municipalities Total HU

Kuimba 16 Mbanza Congo 32 Noqui 12 Tomboco 19 Nzetu 19 Soyo 31 Total 129