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 Luanda GRA Government of the Republic of Angola 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 Huambo 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. Cabinda 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 Luanda province. 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 Moxico, 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;