U.S. PRESIDENT'S MALARIA INITIATIVE
StopPalu+ President’s Malaria Initiative (PMI) Program Component Quarterly Report (Quarter 1, FY 2019)
January 30, 2019 This publication was produced for review by the United States Agency for International Development. It was prepared by RTI International. StopPalu+ President’s Malaria Initiative (PMI) Program Component Quarterly Report
October 1–December 31, 2018 Cooperative Agreement No. 72067518CA000015
Prepared for Dr. Lamine Bangoura, MD Agreement Officer’s Representative (AOR) USAID/Guinea Telephone: +224.657.10.4433 Email: [email protected]
Submitted by Dr. Aissata Fofana COP StopPalu+ RTI International 3040 East Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194
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Table of Contents Page
List of Figures ...... iv
List of Tables ...... v
Abbreviations ...... vi
1 EXECUTIVE SUMMARY ...... 1
2 INTRODUCTION ...... 3 2.1 Background ...... 3 2.1.1 Malaria context in Guinea ...... 3 2.2 Program Description ...... 4 2.2.1 Project goal and objectives ...... 4 2.2.2 Partners...... 4 2.2.3 StopPalu+ results framework ...... 5
3 ACTIVITIES BY RESULT (IR) ...... 6 3.1 IR 1: Increased Use of LLINs by the Population ...... 6 3.1.1 Sub-IR 1.1: Increased knowledge and skills of health care providers and community leaders on malaria prevention and the effectiveness, correct use, and care of LLINs ...... 6 3.1.2 Sub-IR 1.2: Increase ownership of effective LLINs through continuous and mass distribution...... 12 3.1.3 Sub-IR 1.3: Increased awareness of family members of the need for vulnerable populations to be protected from malaria ...... 29 3.2 IR 2: Increased Use of IPTp During Antenatal Visits ...... 31 3.2.1 Sub-IR 2.1: Improved technical capacity and interpersonal skills of providers ...... 31 3.2.2 Sub-IR 2.2: Increased knowledge of women and other family members of the benefits of ANC visits, including IPTp ...... 33 3.2.3 Sub-IR 2.3: Alternative approaches to improved access to IPTp services rolled out ...... 33 3.2.4 Sub-IR 2.4: Increased availability of SP and ancillary supplies ...... 34 3.3 IR 3: Increased Prompt Care-Seeking and Treatment ...... 35 3.3.1 Sub-IR 3.1: Improved technical and interpersonal skills of providers in malaria diagnosis and care ...... 35 3.3.2 Sub-IR 3.2: Increased availability of quality diagnostic tests and treatment at facilities and community level ...... 46 3.3.3 Sub-IR 3.3: Increased knowledge and awareness by communities and family members of seriousness of childhood illnesses, key signs, and symptoms, and when treatment is ineffective ...... 48 3.4 IR 4: Increased Full Dose of SMC Delivered in a Timely Manner ...... 49
StopPalu+—Quarterly Report—October to December 2018 iii 3.4.1 Sub-IR 4.1: Increased awareness by community and family members of the need for infants and children U5 to be protected from malaria 49 3.4.2 Sub-IR 4.2: Increased availability of SMC (SP+AQ) and commodities for continuous and mass distribution during high-transmission season in targeted districts ...... 50 3.4.3 Sub-IR 4.3: Improved providers’ (health facility and CHW) technical and interpersonal skills in effective administration of SMC ...... 52 3.4.4 Sub-IR Transversal 1. Increased Community Involvement in and Support for Malaria Prevention and Care...... 54 3.4.5 Sub-IR Transversal 2: Improved Capacity of NMCP (Central, Regional, District) to Manage, Implement, and Monitor Prevention, Care, and Treatment Activities ...... 56
4 PROJECT MANAGEMENT ACTIVITIES ...... 57 4.1 Project Deliverables ...... 57
5 OTHER ACTIVITIES ...... 59
6 MAIN ACTIVITIES FOR THE NEXT QUARTER ...... 61
Annex 1: Performance Report for Q1 FY 2019 (Oct–Dec 2018) ...... 62
List of Figures Figure 1: Malaria endemicity in Guinea ...... 3 Figure 2: Results framework ...... 5 Figure 3: % of households with at least one LLIN (Fria) ...... 20 Figure 4: % of LLINs in good condition (Fria) ...... 20 Figure 5: % of sleeping spaces with LLINs (Fria) ...... 20 Figure 6: % of people using LLINs (under 5 and over 5) (Fria) ...... 21 Figure 7: % of households with at least one LLIN (Koundara) ...... 21 Figure 8: % of LLINs used per health center (Koundara) ...... 22 Figure 9: % of households with at least one LLIN / % of sleeping spaces covered by an LLIN (Dubréka) ...... 24 Figure 10: % of people sleeping under an LLIN (Falessadé, Dubreka) ...... 24 Figure 11: % of households with at least one LLIN / % of sleeping spaces with an LLIN in Bokariah (Forécariah) ...... 25 Figure 12: % of households with at least one LLIN / % of sleeping spaces with an LLIN in Allassoyah (Forécariah) ...... 25 Figure 13: % of LLIN use in households in Bokaria (Forécariah) ...... 26 Figure 14: % of LLIN use in households in Allassoyah (Forécariah) ...... 26 Figure 15: % of households with at least one LLIN / % of LLINs hung / % of LLINs in good condition (Labé)...... 28 Figure 16: % of LLINs use in the households (Labé) ...... 29 Figure 17: Performance of participants on the microscopy/diagnostic pre- and post-tests ...... 36
iv StopPalu+—Quarterly Report—October to December 2018 Figure 18: Changes in lab technicians’ performance (detection) ...... 38 Figure 19: Changes in lab technicians’ performance (species identification) ...... 39 Figure 20: Changes in lab technicians’ performance (quantification) ...... 39
List of Tables Table 1: Details of home visits conducted by CHWs during Quarter 1 (October– December 2018) ...... 6 Table 2: Number of group discussions facilitated by project-trained field agents; number of people reached ...... 7 Table 3: Summary of the CAG members trained on their roles and responsibilities ...... 10 Table 4: Number of CAG members trained on development of an action plan ...... 11 Table 5: Staff trained on micro-planning for the LLIN distribution campaign ...... 17 Table 6: Results of the micro planning in the 14 prefectures ...... 18 Table 7: Number of ANC staff trained ...... 31 Table 8: Summary of outreach activities in various health centers ...... 34 Table 9: Details of community case management conducted by CHWs during the reporting period (October–December 2018) ...... 47 Table 10: Results of the fourth round of FY 2018 SMC campaign in PMI zone ...... 51 Table 11: Summary of NGO training ...... 58
StopPalu+—Quarterly Report—October to December 2018 v
Abbreviations
ACT artemisinin-based combination therapy ANC antenatal care AOR Agreement Officer’s Representative APIC Association pour la Promotion des Initiatives Communautaires BCC behavior change communication CAM Club des Amis du Monde CBO community-based organization CDC Centers for Disease Control and Prevention CENAFOD Centre Africain de Formation pour le Développement CHW community health worker CJMAD Comité des Jeunes Mon Avenir D’abord CSH Comité de Santé et d’Hygiène (Health and Hygiene Committee) CSO civil society organization DPS Direction Préfectorale de la Santé (Prefectural Health Directorate) DQA data quality analysis DRS Direction Régionale de la Santé (Regional Health Directorate) EPI Expanded Program on Immunization FY fiscal year INAASPO Initiatives et Actions pour l’Amélioration de la Santé des Populations IPC interpersonal communication IPTp intermittent preventive treatment of malaria in pregnancy IR intermediate result KAP knowledge, attitudes, and practices LLIN long-lasting insecticide-treated net M&E monitoring and evaluation MCDI Medical Care Development International MEL monitoring, evaluation, and learning MICS Multiple Indicator Cluster Survey MOH Ministry of Health NCC National Coordination Committee NGO nongovernmental organization NMCP National Malaria Control Program NMSP National Malaria Strategic Plan PMI President’s Malaria Initiative RDT rapid diagnostic test SBCC social and behavior change communication SGPD Solidarité Guinéenne pour le Développement SMC seasonal malaria chemoprevention SOW statement of work
vi StopPalu+—Quarterly Report—October to December 2018 SP sulfadoxine/pyrimethamine SP+AQ sulfadoxine/pyrimethamine plus amodiaquine TWG technical working group USAID United States Agency for International Development WHO World Health Organization
StopPalu+—Quarterly Report—October to December 2018 vii
1 EXECUTIVE SUMMARY The President’s Malaria Initiative (PMI) Program Component (StopPalu+) is a five-year project (December 2017–December 2022) with the goal of assisting the Government of Guinea in reducing malaria-related morbidity and mortality by 75% compared with 2016 levels. This will be achieved through multiple interventions in prevention, diagnosis and treatment, and capacity building of the National Malaria Control Program (NMCP) while increasing community involvement in and support for malaria prevention and care. RTI International is implementing StopPalu+, supported by sub-partners Jhpiego, Centre Africain de Formation pour le Développement (CENAFOD), and Medical Care Development International (MCDI). In the past five years, Guinea has made tremendous progress in malaria control, substantially reducing malaria prevalence in children under 5, annual malaria incidence, and in-patient deaths. Despite this progress, malaria remains the most burdensome communicable disease in Guinea. The entire population of 12.1 million remains at risk, with approximately 1 million cases reported in 2016, accounting for 31% of outpatient visits. The Multiple Indicator Cluster Survey (MICS) showed that malaria prevalence in Guinea is quite heterogeneous, with prevalence ranging from 1.9% in Conakry to 30.2% in N’Zérékoré. The goal of the National Malaria Strategic Plan (NMSP) 2017–2022 is to reduce malaria morbidity and mortality by 75% by 2022. Because of funding delays, the project, in agreement with the United States Agency for International Development (USAID), reduced the number and spread of some activities, focusing on essential priorities during the period covered by this quarterly report, October 1– December 31, 2018. These priority activities included the preparatory activities for the 2019 long-lasting insecticidal net (LLIN) mass distribution campaign; training for new antenatal care (ANC) staff, health providers, and community health workers (CHWs) who were not trained during fiscal year (FY) 2018; and implementation of the fourth round of the 2018 seasonal malaria chemoprevention (SMC) campaign. To further increase household LLIN ownership, StopPalu+ supported the NMCP in implementing the LLIN mass distribution campaign. As a first step for campaign preparation, the project worked with the Prefectural Health Directorates (DPSs) to develop micro-plans for the 2019 LLIN mass campaign in the 14 prefectures supported by the project. In addition, the project worked with the campaign’s National Coordination Committee to develop and validate the monitoring and evaluation tools and the social and behavior change communication (SBCC) materials for the campaign. To increase the use of intermittent preventive therapy during pregnancy (IPTp) during ANC visits, StopPalu+ worked with the NMCP to train 178 new ANC staff members in the regions of Boké and Labé on preventing malaria during pregnancy. To improve the quality of services at both health facility and community levels, the project team worked with the DPSs to train 153 new health providers and 70 new CHWs in the regions of Conakry and Forécariah on malaria case management, including the use of rapid diagnosis tests (RDTs). StopPalu+ also trained 20 lab technicians from 15 health facilities in Conakry on malaria diagnosis (microscopy and RDT use). In addition, the project conducted on-site trainings for facilities that were identified during supervision visits as needing additional support. The project teams conducted supervision visits at both the facility and community levels to assess the quality of services provided and also to reinforce competencies where needed. Another large part of StopPalu+’s efforts focused on implementing the fourth round of the SMC campaign in eight districts to increase malaria prevention among children ages 3–59
StopPalu+—Quarterly Report—October to December 2018 1 months. During this round, the project treated 355,175 children (99% of targeted children between ages 3 months and 59 months). To increase community involvement in malaria control activities, StopPalu+ supported the establishment of 37 community action groups (CAGs) in the prefectures of Boffa, Dubréka, and Mali and the communes of Dixinn and Kaloum. The project trained a total of 392 members of these groups on their roles and responsibilities. StopPalu+ also trained 174 imams from Conakry and Boffa on key messages dealing with malaria prevention and treatment. The trained imams disseminated these messages in mosques and during religious ceremonies. (These key messages were translated into Arabic for ease of use.) The project continued to support monthly monitoring meetings at health centers and DPSs, followed by data quality analysis (DQA) activities in the facilities identified during monthly meetings as having possible data issues. The project also supported monthly meetings of the various technical working groups (TWGs) as well as the National Coordination Committee overseeing the 2019 LLIN mass distribution campaign. The main results for StopPalu+’s first quarter of performance in FY 2019 are the following: • 74 regional and prefectural trainers trained on micro-planning for the LLIN mass distribution campaign • 501 agents (health facility workers and members of Health and Hygiene Committees [CSHs] and nongovernmental organizations [NGOs]) trained on micro-planning • 14 micro-plans developed in the prefectures covered by the project • 69,892 LLINs distributed at health facilities • 178 ANC staff members trained on prevention and care for malaria in pregnancy, including IPTp • 20 lab technicians trained on malaria diagnosis (microscopy and RDT use) • 153 health providers and 70 new CHWs trained on malaria case management • 54,854 people tested for malaria by CHWs • 34,243 people treated for malaria by CHWs • 129,573 home visits conducted by CHWs • The fourth round of the 2018 SMC campaign conducted, with 355,175 children receiving treatment • 392 CAG members trained on their roles and responsibilities • 148 CAGs trained on action plan development and monitoring • 174 imams trained on key malaria control messages • 119 NGO field agents and 27 NGO managers trained on how to implement community-level malaria prevention and control activities • 465 health centers’ monthly monitoring meetings supported • 57 DPS monthly monitoring meetings supported • An epidemiology and entomology investigation conducted in Conakry and Dubréka
2 StopPalu+—Quarterly Report—October to December 2018 2 INTRODUCTION
2.1 Background
2.1.1 Malaria context in Guinea Guinea has made tremendous progress in malaria control over the past five years, substantially reducing malaria prevalence in children under 5, annual malaria incidence, and in-patient deaths. Despite this progress, malaria remains the most burdensome communicable disease in Guinea. The entire population of 12.1 million remains at risk, with approximately 1 million cases reported in 2016, accounting for 31% of outpatient visits. The Multiple Indicator Cluster Survey (MICS) showed that malaria Figure 1: Malaria endemicity in Guinea prevalence in Guinea is quite heterogeneous, with prevalence ranging from 1.9% in Conakry to 30.2% in N’Zérékoré (Figure 1). The major malaria vectors in the country are members of the Anopheles gambiae complex, including An. gambiae s.s., An. arabienesis, and An. melas (on the coast), as well as members of the An. funestus complex. The goal of the National Malaria Strategic Plan (NMSP) 2018–2022 is to reduce malaria morbidity and mortality by 75%. NMSP implementation has benefited from the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has contributed approximately $50 million, and the President’s Malaria Initiative (PMI), which provides $12 million per year.
StopPalu+—Quarterly Report—October to December 2018 3 2.2 Program Description
2.2.1 Project goal and objectives The goal of the StopPalu+ project is to assist the Government of Guinea in its efforts to reduce malaria-related morbidity and mortality by 75% compared with 2016 levels. The project’s primary results include the following: 1. Increased use of long-lasting insecticidal nets (LLINs) by the population 2. Increased use of intermittent preventive treatment of malaria in pregnancy (IPTp) during antenatal care (ANC) visits 3. Increased prompt care-seeking and treatment 4. Increased numbers of children receiving the full dose of seasonal malaria chemoprevention (SMC) delivered in a timely manner 5. Increased community involvement in and support for malaria prevention and care 6. Improved capacity of the National Malaria Control Program (NMCP) (central, regional, and district levels) to manage, implement, and monitor prevention, care, and treatment activities For each result area, our operational strategy integrates and links the inputs, processes, and systems required for strong results.
2.2.2 Partners RTI International’s partners for StopPalu+ include the following: • Jhpiego: Jhpiego works to improve the use of IPTp during ANC visits. • Medical Care Development International (MCDI): MCDI provides StopPalu+ with evidence-based and context-appropriate approaches to consensus-based diagnostic training and capacity building, monitoring and evaluation (M&E) of laboratory practices and collaborative quality improvement, and country-owned solutions for enhanced performance. • Centre Africain de Formation pour le Développement (CENAFOD): CENAFOD works to increase community involvement in and support for malaria prevention and care. • Local partners include five Guinean nongovernmental organizations (NGOs) with demonstrated PMI program results in behavior change communication (BCC), social mobilization, and support to community health workers (CHWs): − Association pour la Promotion des Initiatives Communautaires (APIC) − Club des Amis du Monde (CAM) − Comité des Jeunes Mon Avenir D’abord (CJMAD) − Initiatives et Actions pour l’Amélioration de la Santé des Populations (INAASPO) − Solidarité Guinéenne pour le Développement (SGPD)
4 StopPalu+—Quarterly Report—October to December 2018 2.2.3 StopPalu+ results framework The project’s main objective as well as the four main results (called Intermediate Results [IRs]) and the two Transversal Sub-IRs are shown in Figure 2. The sections that follow describe the activities carried out for each of these results, with a separate section on project management.
Figure 2: Results framework
StopPalu+—Quarterly Report—October to December 2018 5
3 ACTIVITIES BY RESULT (IR)
3.1 IR 1: Increased Use of LLINs by the Population
3.1.1 Sub-IR 1.1: Increased knowledge and skills of health care providers and community leaders on malaria prevention and the effectiveness, correct use, and care of LLINs During Quarter 1, FY 2019, StopPalu+ implemented the following activities: Activity 1.1.1 Develop and implement a social and behavior change communication (SBCC) campaign for LLIN uptake, proper use, and care StopPalu+, through its NGO partners, supported CHWs in conducting door-to-door visits to monitor the regular and correct use of LLINs and, if needed, hang LLINs and disseminate key messages on IPTp and malaria case management. The project-supported CHWs conducted 129,573 home visits and reached 639,993 people, including 362,934 women. The details of these activities are presented in Table 1.
Table 1: Details of home visits conducted by CHWs during Quarter 1 (October– December 2018) Number of home Number of people reached Prefecture visits conducted Men Women Total Boffa 6,900 15,829 21,404 37,233 Boké 9,068 28,339 38,355 66,694 Coyah 6,486 14,649 19,208 33,857 Conakry 1,440 3,194 3,960 7,154 Dinguiraye 7,032 19,670 26,474 46,144 Dubréka 9,794 20,504 24,506 45,010 Forécariah 10,729 23,907 28,353 52,260 Fria 4,954 11,713 14,564 26,277 Gaoual 6,785 15,006 17,709 32,715 Koubia 7,942 20,598 22,811 43,409 Koundara 5,556 9,779 13,409 23,188 Labé 19,092 32,034 45,570 77,604 Lélouma 10,671 17,391 26,756 44,147 Mali 12,756 26,426 34,822 61,248 Tougué 10,368 18,020 25,033 43,053 Total 129,573 277,059 362,934 639,993
Discussion groups facilitated by the project’s NGO partners To increase knowledge about malaria and promote the practice of healthy behaviors related to malaria prevention and treatment, the project’s 112 field agents conducted 2,734 group discussions and reached 49,547 people, including 29,437 women, in the 14 prefectures and 5 communes covered by the project (see Table 2 for details of the discussions in prefectures). These discussions took place in health centers and public places such as soccer fields, marketplaces, hair salons, and sewing salons. During the past quarter, the messages focused on promoting regular and correct use of LLINs and early care-seeking, especially for pregnant women and children under 5.
6 StopPalu+—Quarterly Report—October to December 2018 Table 2: Number of group discussions facilitated by project-trained field agents; number of people reached Number of group Number of people reached Prefectures discussions Men Women Total Boffa 134 1,220 1,292 2,512 Boké 295 2,503 3,275 5,778 Conakry 988 6,595 10,760 17,355 Coyah 61 316 585 901 Dinguiraye 112 847 1,217 2,064 Dubréka 119 504 1,039 1,543 Forécariah 130 915 1,178 2,093 Fria 112 636 1,102 1,738 Gaoual 97 717 768 1,485 Koundara 101 1,219 1,374 2,593 Koubia 72 759 1,270 2,029 Labé 130 1,216 2,019 3,235 Lélouma 146 890 1,271 2,161 Mali 165 1,087 1,362 2,449 Tougué 72 686 925 1,611 Total 2,734 20,110 29,437 4,9547
The project also worked with the Orange phone company to disseminate text messages (SMS) to promote regular and correct use of LLINs. During Quarter 1, FY 2019, two different SMS texts were sent to Orange customers in the 19 prefectures/communes covered by the project. Activity 1.1.2 Update communication materials for all aspects of LLIN use, care, and maintenance After analyzing the results of the survey on knowledge, attitudes, and practices (KAP), the project organized focus groups to deepen StopPalu+’s understanding of the target groups’ perceptions, attitudes, and beliefs that either hinder or foster malaria prevention and care behavior. The focus groups were held in the regions of Kindia, Boké, and Labé. In each of the regions, the prefecture that had the lowest LLIN utilization rate in the KAP survey was selected. The project conducted focus groups in the health centers that had the highest malaria incidence rates during the July–September 2018 quarter (an urban health center and a rural health center). The focus groups targeted the following categories: CHWs, health center providers, LLIN users, and people who responded on the KAP survey that they did not use LLINs. Each group was composed of eight people. In each district, four focus groups were held, making a total of 96 participants. The text box below highlights some of the findings from the focus group discussions.
Focus group with people in Bintimodia who do not use Focus group with CHWs from the prefecture of Boké LLINs
StopPalu+—Quarterly Report—October to December 2018 7
Focus group findings on perceptions, attitudes, and beliefs regarding malaria care and prevention • The community trivializes malaria because it has existed for centuries and its treatment is accessible throughout the country. • The community does not know the consequences related to malaria such as a sick child falling behind in school work or a head of household losing time (and money) at work. • Some people said that they use LLINs during a specific season because for them, mosquitoes are only active during that season. • Some people said that if they sleep in air conditioning or under a fan, mosquitoes cannot bite them. • Some said they no longer have LLINs because the nets have been damaged since 2016. • Others said sleeping under LLINs chokes them and they feel like they are in a coffin. • Most people who do not use LLINs said the nets are too small for their beds or they prefer conical LLINs rather than rectangular ones. • One participant told us that in Fouta, there are no mosquitoes because it is clean. • A participant in Boké told us that she knows people who have been sick with malaria, but nobody has died from malaria. • During the routine distribution of LLINs in health centers, health workers do not place special emphasis on the dangers and consequences of malaria. • The awareness-raising sessions are conducted in 15-minute blocks of time in the health centers’ reception areas during busy days, and the topics discussed cover more than just malaria, so there is not enough time for patients to ask questions they may have about the disease.
Based on the results of the KAP survey and findings from the focus groups, StopPalu+ recruited a national consultant to help review and develop materials for facilities, CHWs, civil society organizations (CSOs), and community-based organizations (CBOs). The project is planning to validate these tools with the NMPC SBCC TWG during the next quarter. After the validation, the project will pretest the materials, then produce and disseminate them. The resources will be designed for use during CHW home visits and at facilities during routine LLIN distribution and as part of ANC and immunization visits. Also, during Quarter 1, the Materials revised based on KAP project produced the 2019 calendar with key survey/focus group results messages on LLIN use, emphasizing the • Story boards importance of using LLINs, regardless of the • Posters place of residence, the season, the type of • Radio and television spots sleeping arrangement, and the use of an air conditioner or fan. These calendars are being disseminated to health facilities and CHWs for use and display during communication activities. Activity 1.1.3 Review and revise training manuals, materials, and job aids Based on the formative research results, the CHW focus groups, and health provider key informant interviews, StopPalu+ worked with the NMCP and the consultant to revise manuals and job aids for providers, CHWs, and community leaders by incorporating SBCC methods such as counseling on malaria prevention during patient consultations and new techniques on how to improve the quality of home visits conducted by CHWs to ensure regular and correct use of LLINs as a means to protect oneself from malaria. During Quarter 2, FY 2019, StopPalu+ will use these new materials to train a pool of 20 national SBCC trainers who already work with other health programs.
8 StopPalu+—Quarterly Report—October to December 2018 Activity 1.1.4: Enhance provider training and supervision During Quarter 1, the project team trained 331 health providers and 70 CHWs on malaria prevention, diagnosis, and treatment. Training included a session on LLIN use and care, with job aids for demonstrations such as how to hang up, properly use, and store an LLIN. To improve supervision after training, StopPalu+ worked with district health teams and health facility heads to identify a Ministry of Health (MOH) staff member to serve as a quality service champion in each facility (and in the hospitals, one champion per unit, such as the maternity ward). This champion will be responsible for internal supervision and ensuring adherence to protocols. Activity 1.1.5 Train community action groups (CAGs) During Quarter 1, the project team worked with the DPSs to train the members of the 37 new CAGs as described below: Training CAGs on their roles and responsibilities Once all 37 health centers had selected their CAGs, the project organized a two-day training for the CAG members. Objective of the initial CAG training Build the capacity of CAG members to understand their roles and responsibilities so that they fully participate in mobilizing communities for improving their health in general and particularly in the fight against malaria.
CAG training topics (roles and responsibilities) Four sessions were developed for the training: Session 1: Definitions of key concepts During this session, participants discussed the main health issues of their communities. The facilitators explained the services provided at the community level. The facilitators shared information on the most frequent diseases in their community such as malaria, diarrhea, and acute respiratory diseases, etc. Session 2: Purpose, principles, and foundations; criteria/qualities of members; composition, roles/responsibilities, organization, and operation of the CAG Session 3: General information about malaria This session, facilitated by the heads of health centers, explained the cause of malaria, the signs, the key prevention methods, the difference between simple and severe cases of malaria, and the treatment. Facilitators emphasized the fact that malaria treatment is free, describing all malaria prevention and treatment services that are available at both the health facilities and at the community level. They also emphasized the importance of a clean environment as a means to prevent malaria. Session 4: General information about interpersonal communication (IPC) techniques To improve the participants’ communication skills, the facilitators shared some basic information about what good communication is, how to keep you audience’s attention, and how to use communication materials (story boards, posters, etc.). At the end of this session, participants demonstrated how to conduct a home visit, how to conduct group discussions, etc. The role-play allowed participants to practice the techniques and use the information they had learned during the sessions. The demonstrations consolidated the participants' understanding of the CAG’s roles and responsibilities, the facilitation techniques, and the interaction between the CAGs and the communities as well as between the CAGs and the deconcentrated and decentralized services.
In total, 392 CAG members were trained (Table 3). During the last day of the trainings, each CAG selected its president and developed its monthly action plan.
StopPalu+—Quarterly Report—October to December 2018 9 Table 3: Summary of the CAG members trained on their roles and responsibilities CAG members Prefectures Men Women Total Boffa 61 18 79 Conakry 46 18 64 Dubréka 75 13 88 Forécariah 26 4 30 Mali 103 28 131 Total 311 81 392
At the end of the training, the participants made the following recommendations: • Continue the process of building the capacity of CAG members on all aspects related to the fight against malaria. • Increase the number of women in the CAGs. • Support and monitor implementation of the CAG action plans. • Reinforce the information shared with communities through public viewings of the project video on the importance of regular and correct use of nets, starring the comedy group “Kabakoudou and Grand Devise.” • Set up community mobilization teams in the prefectures.
Participants during the CAG training in Dubréka Participants during the CAG training in Boké
Training CAGs on how to develop and monitor an action plan During the first year that CAGs were established, the project team noticed that most of the CAGs were not familiar with developing and monitoring a clear action plan. They needed support from the NGOs to be able to develop these plans. To address this situation and make the CAGs independent, the project planned to train CAG members on how to develop a concrete action plan. During Quarter 1, FY 2019, the project organized seven workshops for the eight prefectures and communes where CAGs have been established. (In Conakry, one workshop was held for the CAGs from two communes—Dixinn and Kaloum.) Objective of the follow-up CAG training The objective of the workshops was to equip CAG members with the techniques necessary to facilitate the planning, implementation, and monitoring of concrete activities that strongly influence communities’ behaviors that can help reduce the prevalence of malaria.
10 StopPalu+—Quarterly Report—October to December 2018 CAG training topics (developing/monitoring an action plan) During the two days of training, the following topics were discussed: Definition of an action plan: The search for the definition of the action plan allowed the participants to understand that several definitions can be found. The key is to find the key words: "An action plan is an internal document of structures. It defines a strategy to apply to achieve a desired result.” Importance of an action plan: Through role-play, featuring a CAG that works with an action plan and another with no action plan, the CAG members developed an understanding of the importance of an action plan, which serves as a structure to better identify effective activities, develop the means for good coordination, and ensure that activities are followed up in a meaningful manner. Stages of development of an action plan: This content allowed participants to understand that in a planning process, taking into account the opinion and the participation of the communities is very important. CAG members should engage with the community to identify, classify, and prioritize issues; identify solutions; and identify activities and timeframes. Elements of an action plan: During this session, CAG members understood that in a work plan, it is important to have a list of activities, the description of the activities, the period (time frame), the person responsible for the activity, and the budget. These elements are not the only ones, but they are the key. Mechanisms for managing activities: This content allowed participants to better understand how to ensure the proper management of action plans. This management must adhere to the following guidelines: • The establishment of a management unit • The definition of the attributions of the unit • The identification of the periodicity of meetings to follow up the management of activities • The organization of meetings for the review of the action plan • Implementation of the recommendations Development of an action plan: Through practice, this content has allowed each CAG to develop a draft action plan to be submitted to other members for validation.
In total, 148 CAG members were trained (Table 4).
Table 4: Number of CAG members trained on development of an action plan Numbers of CAG members Prefectures Men Women Total Boffa 18 4 22 Boké 30 2 32 Conakry 13 1 14 Dubréka 18 0 18 Labé 27 9 36 Mali 20 6 26 Total 126 22 148
At the end of the training, the participants made the following recommendations: • Continue the process of building the capacity of CAG members on all aspects related to the health of the communities. • Follow up and mentor the CAGs in the implementation of their activities. • Establish community mobilization teams at the prefectural level to support the CAGs.
StopPalu+—Quarterly Report—October to December 2018 11
Participant at the CAG training presenting the result Participants working on identifying activities and of group work prioritizing them
At the end of the trainings, some participants offered the following testimony:
“The action plan is a heavy responsibility [and] tool. We must be reassured that the community is with us in its design, if we want them to participate and support its implementation. " Religious leader
3.1.2 Sub-IR 1.2: Increase ownership of effective LLINs through continuous and mass distribution During Quarter 1, FY 2019, to further increase household LLIN ownership, StopPalu+ supported the NMCP in implementing the LLIN mass distribution campaign and continued to support routine and continuous LLIN distribution. StopPalu+ implemented the following activities. Activity 1.2.1 Support FY 2019 LLIN mass distribution campaigns StopPalu+ supported the MOH/NMCP to develop training materials, micro-plans, and data collection tools as described below: Support coordination activities at the central, regional, and prefectural levels, as well as support the national mass distribution coordination committee One of the difficulties that this campaign has faced is the lack of coordination that has delayed important decision-making concerning, among other things, the campaign tools and also the strategy. After the establishment of the National Coordination Committee (NCC) in September 2018, the first meeting took place on December 6, 2018. During this meeting, the NMCP shared the preliminary activities of the campaign, namely the finalization of the implementation plan and the budget. The NMCP coordinator also presented the draft schedule and the topics around which consensus was not reached. These include (1) production of distribution vouchers with or without a hologram, (2) distribution of LLINs per sleeping space (as usual) versus one net for every two people, and (3) the importance of NCC functionality. After listening to the participants, the Secretary-General, who had been appointed as chair of the NCC, said that he understood that there are problems in organizing the campaign. He said, however, that he has a busy schedule, so he is not available to coordinate this
12 StopPalu+—Quarterly Report—October to December 2018 campaign. He appointed the senior advisor to the Minister and the National Director of Major Endemics and Disease Control to coordinate the campaign. For this reason, during Quarter 1, StopPalu+ participated in two NCC meetings held on December 6 and 27. During these meetings, the following items were agreed upon: • The first draft of the timeframe was approved. The NCC agreed that the campaign will be conducted in three phases: the first phase will involve the zone where the Against Malaria Foundation (AMF) is working in four regions, the second zone in three regions, and the third phase will involve the region of Conakry. The gap in LLIN distribution for Conakry will be covered by the Government of Guinea, but there is no confirmation on the dates yet. • The NCC also approved the NMCP proposition to use two types of distribution vouchers in country. One for the Global Funds zone with holograms and the second in the PMI zone without holograms. It is important to note that in the NMCP campaign budget (shared and approved), there was no mention of holograms. The cost of the vouchers with the holograms is three times more expensive than the vouchers without holograms. Guinea is in its third nationwide LLIN mass distribution campaign; holograms were not used for the two-previous campaign and the first StopPalu project did not notice any fraud related to the production of vouchers. For these two reasons, PMI decided to produce the vouchers without holograms. • Additionally, based on the NMCP’s suggestion, the NCC decided to distribute one net per two people, as recommended by Alliance for Malaria Prevention (AMP). During the second meeting, the NCC members asked the NMCP to review the campaign schedule because Catholic Relief Services and StopPalu+ reported that the campaign tools will not be available before January 16, therefor the enumeration cannot start on January 10 as proposed by the NMCP. After the meeting, the NMCP revised the schedule and proposed the date of February 7, 2019, for the beginning of enumeration in the AMF zone. StopPalu+ supported the NMCP in establishing and launching of regional and prefectural mass distribution coordination committee in 2 regions and 14 prefectures supported by the project. The project supported the first meeting of each of these committees, during which facilitators presented the statement of work (SOW) for each committee.
Objectives of regional and prefectural coordination committees • Involve the various affected actors from the region/prefecture in the campaign process • Inform the various actors about the LLIN distribution campaign process • Present the expectations and roles and responsibilities of the actors • Set up a regional/prefectural coordination committee for the mosquito net distribution campaign; • Validate the committee’s composition by an act of the main administrative authority (prefect or governor)
Regional committees In the two regions, the project supported the organization of one-day orientation for the committee members. The participants were the authorities of the governorate through the director of the cabinet and the political advisor of the governor; the regional Directorate of health; representatives of the religious leaders, the army, local NGOs, CSOs, and the other health partners.
StopPalu+—Quarterly Report—October to December 2018 13 During the orientation, the NMCP and the project representatives explained the objectives of this 2019 campaign: • Identify and enumerate 100% of households • Distribute 100% of the LLINs to enumerated beneficiaries • Ensure that 100% of beneficiaries hang their LLINs in the households • Get at least 90% of the population to sleep under LLINs every night and all year round They also explained the key steps of the campaign, including the micro-planning, the enumeration, the distribution, and the post-distribution visits. They shared the strengths and the weaknesses of the 2016 LLIN mass distribution campaign. The last session of the orientation used group work to identify ways to correct the weaknesses of the 2016 mass campaign. The authorities, for their part, welcomed the initiative to set up the committees and to support the organization of these coordination meetings, which, according to them, will strongly help the campaign’s success. In all the regional meetings, the authorities emphasized the need for commitment and availability from all committee members, who will have to actively be involved in the whole process. Prefectural committees In addition to the regional committees, in each health district, a prefectural coordination committee for the LLIN mass distribution campaign composed of 12 members has been set up. The main objective is to set up a prefectural coordinating committee involving officials at all levels of the prefecture so that they become actively involved and to give a more appropriate dynamic (strong local support) to foster success in the 2019 LLIN distribution campaign. During the meeting, the facilitator made a presentation on the context, the objectives, the interventions, the phases, and their duration of the campaign and the distribution strategies of the 2019 mass distribution campaign. Then the roles and responsibilities of each member of the committee were largely detailed. The strengths and weaknesses of the 2016 campaign were also presented and widely discussed. During these debates, the following points attracted the most attention from participants: • The choice of enumerators and distributors • The actual enumeration of all households • Communication
Committee roles at the prefectural level • Support health center managers in the selection of social enumerators/mobilizers according to the selection criteria • Support DPS and health center managers to obtain free warehouses from communities (community contribution) • Strengthen household awareness for their participation and acceptance of rectangular nets • Supervise field teams to assist in delineating neighborhoods, villages, and areas during enumeration • Support security during the 2019 campaign process • Raise people’s awareness about using mosquito nets every day and all year round • Emphasize honesty during enumeration—do not inflate numbers • Educate people on orderly conduct during distribution • Visit some households to ensure effective use of nets
14 StopPalu+—Quarterly Report—October to December 2018
The meeting of the prefectural committee of Forécariah The meeting of the regional committee of Labé
With the national coordination committee, review/develop management and data collection tools for the universal campaign. Revise distribution and data collection tools. In collaboration with the national coordinating committee, the project supported the revision of the distribution and data collection tools used during the FY 2016 campaign. This revision took into consideration AMF requirements on data collection and quality. The main changes were as follows: • On the voucher, include the names of the households’ members (up to 9 people) • On the voucher, include the number of LLINs received by the household during the distribution • Add a column for beneficiaries’ signature on the households’ synthesis form and make it carbonless After the validation of these tools, StopPalu+ started producing copies to be distributed at all levels in the prefectures where the project will implement distribution activities. It is important to mention that because the distribution period in Conakry has not been defined yet, the project did not order the tools for Conakry. Develop, pre-test, and produce communication materials and support materials for all steps of the mass distribution campaign (enumeration and voucher distribution, LLIN distribution, and social mobilization). In collaboration with the NCC’s BCC sub-committee, StopPalu+ revised key messages and updated the social mobilization guides to be used for all training. Models of tee-shirts, caps, banners, and posters have been developed and validated. Messages for radio and television spots have been developed and validated. Because of the long period between enumeration and distribution due to the AMF procurement policy, special messages have been developed to emphasize the importance of keeping the distribution vouchers, employing the slogan “No voucher, no nets.” StopPalu+ has also developed short messaging service (SMS) messages to inform the population on the dates of enumeration and ask them to accept the enumerators in their households. However, because of the non-availability of funds, the project was not able to order the communication materials. We hope to receive the funds by January 21 to be able to produce the communication materials needed for the enumeration that is planned for February 7.
StopPalu+—Quarterly Report—October to December 2018 15 Conduct cascade trainings of community agents and supervisors (micro-planning, logistics, social mobilization, enumeration, and distribution) for the universal distribution campaign. During Quarter1, the project supported the national, regional, prefectural, and health center trainings on micro-planning. During November 7–8, 2018, the national consultant for the campaign trained the national trainers on the micro-planning tools (forms) in Coyah.
The training on micro planning Training objectives for national trainers reinforced participants’ capacities on household calculation • Familiarize trainers with the new micro-planning tools methods based on the size of the provided by AMP; trainers learn how to fill them out population, the number of LLINs • Orient participants on the SOWs for the different needed, the amount of storage coordination committees space required, the transport of • Prepare the teams to support the micro-planning and LLINs, the number of distribution to help set up coordinating committees sites based on the number of households per site, and the criteria for identifying a distribution site.
A total of 36 trainers from the Categories of people trained at various levels national level were trained on micro-planning, advocacy, and Regional level SOWs for the regional and (four from each DPS) prefectural campaign • Prefectural Health Director coordination committees. At the • Doctor in charge of statistics end of the training, the trainers • District malaria focal point were divided into groups to • Director of prefecture micro-projects (directeur de conduct the same training in the micro réalisations) various regions of the country. (and four from each DRS) At the regional level, four people • Regional Health Director from each DPS and four people from the Regional Health • Doctor in charge of disease Directorate (DRS) participated in • Doctor in charge of statistics the training. In the project- • Director of the Regional Office for Support to supported regions, 74 regional Communities and Coordination of Cooperative and and prefectural trainers were NGO Interventions (Service régional d'appui aux trained (29 in the region of Boké, collectivités et de coordination des interventions des 13 in Kindia, and 32 in Labé). coopératives et ONG) At the end of these trainings, the Health center level teams of trainers also trained 279 (four from each health center) people (95 in Boké, 54 in Kindia, • Head of the health center and 119 in Labé regions and 11 • Expanded Program of Immunization (EPI) agent in the prefecture of Dinguiraye) at • Health and Hygiene Committee (CSH) member the health center level on micro- • Representative of the project’s NGO partners planning. At each health center, four people were trained. Thus, in total, in the 14 prefectures, 501 people were trained: 279 health workers, 134 CSH members, and 88 neighborhood leaders or NGO facilitators. A summary of the number of people trained, by region and health district, is shown in Table 5.
16 StopPalu+—Quarterly Report—October to December 2018 Table 5: Staff trained on micro-planning for the LLIN distribution campaign Prefectures/ Participants Conakry communes Health staff CSH staff Local NGO TOTAL Boffa 20 8 5 33 Boké 29 13 17 59 Fria 15 6 5 26 Gaoual 11 8 9 28 Koundara 16 9 7 32 Coyah 23 11 10 44 Dubréka 14 6 5 25 Forécariah 16 8 8 32 Koubia 16 7 4 27 Labé 12 6 2 20 Lélouma 36 18 12 66 Mali 25 11 2 38 Tougué 26 13 1 40 Dinguiraye 20 10 1 31 Total 279 134 88 501
Conduct micro-planning, budget development, logistics planning, and development of a distribution plan for the universal campaign at prefectural, regional, and central levels After the micro-planning training, the teams trained at the health center level filled in the micro-planning forms. The information collected by each health facility team helped estimate the LLIN needs, material needs (registers, materials to record distribution, vouchers, markers, pens, chalk), staffing needs (enumerators/mobilizers, distribution agents, supervisors), distribution points (number and location), and storage space for each village and health center.
Calculation methods used during micro-planning (estimations) • # of nets = population # divided by 1.7 • # of households = population # divided by 7 • # of enumerator teams = # of households divided by 25 and times 12 days in the prefectures • # of distributions sites (urban areas) = # of households divided by 300 and times 5 days • # of distribution sites (rural areas) = # of households divided by 200 and times 5 days
After filling in the forms, each health center presented the information it had collected and discussed it with other health centers; prefectural and regional authorities corrected the data when necessary and validated the data per health center. It is important to mention that the micro-planning agenda was affected by the polio immunization campaign combined with the distribution of Vitamin A and also the annual planning for family planning activities, which were all conducted at the same time. The summary results of the micro-planning per health district are shown in Table 6.
StopPalu+—Quarterly Report—October to December 2018 17 Table 6: Results of the micro planning in the 14 prefectures Number of Number of Number of Number of Prefectures Population households LLINS distribution sites villages Boffa 327,605 46,650 182,003 50 137 Boké 789,954 96,682 438,863 110 190 Coyah 406,206 58,029 225,670 49 153 Dinguiraye 294,289 42,029 163,494 43 790 Dubréka 539,431 77,062 309,117 64 197 Forécariah 457,206 65,315 254,003 65 282 Fria 104,161 14,880 57,867 14 55 Gaoual 264,952 37,850 147,196 39 78 Koubia 123,355 17,622 71,525 19 565 Koundara 176,189 24,881 97,883 25 118 Labé 486,237 69,215 273,213 58 1,028 Lélouma 261,446 37,349 151,054 38 728 Mali 316,810 45,318 163,784 55 1,876 Tougué 155,765 22,252 87,936 23 808 Total 4,703,606 655,134 2,623,608 652 7,005
Microplanning activity in Forécariah Microplanning activity in Coyah
Activity 1.2.2 Support routine LLIN distribution at health facilities To continue ensuring universal coverage and/or replace old and damaged LLINs, StopPalu+ continued to support routine distribution in all public and private health centers covered by the project and in the 171 integrated health posts. During Quarter 1, FY 2019, StopPalu+ worked with the NMCP, the Central Pharmacy of Guinea (Pharmacie Centrale de Guinée [PCG]), private carriers, and the DPSs to deliver 7,300 LLINs to health facilities in the Conakry Region and 33,640 LLINs to health facilities in the districts of Boffa, Boké, and Koundara. The project also provided LLIN distribution vouchers to public health facilities. The project supported supervision of routine LLIN distribution, which is integrated into the national supervision guide.
18 StopPalu+—Quarterly Report—October to December 2018 Activity 1.2.4 Conduct community outreach activities to promote and monitor correct LLIN use and care During the reporting quarter, the project team, in collaboration with the CSOs and CBOs, conducted door-to-door visits to monitor the regular and correct use of LLINs in the regions of Boké, Conakry, Kindia, and Labé. In the Boké region, the health centers of Baguinet and Banguigny in Fria and Youkounkoun in Koundara were among the 10 health centers that had the highest incidences of malaria in the past quarter. For this reason, the regional project team, supported by the DPS team, decided to conduct home visits to assess the situation.
Assessment objectives • Understand the level of use of LLINs in the communities • Determine the household coverage rate in LLINs • Determine the LLIN utilization rate by age group • Assess the state of LLINs used in households • Understand the level of access to care (use of care) • Identify areas of high impact (sectors) • Evaluate the impact of community relays (facilitators) in the fight against malaria (awareness and management) • Evaluate communities’ knowledge of malaria • Reinforce the advanced strategy in these localities
Under the supervision of the health authorities of the prefectures of Koundara and Fria, the actors involved were the directors of prefecture micro-projects, two DPS staff members, the health center heads, the health agents, the EPI agent and the ANC staff of each health center, three project staff members, the malaria districts focal points, two members of the project NGO partners, and CHWs. The assessment activities were held on October 26 and 27, 2018, in the prefecture of Frida, and in Koundara from December 8 to 10, 2018. In each health center, a working session brought together all the actors involved in the process to explain the correct use of the data collection sheet and to harmonize all the investigators’ understanding so that field approaches would be aligned. After the theoretical orientation, participants simulated filling out a questionnaire to ensure that all interviewers would conduct the assessment correctly. Then the investigators were deployed in the field for the household visits. A synthesis meeting was organized in the evening to share the findings.
Orientation of the team in Youkounkoun Synthesis meeting in Baguinet
StopPalu+—Quarterly Report—October to December 2018 19 In the prefecture of Koundara, a total of 300 households were surveyed (160 households in Youkounkoun and 140 households in Kamaby); in the prefecture of Fria, 204 households were surveyed (118 in Baguinet and 86 in Banguigny). Results from the prefecture of Fria Availability and condition of LLINs During the household survey, the availability of at least one LLIN per household varied respectively from 98% for Baguinet health center to 94% for Banguigny health center. Among the LLINs found in the households, 59% are in good condition in Baguinet and 61% in Banguigny, with an average of 60% of LLIN s in good condition for the two health centers. (See Figures 3 and 4.)
Figure 3: % of households with at least Figure 4: % of LLINs in good condition one LLIN (Fria) (Fria)
98% 99% 97% 61% 98% 94% 62% 97% 61% 60% 96% 61% 95% 60% 59% 94% 60% 93% 59% 92% 59% 58%
Use of LLINs The results of the household surveys have shown that the percentage of sleeping spaces that have LLINs is higher in Baguinet (84%) than in Baguigny (77%). The use of LLINs is higher in Baguinet than in Baguiny, both in populations under 5 years of age and those over 5 years of age, with 82% and 61% (respectively) in children less than 5 years old and 95% and 50% (respectively) among those over 5 years old. It should also be noted that in Baguigny, unlike Baguinet, more children under 5 years use LLINs (61%) than do people over 5 years (50%). (See Figures 5 and 6.)
Figure 5: % of sleeping spaces with LLINs (Fria)
BANGUINET BANGUIGNY TOTAL
84% 85% 81% 77% 80%
75%
70% BANGUINET BANGUIGNY TOTAL
20 StopPalu+—Quarterly Report—October to December 2018 Figure 6: % of people using LLINs (under 5 and over 5) (Fria)
95% 100% 82% 90% 77% 73% 80% 70% 61% 60% 50% 50% 40% 30% 20% 10% 0% BANGUINET BANGUIGNY TOTAL
Blue: % of people under 5 years using an LLIN Red: % of people 5 years or older using an LLIN
Results from the prefecture of Koundara Availability and condition of LLINs The household visits in Koundara showed that 100% of the households had at least one LLIN (Figure 7). The availability of LLINs per bed varies from 69.5% in Youkounkoun to 83% in Kamaby. This low availability in Youkounkoun could be explained by the poor condition of LLINs distributed in 2016 and the use of LLINs for other purposes—contributing to both the low use of LLINs and the rise of malaria incidence in Youkounkoun.
Figure 7: % of households with at least one LLIN (Koundara)
100% 100% 100%
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% YOUKOUNKOUN KAMABY TOTAL
StopPalu+—Quarterly Report—October to December 2018 21 Use of LLINs Regarding the use of LLINs, the results of the household visits showed that 72% of surveyed households in the two health centers in Koundara use LLINs. The rate is 76% at Kamaby and 70% at Youkounkoun (Figure 8).
Figure 8: % of LLINs used per health center (Koundara)
YOUKOUNKOUN KAMABY TOTAL
76%
78% 76% 72% 74% 70% 72% 70% 68% 66% YOUKOUNKOUN KAMABY TOTAL
At the end of the household visits, the project, in collaboration with the two health districts’ authorities, organized community dialogues to share the findings of the visits, work with the community to identify the challenges that prevent the correct and regular use of malaria control products and services and propose concrete actions to overcome these challenges. During these community dialogues, several topics were discussed:
Community dialogue topics (after LLIN assessment) • Causes of high malaria incidences in the communities • The challenges faced by communities in regard to malaria prevention and malaria treatment at both the health facility and community levels • Effectiveness of free products and services, including diagnosis by rapid diagnostic test (RDT), sulfadoxine/pyrimethamine (SP) for IPTp, malaria treatment with all forms of artemisinin-based combination therapy (ACT) • The role and place of CHWs in the fight against malaria • Denunciation of unwanted behaviors such as the use of LLINs for purposes other than protection against mosquitoes, refusal to seek care at the first signs of sickness, etc.
In all four communities where these dialogues were conducted, it appears that communities face several challenges: • Perception and barriers related to the use of prevention measures (discomfort of LLIN use, shape and size of LLINs) • Persistent beliefs that LLINs should only be used during the rainy season and when sleeping in a house • The sale of products in some health facilities (RDTs, ACT) • The stock-out of some commodities • Lack of information on the availability of antimalarial products at no cost • Weaknesses in the use of IPC between patient and provider on malaria prevention and treatment during patient visits
22 StopPalu+—Quarterly Report—October to December 2018 • Some CHWs who are not well known in their communities • The lack of regular outreach strategies in the villages to provide services to populations that are hard to reach For each challenge, the facilitators and the local authorities proposed some concrete actions. As a first step, and the first concrete action, StopPalu+ staff members provided basic information during these dialogues.
Information shared during community dialogues • Malaria knowledge (mode of transmission, symptoms, forms, and consequences of malaria) • The importance of LLINs in malaria prevention • Malaria products and services that are available at both community and health facility levels • The roles of CHWs in the fight against malaria • The roles of local authorities and community leaders in the fight against malaria
After this presentation, the participants asked many questions. The most frequent questions were the following: • Where can we get LLINs when the ones we have are damaged? • How can we use the nets when we sleep outside? • Can we refuse to pay if a health provider asks us to pay for a malaria product? At the end of the dialogues, participants committed to the following actions to reduce malaria incidence in their communities: • Community and religious leaders promised to increase the promotion of correct and regular use of LLINs and to promote adherence to ANC visit schedules and early care-seeking. These leaders will use opportunities in the mosques, the churches, and during civil ceremonies such as wedding and baptisms. • The CHWs committed to increase the number of home visits and the quality of these visits. They also promised to visit villages that do not have CHWs more often. • The heads of health centers and the DPS representatives promised to increase outreach activities to provide health services (LLINs, IPTp, malaria testing and treatments) to eligible patients. • The project team committed to support all these actions.
The community dialogue in Kamaby The president of Baguinet districts talking to his community during the community dialogue
StopPalu+—Quarterly Report—October to December 2018 23 In the region of Kindia, the project team conducted the same activities in the health structures that reported a high incidence of malaria during the previous three months (July, August, and September 2018). The Falessadé health center in Dubréka Prefecture and Alassoyah and Bokariah health centers in Forécariah Prefecture benefitted from these activities respectively on November 12, 27, and 28, 2018. In each community, 150 households were surveyed. Results from the prefecture of Dubréka Availability of LLINs In Falessadé, the survey showed that 100% of households visited have at least one LLIN, and 81% of sleeping spaces are covered by an LLIN (Figure 9).
Figure 9: % of households with at least one LLIN / % of sleeping spaces covered by an LLIN (Dubréka) % of LLIN coverage and access in the households visited
107% 100% 81%
% of households with LLIN access rate % of sleeping space at least one net (1 LLIN for 2 people) with one net
Use of LLINs In the households visited in Falessadé, 90% of people over 5 years of age, 89% of children under 5, and 85% of pregnant women slept under a net (Figure 10)
Figure 10: % of people sleeping under an LLIN (Falessadé, Dubreka)
% of LLIN use in the households visited
90% 89%
85%
% of people who % of children U5 % of pregnant slept under a net who slept under a women who slept during the net during the under a net during previous night previous night the previous night
24 StopPalu+—Quarterly Report—October to December 2018 Results from the prefecture of Forécariah Availability of LLINs In the two health facilities in Forécariah that were visited, the availability of LLINs is very high—95% of the households have at least one LLIN in Bokariah and 88% in Allassoyah. However, the percentage of sleeping spaces covered by an LLIN is low in both health facilities. In Allassoyah, only 52% of the sleeping spaces have a net, and in Bokariah it is 67% (Figures 11 and 12).
Figure 11: % of households with at least one LLIN / % of sleeping spaces with an LLIN in Bokariah (Forécariah) % of LLIN coverage and access in the households visited
106% 95%
67%
% of households with at LLIN access rate % of sleeping space least one net (1 LLIN for 2 people) with one net
Figure 12: % of households with at least one LLIN / % of sleeping spaces with an LLIN in Allassoyah (Forécariah)
% of LLIN coverage and access in the households visited
88% 80%
52%
% of households LLIN access rate % of sleeping with at least (1 LLIN for space with one one net 2 people) net
StopPalu+—Quarterly Report—October to December 2018 25 Use of LLINs The results of the survey showed that in the two communities of Forécariah, LLIN use varies according to the target population. In Bokariah, the lowest rate is among children under 5 (59%), and the rate is 89% among pregnant women. In Allassoyah, the lowest rate is among the general population (44%), and 66% of children under 5 sleep under nets. The highest rate is among pregnant women (81%) (Figures 13 and 14).
Figure 13: % of LLIN use in households in Bokaria (Forécariah)
% of LLIN use in the households visited
89% 72% 54%
% of people who % of children U5 % of pregnant slept under a net who slept under a women who slept during the previous net during the under a net during night previous night the previous night
Figure 14: % of LLIN use in households in Allassoyah (Forécariah)
% of LLIN use in the households visited
81% 66% 44%
% of people who % of children U5 % of pregnant slept under a net who slept under a women who slept during the previous net during the under a net during night previous night the previous night
26 StopPalu+—Quarterly Report—October to December 2018 After these visits, the teams organized community dialogues to share the findings and make some recommendations. They key points shared during the dialogues are as follows. Strengths: • Community well informed about malaria through radio • Strong involvement of religious leaders and CHWs in Falessadé in raising community members’ awareness about malaria • Involvement of local officials during the activity • Good availability of LLINs in the households of Falessadé and Bokariah and in some villages of Alassoyah • Commitment of the community of Hermakonongbé District (Bokariah) in the fight against malaria • Strong improvement in household use of LLINs in Falessadé (90% of people sleeping under LLINs) Areas needing improvement: • Insufficient amounts of home visiting activities conducted by the new CHWs of Bokariah and Alassoyah • Lack of CHWs in the center of Alassoyah and Bokariah because of the presence of the health centers • Low use of LLINs in some households (reported reasons: due to heat or because people think mosquitoes do not exist in November) • Poor conditions of many LLINs used in households • Non-adherence to the “no cost” rule for malaria products at the health centers of Allassoyah and Bokariah At the end of the dialogues, the facilitators took some concrete actions: • Facilitators presented information to the community members concerning all malaria products, with clear explanations provided specifically to district presidents and sector leaders that these are available at both community and health facility levels free of charge (RDTs and all forms of ACT). • The Allassoyah and Bokariah health center teams provided information about a free number that people can call to report if antimalarial products are being sold by health workers. • Facilitators raised households’ awareness on the benefits of using LLINs every night for malaria prevention, especially for children under 5 and pregnant women. • Facilitators recommended that the health facilities and communities should identify new CHWs at the Allassoyah and Bokaria health centers.
StopPalu+—Quarterly Report—October to December 2018 27 Results from the region of Labé In the region of Labé, the project team conducted the same activities in five health centers of the prefecture of Labé. The health centers were Leysaré, Fafabhé, Daka, Pellèle, and Lombonna. In each community, 20 households were surveyed. Availability and condition of LLINs In the five health centers visited, the availability of LLINs is very high—95% of households have LLINs, 86% of LLINs are hung, and 42% are in good condition (Figure 15).
Figure 15: % of households with at least one LLIN / % of LLINs hung / % of LLINs in good condition (Labé)
% of households that have at least % of LLINs hung one net
100 85 84 80 80 86 100 100
95 95
90 90
Leysaré Daka Pellèle FafabhéLombonna Total
% of LLINs in good condition
64 53 42 40 39
24
Leysaré Daka Pellèle Fafabhé Lombonna Total
Use of LLINs The village with the highest LLIN utilization rate among children under 5 was in Pellèle, with 96%, and the lowest was in Lombonna, with 76%. Among people ages 5 and over, the highest rate of use was observed in Daka (92%) and the lowest in Lombonna (62%). The average rate of LLIN use by children under 5 is 86%, and 83% for people 5 years and older (Figure 16).
28 StopPalu+—Quarterly Report—October to December 2018 Figure 16: % of LLINs use in the households (Labé)
120
96 100 89 92 91 92 88 90 86 85 82 83 85 88 83 85 76 80 69 62 60
40
20
Leysaré Daka Pellèle Fafabhé Lombonna Total
Le pourcentage (%) de personnes qui ont dormi sous MILDA la veille de l’enquête Moins de 5 ans Le pourcentage (%) de personnes qui ont dormi sous MILDA la veille de l’enquête 5 ans et plus Le pourcentage (%) de personnes qui ont dormi sous MILDA la veille de l’enquête Total
3.1.3 Sub-IR 1.3: Increased awareness of family members of the need for vulnerable populations to be protected from malaria During Quarter1, FY 2019, StopPalu+ implemented the following activities: Activity 1.3.1 Conduct multisectoral outreach and SBCC activities. During Quarter 1, in order to reach some vulnerable people in the district of Correrah, the project team organized a village vigil. These populations stay out late, and most of the time they do not listen to radios, so the best way to reach them is to organize a social event, especially at night. This event was an opportunity to share general information about malaria with these populations, to inform them about malaria products and services that are available at both health facilities and community levels, and to promote regular and correct use of LLINs even when sleeping outside and during the entire year. The team also explained the techniques for transforming rectangular LLINs into circular ones, and they specified that LLINs are used on all types of sleeping spaces. During the vigil, the project team played the video of the skit by the Troupe Grand Dévise & Kabakoudou to inform, educate, and raise awareness among the majority of young adolescents, mothers, and local officials. The video’s topics are malaria, the use of LLINs for other purposes, the consequences of delaying care at health facilities or through CHWs, and the availability at no cost of antimalarial products in public health centers and in community settings. The video was shown at a public square, and people from different sectors of the neighborhood came to listen to the messages and answer questions (with prizes given out for correct responses).
StopPalu+—Quarterly Report—October to December 2018 29
The village vigil in Correrah
Lessons learned and proposed adaptations (IR 1) Over the first year of the award, StopPalu+ identified issues in the correct and regular use of LLINs as a challenge for several reasons. As described above, to address this challenge, the team first collected additional information on why key populations were not correctly using their LLLINs. First, populations tend to trivialize malaria as something normal and habitual. Second, although malaria exits year-round, some communities rarely use LLINs in the dry season. And third, people who move a lot or sleep outdoors have difficulty using LLINs. Based on these learnings, the project increased the number of home visits to verify the actual use of LLINs and also to organize community dialogs to promote the regular and correct use of LLINs. Activities Planned for Next Quarter (IR 1) • Conduct enumeration activities in the 14 prefectures supported by the project • Revise training manuals and BCC materials based on the results of the KAP survey • Continue to support routine LLIN distribution
30 StopPalu+—Quarterly Report—October to December 2018
3.2 IR 2: Increased Use of IPTp During Antenatal Visits During Quarter 1, FY 2019, to IPTp uptake, StopPalu+ trained new ANC staff members and CHWs and conducted several supervisions activities to assess the quality of the services and continue to build the capacity of health workers.
3.2.1 Sub-IR 2.1: Improved technical capacity and interpersonal skills of providers For Quarter 1, the project implemented the following activities: Activity 2.1.1 Support provider training on technical and IPC skills To improve the technical and IPC skills of health providers, the project team used the national trainers trained during FY 2018 to train ANC staff in the six districts covered by the project that did not receive training in FY 2018 because of funding delays. The districts are Gaoual, Koubia, Koundara, Lélouma, Mali, and Tougué.
Health provider training objectives • Prepare providers to educate and counsel pregnant women on how to prevent malaria during pregnancy. • Prepare providers to administer appropriate IPTp for pregnant women. • Equip providers with the necessary knowledge to recognize and treat uncomplicated malaria during pregnancy. • Equip providers with the necessary knowledge to recognize, refer, and/or treat women with severe malaria during pregnancy.
During the three days of training, the following topics were discussed.
Health provider training topics • Generalities, including the epidemiology of malaria • Focused prenatal care • Malaria transmission • Prevention of malaria during pregnancy • Treatment of malaria in pregnant women
Results In total, 178 participants were trained, among whom 120 women (Table 7).
Table 7: Number of ANC staff trained Participants Prefectures Men Women Total Gaoual 18 5 23 Koundara 3 26 29 Koubia 6 12 18 Lélouma 10 26 36 Mali 10 29 39 Tougué 11 22 33 Total 58 120 178
StopPalu+—Quarterly Report—October to December 2018 31 At the end of the workshops, the following results were obtained: • Participants in total regularly attended the three days of each training session. • All themes on the agenda have been addressed. • All trained participants received the reference manual and participant manual.
Participants performing RDTs during the training in Participants during the training in Lélouma Koubia
Training for CHWs on IPTp During the reporting quarter, the project team worked with the DPS of Forécariah and the Communal Health Directorate (DCS) of the Conakry regions to train 70 new CHWs. The training included a session on IPTp.
CHW training objectives • Explain the importance of IPTp in preventing malaria for pregnant women and their babies • Explain IPTp administration protocols (during which stage of pregnancy to begin, the number of tablets per dose, where pregnant women can receive IPTp, etc.) • Share key message on IPTp promotion • Explain the roles of CHWs in improving IPTp uptake (promotion during home visits, referral, etc.)
After the trainings, CHWs will use their home visits to identify pregnant women and also verify if they are attending their ANC appointments (and refer pregnant women who are not attending their appointments). Activity 2.1.3 Improve supervision of providers and tracking of pregnant women During Quarter 1, StopPalu+ conducted several supervision activities and also supported the DPS and DCS to conduct their bimonthly supervision visits. These supervision visits integrated all malaria control activities, including IPTp. For more details please see Activity 3.1.7.
32 StopPalu+—Quarterly Report—October to December 2018
3.2.2 Sub-IR 2.2: Increased knowledge of women and other family members of the benefits of ANC visits, including IPTp During Quarter 1, FY 2019, StopPalu+ implemented the following activities: Activity 2.2.1 Implement SBCC activities to promote ANC and IPTp During December 2018, the project team organized community dialogues in the communities of Correrah and Kolaboui. During these dialogues, facilitators emphasized the importance of IPTp for preventing malaria in both the mother and the baby. They explained that pregnant women must take three tablets of SP from the 13th week of pregnancy up to delivery, with a one-month interval between doses. They also emphasized that LLINs and SP are available to all eligible women free of charge during ANC visits. During these community dialogues, clear and strong messages about the “no charge” aspect of antimalarial commodities and services is quite important, both for the health providers and for the population. One of the barriers that prevents people from going to health facilities is their belief that they cannot afford the cost of a medical consultation or products. Providing malaria services for free will encourage the population to consult a health center as soon as they are sick.
Women during the community dialogue in Corrirah The head of the health center of Kolaboui showing the antimalaria drugs, which are free of charge
3.2.3 Sub-IR 2.3: Alternative approaches to improved access to IPTp services rolled out During Quarter 1, FY 2019, StopPalu+ implemented the following activities: Activity 2.3.1 Support provider outreach services. StopPalu+ supported the health centers of Correrah, Kamabi, and Youkounkoun to conduct monthly outreach services to provide health services such as IPTp and EPI to eligible patients, test all cases of fever, treat positive simple malaria cases, and refer negative or severe cases to the necessary higher health facility. The data collected during these activities are recorded in the health facilities’ data records. Details from these various outreach activities are presented in Table 8.
StopPalu+—Quarterly Report—October to December 2018 33 Table 8: Summary of outreach activities in various health centers
Pregnant women Children who Health Suspected People Confirmed Treated who received received EPI Total centers cases tested cases cases ANC services services referred Correrah 24 24 16 16 03 04 07 Youkounkoun 142 142 42 42 00 00 00 Kamabi 106 106 43 43 05 07 00 Total 272 272 101 101 08 11 07
3.2.4 Sub-IR 2.4: Increased availability of SP and ancillary supplies For Quarter 1, RY 2019, StopPalu+ implemented the following activities: Activity 2.4.1 Collaborate with the PSM project on macro-planning and stock management StopPalu+ continued to work closely with the Procurement and Supply Management (PSM) project, the district malaria focal points, and the NMCP team to monitor the supply of commodities at health facilities. It should be noted that during Quarter 4, FY 2018, despite several emails and meetings, there were commodity stock-outs in several prefectures. The reason given by the PCG is that it was busy with inventory, so it could not deliver the orders that the health structures submitted. The project team worked with the DPSs to internally reallocate commodities between facilities that had high stock levels and those that were out of stock. Despite this strategy, many districts and health facilities are still out of certain supplies. To reduce the stock-outs, the NMCP Supply Chain TWG will increase the “security” stock (amount of stock kept on hand to avoid stock-outs) to a two-month supply instead of one. In January 2019, StopPalu+ will continue to work with the PSM project and the PCG to ensure that all the prefectures and health facilities receive the commodities they order. Lessons learned and proposed adaptations (IR 2) A major challenge identified by the project is the lack of regular attendance at ANC follow-up appointments by pregnant women. To address this challenge, StopPalu+ incorporated the following learning question into their Learning Agenda: How can we improve IPTp coverage for pregnant women? Focusing on this question enabled the team to collaboratively discuss the issue with USAID, the NMCP, and partners and develop learning activities to better understand why women are not attending the appointments. To improve IPTp coverage, the project uses the ANC registers to monitor attendance of pregnant women in health centers to identify health centers with low attendance rates and to propose solutions. The project also supports advanced strategy activities that reach women in difficult-to-reach locations. Activities Planned for Next Quarter (IR 2) • Train health post staff members • Conduct supervision activities • Support health facilities’ outreach activities
34 StopPalu+—Quarterly Report—October to December 2018
3.3 IR 3: Increased Prompt Care-Seeking and Treatment During Quarter 1, FY 2019, to increase prompt care-seeking and treatment, the project trained new health providers, CHWs, and lab technicians on malaria case management. The project also conducted on-site training in health facilities identified during supervision as needing capacity building. Furthermore, the project conducted several supervision activities to assess the quality of care and continue to build the capacity of health providers.
3.3.1 Sub-IR 3.1: Improved technical and interpersonal skills of providers in malaria diagnosis and care During Quarter 1, StopPalu+ implemented the following activities: Activity 3.1.1. Strengthen malaria diagnostics for case management Training of lab technicians As part of the capacity building for laboratory technicians on the biological diagnosis of malaria, the project organized one session from December 17 to 22, 2018. During this session, 20 participants, including 7 women, from 15 health facilities (including 2 private health facilities and 2 medical facilities that are part of the armed services) attended the training. General objective: To strengthen the capacity of laboratory technicians in the biological diagnosis of malaria
Specific objectives of the microscopy/diagnostic training course • Conduct prerequisite assessment of participants • Develop the module on general information on malaria • Explain the morphological characters of the different plasmodial species • Explain blood collection methods • Explain the methods of making and coloring thick drop/thin smear slides properly − Explain the dye preparation method and its use − Review the images − Explain methods of microscopic reading and explanation of results • Correctly perform a malaria RDT • Distinguish artifacts, figured elements of blood, parasites • Estimate the parasite load • Develop skills in microscope maintenance, quality assurance/quality control, data collection and retention, good laboratory practices, standard operating procedures, and supervision • Perform post-test evaluation of participants
A pre-test was conducted for each participant at the beginning of the training to assess baseline knowledge about malaria. The key areas tested were related to disease pathogenesis, laboratory knowledge, and quality assurance. A post-test was conducted at the end of the training to assess knowledge gained during training. In the pre-test, 12 out of 20 participants had an average over 50%, and 8 out of 20 participants had an average of less than 50%. In the post-test, 19 participants (95%) out of 20 had an average higher than 50%, and 1 out of 20 had an average of less than 50%. By deduction, the participants significantly increased their knowledge level, with an average performance that improved from 20%–76% on the pre-test to 73%–98% on the post-test (Figure 17).
StopPalu+—Quarterly Report—October to December 2018 35 Figure 17: Performance of participants on the microscopy/diagnostic pre- and post-tests
90% 77% 80% 80% 70% 60% 45.40% 46.10% 50% 40% 30% 23.75% 20.35% 20% 10% 0%
IN IN IO IO
IO IO
IT IT CT CT
UN UN ICA ICA
IF IF
CO CO DE DE
PARA PARA
IT IT IDE IDE IT IT
PARA PARA PARA PARA PRE Test Post Test
Strengths of the trainings: • Presence of performing microscopes • Effective presence and motivation of participants • Availability of all training materials • Appropriate training room • National Directorate of Laboratories participation in the workshop Areas needing improvement: • Participants’ low knowledge level Microcopy training participants in the training room in quantification and identification Conclusion: This microscopy training session allowed each participant to improve their capacity and competence in malaria diagnosis. However, only 1 out of 20 participants qualified as a level 2 expert, according to World Health Organization (WHO) recommendations, and 19 out of 20 participants are at level 4. This is due to the fact that participants did not score very well in quantification and identification. This remains a challenge for biological Microscopy participants performing an RDT diagnosis of malaria in laboratories.
36 StopPalu+—Quarterly Report—October to December 2018 Supervision of biological diagnostic activities in laboratories As part of the follow-up on recommendations from previous supervision visits, the StopPalu+ project, in collaboration with the NMCP, conducted a formative supervision of certain structures in the Conakry and Kindia regions. Main objective: The main objective of malaria diagnosis supervision is to evaluate the implementation of the recommendations from previous supervision visits.
Specific objectives of laboratory supervision • Observe the technicians as they work • Identify technicians’ capacity gaps or weaknesses • Correct these gaps (personalized training) • Encourage and support technicians (work morale) • Review equipment, reagents, and consumables • Fill in the supervisory grids • Evaluate the technicians’ performance • Formulate recommendations • Share supervision results with the health authorities
Results of the malaria diagnosis supervision and assessment To assess laboratories’ performance, these supervision visits include testing technicians’ diagnostic skills for reading slides. Some of the slides used were from the facility (internal quality control [IQC]) and some were WHO-validated slides (external quality control [EQC]). For IQC, the team checks slides read by the technicians and rates the agreement (concordance) between the two readings. For EQC, technicians read slides provided by WHO, and their responses are checked against the WHO-validated results. This supervision involved 163 staff, including 65 women, and covered 27 facilities, including 2 national hospitals (Donka University Hospital, Ignace Deen), 2 improved health centers (centres de santé améliorés), 6 communal medical centers (CMCs), 2 institutes, 3 prefectural hospitals, 11 health centers, and 2 regional hospitals (Boké and Labe).
StopPalu+—Quarterly Report—October to December 2018 37 Monitor improvements and changes in lab technicians’ performance Detection:
Figure 18: Changes in lab technicians’ performance (detection)
Performance in Parasites Detection 100%
88% 88% 90% 81% 77% 76% 78% 76% 80% 69% 75% 70% 72% 70% 69% 67% 67% 68% 70% 67%
60% 51% 50%
40%
30%
20%
10%
0% Performance Sensibilty Specificity Performance Sensibilty Specificity Fourth quarter FY 2018 First quarter FY 2019
Conakry Kindia Global Performance
The graph in Figure 18 shows that the technicians significantly increased their level of detection compared with measurements during the previous supervision last year, with the average performance scores in the two regions improving from 69% in Quarter 4 of FY 2018 to 76% in Quarter 1, FY 2019.
38 StopPalu+—Quarterly Report—October to December 2018 Identification:
Figure 19: Changes in lab technicians’ performance (species identification) Performance in Parasites Identification
67% 57% 50%
33% 30% 31.25%
CONAKRY KINDIA GLOBAL PERFORMANCE
Fourth quarter FY 2018 Performance First quarter FY 2019 Performance
The graph in Figure 19 shows that participants improved their performance in species identification in both regions, with an average performance of 31.25% in Quarter 4 of FY 2018 raised to 57% in Quarter 1, FY 2019.
Quantification:
Figure 20: Changes in lab technicians’ performance (quantification) Performance in Parasites counting
67%
54% 53% 44% 46.00%
33%
CONAKRY KINDIA GLOBAL PERFORMANCE
Fourth quarter FY 2018 Performance First quarter FY 2019 Performance
From the graph in Figure 20, it appears that technicians have improved their performance in quantification in the region of Kindia, with an average performance that went from 33% in Quarter 4, FY 2018, to 67% in Quarter 1, FY 2019. However, in the Conakry Region, performance declined, with an average performance that went from 54% in Quarter 4, FY 2018, to 44.44% in Quarter 1, FY 2019.
StopPalu+—Quarterly Report—October to December 2018 39 In terms of equipment, all the structures visited have microscopes, but some are not functioning, notably those of the National Institute of Child Health and Nutrition (Institut National de Santé de l’Enfant), the CMC of Minière, and Ignace Deen hospital. Almost all the structures visited have reference documents on the biological diagnosis of malaria. The use of ethanol for the fixation of thin smear slides and stock-outs of reagents (Giemsa and blades) were noted in all visited structures. The supervisors also noticed the low rate of use of the IQC systems put in place in the health facilities, despite the fact that the project has equipped these facilities with storage boxes for the blades and IQC registers. At the end of the supervision visits, the team shared the finding with the heads of the facilities and made some recommendations with concrete actions. During the next supervision visits, supervisors will evaluate how well these actions are being implemented. Activity 3.1.3 Conduct on-site training for providers in technical and IPC skills During the reporting period, StopPalu+ conducted on-site training for providers at health facilities that were identified during supervision visits as having some capacity reinforcement needs. These on-site training sessions offered project staff the opportunity to share basic malaria control information with the health facility staff, especially new staff members and interns who are performing tasks with no training on national guidelines and protocols. During December 2018, the project team conducted an on-site training for Topics discussed during onsite trainings the staff of the emergency unit at the for health facility staff national hospital of Donka. In fact, the • Adherence to protocols project visited the Donka hospital • Data recording during a data quality analysis (DQA) • Internal supervision exercise conducted with the Centers for • IPC methods for discussing early care-seeking Disease Control and Prevention (CDC) with clients and the NMCP in December 2018 in Conakry. The DQA surveyors found that despite several trainings and supervision sessions conducted in this hospital, there were many weaknesses, and the health providers were not following national guidelines. After the DQA, the project team shared the findings with the hospital directors and the DCS. During that meeting, it was recommended that the project organize on-site training for all the services that needed capacity building. The emergency unit was the first one that was available. In the region of Labé, the clinic of the regional military camp was also identified as needing capacity building. The training occurred on November 29, 2018. In the region of Boké, the project team organized on-site trainings at the regional hospital of Boké and the health centers of Dibia, Correrah, and Kolaboui. In the region of Kindia, the project team organized an on-site training in December 2018 for the staff of the prefectural hospital of Forécariah. During a supervision session in November 2018, project staff had identified this hospital as needing capacity building. In total, 114 participants (53 in Boké, 33 in Conakry, 20 in Kindia, and 8 in Labé), including 42 women (33 in Boké, 8 in Conakry, and 1 in Labé), participated in these trainings.
40 StopPalu+—Quarterly Report—October to December 2018
On-site training participants at the Donka hospital On-site training participants from the Labé military clinic
Activity 3.1.4 Conduct training and coaching for hospital providers Because of weaker compliance with protocols among hospital providers (compared with those in lower-level facilities), in FY 2019 the StopPalu+ team decided to hold separate trainings for hospital providers on malaria prevention and case management. During Quarter 1, FY 2019, the project organized two training sessions for health providers at the six CMCs and the two national hospitals of Conakry. General objective: To reinforce the knowledge and competences of the hospital providers to provide malaria prevention, diagnosis, and treatment services according to national protocols and guidelines Expected results: At the end of this training, participants will be able to properly ensure malaria prevention and treatment services according to national protocols and guidelines. Methodology: The training was facilitated with a participatory method and used the following techniques: illustrated presentations, discussions, question-and-answer sessions, brainstorming, group work, demonstrations, case studies, and summary at the end of each session. Training topics: For five days and in accordance with the terms of reference, all the sessions from the training manual were presented during the various training sessions.
Modules from the malaria prevention and treatment training manual • Session 1: General information on malaria • Session 2: Biological diagnosis of malaria using microscopy or an RDT • Session 3: Treatment of uncomplicated malaria according to national guidelines • Session 4: Treatment of severe malaria according to national guidelines • Session 5: Management of malaria in pregnant women • Session 6: Preventing malaria in pregnancy • Session 7: Prevention of malaria in children. • Session 8: LLINs and means of prevention • Session 9: Inventory management and procurement • Session 10: Data management • Session 11: BCC in the fight against malaria • Session 12: Proper waste management
StopPalu+—Quarterly Report—October to December 2018 41
Participants during the training session on malaria prevention and treatment
Pre- and post-test results: The evaluation of participants showed that all participants gained knowledge and progressed. During the first workshop,13 participants achieved a performance of 85% or more, and 10 participants had between 30% and 76%. For the second workshop, on the pre-test, 11 participants had less than 50%, but on the post-test, all 27 participants had a performance of 95% on average. Recommendations: At the end of the training, the following recommendations were made: To the Conakry DRS: • Make drugs and commodities available in CMCs and hospitals • Continue supervision and monitoring of hospitals and CMCs • Provide ongoing training for staff To participants: • Share the knowledge learned with all staff of their respective service upon their return • Ensure the proper care of any patient suffering from malaria • Strictly observe the policies and care guidelines as defined by the NMCP • Strictly adhere to the slogan "cases confirmed = cases treated" • Ensure the management of commodities according to the national policy To StopPalu+: • Continue to provide technical and financial support and training for all health personnel • Give certificates to the participants • Support post-training follow-up of trained health workers • Support regular supervision visits
42 StopPalu+—Quarterly Report—October to December 2018 Activity 3.1.5 Conduct training and refresher training for malaria case management. Training of new health providers at health centers During the reporting quarter, as part of capacity building for health providers, StopPalu+, in collaboration with the NMCP, organized a training for 103 new providers from the prefectures of Dinguiraye (40), Forécariah (31), Koubia (12), and Tougué (20). These prefectures did not benefit from the trainings in FY 2018 because of funding delays. In total, four sessions (5 days each) were held. One national trainer and one trainer from the DPS facilitated the sessions. The objectives were the same as for the trainings of hospital providers detailed in the Activity 3.1.4. Four training sessions were held, one per prefecture. Again, these sessions were participatory, using illustrated presentations, question-and- answer sessions, group work, case studies, and plenary discussions. On the last day of each training session, the facilitators organized a 1-day clinical course at the hospital and the urban health centers of the prefectures. This practical course helped participants to better understand malaria case management according to national guidelines. During these courses, participants who were in the curative service units examined patients in a clinical setting, administered RDTs if deemed necessary to make a diagnosis of malaria (or to rule it out), and proposed a treatment protocol for the positive cases according to the national directives. Participants who have transferred into the preventive service units observed, noted, and asked questions of the malaria prevention officers. After the clinical course, the participants returned to the training room, and each group presented their work followed by discussions. Pre- and post-test results: In order to evaluate the efficacy of the training, participants completed a pre-test and a post- test. It is important to mention that in Dinguiraye, four participants did not score over 80% on the post-test the first time, so they took the post-test a second time and scored higher than 90%.
Participants during the clinical sessions of the new health provider training
Training of new CHWs During the reporting period, StopPalu+ worked with the NMCP and the DPSs to train new CHWs in the prefecture of Forécariah and the communes of Conakry, areas that did not receive these trainings in FY 2018 because of funding delays. These new CHWs were identified by their communities with the support of the heads of health centers. A total of 70 new CHWs were trained on malaria community case management—making a total of 15 trained CHWs in each health center of the 14 prefectures supported by the project.
StopPalu+—Quarterly Report—October to December 2018 43 The training’s goal was to strengthen the capacities of new CHWs to provide prevention and management care for uncomplicated malaria cases, refer severe cases, and use effective BCC techniques.
Specific objectives for the community case management training for new CHWs At the end of the training, CHWs will be able to do the following: 1. Define, describe modes of transmission and ways to prevent malaria 2. Identify the clinical, biological signs of malaria and classify simple and severe malaria 3. Develop and interpret an RDT for malaria confirmation 4. Ensure proper waste management 5. Ensure the management of uncomplicated malaria according to the national policy 6. Recognize severe malaria and be able to do pre-referral treatment and to refer 7. Organize awareness-raising activities on the need to have a healthy environment and promote other means of protection 8. Provide communication for behavior change activities at the community level
The trainers used illustrated presentations, question-and-answer sessions, brainstorming, videos, role-playing, and demonstrations. Results compared across the pre- and post-test showed significant progress. All the participants scored more than 80% on the post-test, even though some of them had to take the post-test twice.
Participants practicing RDT use The facilitator showing how to use a story board
Activity 3.1.6 Conduct training for microscope maintenance The 20 lab technicians trained during Quarter 1 on malaria diagnosis were also trained on microscope maintenance using the microscope maintenance manual developed in 2018 to train laboratory staff. Activity 3.1.7 Improve supportive supervision for case management During Quarter 1, FY 2019, StopPalu+ worked with the MOH to support the national supervision structure as described below: Supervision of public and private health facilities Boké In the region of Boké, 40 health facilities were supervised (Boffa 16, Boké 8, Fria 5, Gaoual 4 and Koundara 7). • In the prefecture of Boké, the health center of Koulifanyah recorded the highest performance with 95%, followed by pediatrics and maternity units of the regional
44 StopPalu+—Quarterly Report—October to December 2018 hospital with 86% and 84% respectively. The private health facility of Anastasis had the lowest performance of 54%. • In the prefecture of Fria, the health center of Baguinet had the highest performance score with 98%. The private facility of Patience had the lowest score with 73%. • In the prefecture of Gaoual, the urban health center had the highest performance with 96%, and the health center of Kounsitel had the lowest performance with 73%. • In the prefecture of Koundara, the urban health center had the highest rate with 99%, and the health center of Kamaby had the lowest rate with 50%. In all the prefectures, among all the service units in the public facilities, the lowest rates were in the pharmacies and ANC services. The managers of the pharmacies do not properly maintain the commodities management tools. The ANC staff do not properly record the data, and some facilities were also out of LLINs for routine distribution. In the private facilities, despite the training for providers, there are still some weaknesses in the use of RDTs and adherence to national treatment protocols. Conakry During Quarter 1, the region carried out several integrated supervision sessions (prevention and management of malaria). All the agents of the different units of the supervised health facilities received supervision. In total, 26 health facilities were visited, including 4 CMCs (Ratoma, Flamboyants, Matam, and Colèyah) and 9 private facilities (Jean Oury, SESIR, AGVS Koloma, ADD, CMAD, FMG, Saint Gabriel, and Bernay Fotoba). • In the commune of Dixinn, among the three health centers visited, the health center of Hafia had the highest performance rate with 92%, and the Dixinn health center had the lowest rate with 89%. • In the commune of Kaloum, among the four health centers visited, the health center of Boulbinet had the highest rate with 91%, and the health center of Kassa Island had the lowest with 83%. • In the commune of Matam, among the three CMCs visited, Coleyah had the highest rate with 99%, and Matam had the lowest rate with 90%. • For the 12 health centers visited in the commune of Matoto, the health center of Gbessia Port 1 had the highest performance with 99%, and the clinic of the military camp Alpha Yaya had the lowest rate with 42%. • In the comune of Ratoma, the highest performing health facility was Hadja Djènè Kaba with 96%, and the lowest performing was Sonfonia health center with 86%. Kindia In the region of Kindia, 15 health facilities (Coyah 2, Dubréka 9, and Forécariah 4) were supervised during Quarter 1. • In the prefecture of Coyah, the health center of Doumbouyah had the highest performance with 97%, and Kouriah had the lowest rate with 95%. • In the prefecture of Dubréka, the health center of Kondeyah was the highest performing with 90%, and Ansoumania health center was the lowest performing with 71%. • In the prefecture of Forécariah, the health center of Allassoyah had the highest performance rate with 89%, and Kaliah health post had the lowest rate with 81%. • In the region of Boké, in most of the health facilities, the service units that have the lowest performance scores are the pharmacies and the warehouses. In many facilities the commodities management tools are not updated and there are stock- outs.
StopPalu+—Quarterly Report—October to December 2018 45 Labé In the region of Labé, 13 health facilities (Dinguiraye 9, Labé 1, and Mali 3) were supervised during Quarter 1. • In the prefecture of Dinguiraye, the health post of Matagania had the highest rate with 87%, and the health post of Gombo has the lowest rate with 48%. • In the prefectures of Mali, the urban health center had the highest rate with 96%, and the prefectural hospital had the lowest rate with 81%. • In the region of Labé, among all the service units, the pharmacies, the warehouse, and data quality were areas that need improvement. Conclusion: At the end of these supervision sessions, the project found that the overall performance of the health centers and hospitals evaluated varied from 71% to 99%, with an average of 85%. This demonstrates the improvement of the quality of services in the project-supported regions. These good results are due to continuous training of the agents, improved supply of malaria commodities, and the close monitoring and involvement of the heads of the districts and facilities in the supervision activities. Sharing the results of the supervision sessions at health facility and district monthly monitoring meetings is another important factor in this improvement. For Quarter 2, FY 2019, the project team will focus more on health posts and private facilities in all the regions.
Supervision at the health center of M’Bonet Supervision at the health post of Matagania
3.3.2 Sub-IR 3.2: Increased availability of quality diagnostic tests and treatment at facilities and community level During Quarter 1, FY 2019, StopPalu+ implemented the following activities: Activity 3.2.1 Ensure availability of diagnostic supplies and antimalarial treatment During Quarter 1, the project teams worked with the DPSs and the heads of health centers to ensure that the CHWs have necessary commodities such as RDTs, antimalarial drugs, and ancillary supplies for case management of uncomplicated malaria and pre-referral treatment for severe malaria. In the 19 prefectures/communes supported by the project, the CHWs tested 54,854 people—among whom 34,307 were positive—and treated 34,243 people with ACT (Table 9).
46 StopPalu+—Quarterly Report—October to December 2018 Table 9: Details of community case management conducted by CHWs during the reporting period (October–December 2018) Number of Number of people people RDTs Number of Number of treated with referred Prefecture performed positive RDTs negative RDTs ACT Boffa 3,779 2,135 1,644 2,135 26 Boké 7,623 5,477 2,146 5,433 54 Coyah 2,169 1,466 703 1,466 0 Conakry 538 337 201 337 6 Dinguiraye 2,124 1,196 928 1,196 9 Dubréka 3,094 1,987 1,107 1,987 647 Forécariah 4,582 2,990 1,592 2,989 15 Fria 5,246 3,240 2,006 3,240 0 Gaoual 3,747 2,535 1,212 2,535 2 Koundara 4,024 2,788 1,236 2,788 7 Koubia 824 455 369 454 32 Labé 6,100 3,435 2,665 3,422 110 Lélouma 4,497 2,804 1,693 2,804 81 Mali 3,820 1,866 1,954 1,861 42 Tougué 2,687 1,596 1,091 1,596 43 Total 54,854 34,307 20,547 34,243 1,074
Activity 3.2.2 Conduct therapeutic efficacy studies. During the reporting period, the project continued to support the Centre National de Formation et de Recherche en Santé Rurale de Maferinyah (CNFRSR) to conduct therapeutic efficacy studies as per standard WHO protocols. As of November 25, 2018, a total of 1,418 subjects were screened at the two sites—772 at Maferinyah and 646 at Labé— of whom 389 were included in the study, i.e., 97.3% of the recruitment target planned for both sites. Of the 389 participants selected, 226 were recruited from the Maferinyah study site (113% of the recruitment target of 200 subjects planned for the site) and 163 from the Labé study site (81.5% of recruitment target of 200 planned subjects). The participants are divided between the two branches of the study, with 77 (19.8%) belonging to the artesunate- amodiaquine (ASAQ) branch (50 in Maferinyah and 27 in Labé) and 312 (80.2%) in the artemether-lumefantrine (AL 20/120 mg) branch (176 in Maferinyah and the rest in Labé), which indicates a lack of randomization of subjects. Indeed, despite the efforts of the NMCP and CNFRSR, the team was unable to obtain the ASAQ before the start of the study to constitute the second branch in time, which explains why the proportion of participants included in the ASAQ branch as of November 25, 2018, is below the initial forecast. For the time being, two serious adverse events have been reported—two deaths, one at each of the two sites. The cause of the two deaths was probably related to administration of the study drug. At these two sites, 255 participants have already completed their follow-up— 201 in Maferinyah and 154 in Labé. Difficulties encountered in the implementation of the study • The level of recruitment is below expectations in Labé, mainly because of the SMC activities in the study area. • There were delays in supplying RDTs. • There were delays in supplying the ASAQ branch of the study. Activities to overcome the difficulties • The CNFRSR support team from Maferinyah met with local health authorities, district malaria focal points, and heads of study sites to solicit their support to reach the
StopPalu+—Quarterly Report—October to December 2018 47 study’s target population. It was thus agreed to involve the eight CHWs surrounding each health center of the study sites in the community-based screening of simple malaria cases and their referral to these sites after the supply of RDTs was completed. • CDC/Atlanta helped the NMCP and Maferinyah to obtain the needed ASAQ though WHO Geneva.
3.3.3 Sub-IR 3.3: Increased knowledge and awareness by communities and family members of seriousness of childhood illnesses, key signs, and symptoms, and when treatment is ineffective Please see Sub-IR 4.1 for more details on the activities implemented. Lessons learned and proposed adaptations (IR 3) The main challenges in case management are adherence to national guidelines and protocols, especially in the hospitals/CMCs and private health facilities, and stock management. To overcome these challenges, the project team will conduct specific trainings targeting hospital and CMC staff. During these trainings, the project team will identify one person per facility to be the quality service focal point. The project will also increase coaching and supervision visits. Activities Planned for Next Quarter (IR 3) • Train the national malaria diagnosis trainers and lab technicians • Train health providers of hospitals and health posts on malaria case management • Support the national supervisory system
48 StopPalu+—Quarterly Report—October to December 2018
3.4 IR 4: Increased Full Dose of SMC Delivered in a Timely Manner During Quarter 1, FY 2019, StopPalu+ implemented the fourth round of the 2018 SMC campaign in eight districts: Dinguiraye, Gaoual, Koubia, Koundara, Labé, Lélouma, Mali, and Tougué.
3.4.1 Sub-IR 4.1: Increased awareness by community and family members of the need for infants and children U5 to be protected from malaria During Quarter 1, StopPalu+ implemented the following activities: Activity 4.1.1 Develop and implement SBCC and outreach During October 2018, to increase community and family members’ awareness and knowledge of the importance of SMC to protect children under 5 from malaria, the project broadcast two radio spots that were translated into three main local languages. The spots encouraged the communities to keep their children at home during the four days of the campaign. The spots also provided information about the age of the children targeted for SMC, the number of doses that should be administered, and who will administer these doses. The radio spots emphasized the importance of SMC in malaria prevention. In addition to the radio spots, the project organized and broadcast roundtables and interactive programs in the eight prefectures that benefited from the SMC campaign. The roundtables helped communities understand the importance of SMC in the fight against malaria and informed the population about the number of days per round. Activity 4.1.2 Strengthen community mobilization Advocacy meetings As part of community mobilization for the fourth round of the SMC campaign, StopPalu+ organized advocacy meetings in the eight districts that implement SMC. In each district, administrative, political, and religious authorities and leaders of women’s and youth associations attended the meeting.
Objectives of community advocacy meetings during the SMC campaign • Share the results of the previous campaign round and emphasize participation in areas with the lowest coverage rate • Present the strengths and weaknesses of the previous round • Mobilize leaders and communities to support and participate in the SMC campaign, especially in areas where the coverage rates were low • Ensure the adherence of all stakeholders to the SMC campaign objectives • Identify facilitating factors and critical factors that may hinder the SMC campaign’s normal implementation
Advocacy meeting for the SMC campaign in Koundara Advocacy meeting for the SMC campaign in Gaoual
StopPalu+—Quarterly Report—October to December 2018 49 Communication activities Radio spot and programming To inform the population about the dates of the fourth rounds of the campaign, StopPalu+ collaborated with the NMCP to produce a radio spot and another radio program, which have been translated into three national languages. For this round, the radio spot was broadcast 60 times and the radio release aired 350 times. Roundtable events and interactive radio programs To encourage parents, especially mothers and caretakers, to have their children participate in this campaign, the project team facilitated roundtable events and produced interactive radio programs before and during each round. For this round, 8 roundtable events and 19 interactive radio programs were produced and broadcast in the eight districts. Mobile caravans As was done for the previous rounds, StopPalu+ used mobile caravans to circulate in the neighborhoods and sectors of communities to inform and educate them about the SMC campaign, which resulted in strong participation. The mobile caravans spread awareness of when the teams were planning to visit and the importance of keeping children ages 3–59 months at home, so they would benefit from the first dose of drugs. Staff in the mobile caravans also explained to mothers and caregivers the importance of giving their children the additional two doses left by the CHWs. During the fourth round, 14 mobile caravans were organized.
The mobile caravan in the prefecture of Koundara during the fourth round
3.4.2 Sub-IR 4.2: Increased availability of SMC (SP+AQ) and commodities for continuous and mass distribution during high-transmission season in targeted districts During Quarter 1, StopPalu+ implemented the following activities: Activity 4.2.2 Coordinate procurement and distribution of SMC commodities During Quarter 1, StopPalu+ worked with the PSM project, the NMCP, and the PCG to monitor the distribution of the SP+AQ to SMC target districts. However, it is important to mention that the health centers of Gaoual and Koundara received their commodities the day before the campaign, which prevents the distribution from starting early in the morning the first day of the campaign.
50 StopPalu+—Quarterly Report—October to December 2018 Activity 4.2.3 Implement SMC campaigns The fourth round of the 2018 SMC campaign was implemented October 11–14, 2018. After the launch, 2,404 distributing agents and 486 social mobilizers, who were previously selected by the community and trained, began distributing SMC drugs to children in the target age group. In each health center, the facilitators helped the heads of the centers to post the list of distribution teams and their routes for the four-day effort. Team results were also displayed daily. This approach, introduced by the project team, made it easy for people to track campaign activities and identify teams that had not reached the target of 75 children per day. To assist the distributors with their work, the mobilizing agents visited the locations the day before the distribution teams arrived and informed the local authorities and communities that the distribution teams would be there the next day. This approach was a success because in most communities, the children were at home when the distributors arrived. During each round, trained distributors went out to the field to distribute the medication, and social mobilizers helped spread awareness of the campaign in the community and urge people to participate. An NMCP-approved door-to-door strategy was used. For four days, the agents traveled to the households, identified eligible children, and administered the first doses of SP+AQ to them. The agents also advised mothers and caregivers about the benefits of SMC, the importance of taking preventive measures (e.g., the use of LLINs, sanitation), and the way in which subsequent doses were to be administered by mothers and caregivers. The agents then filled in the management tools (reporting forms), compiled the daily data, and submitted the information to the appropriate health center. Each day, a monitoring meeting was organized at the DPS to present the results per health center, share lessons learned and difficulties experienced, and propose solutions. During the monitoring meeting, participants identified the health facilities that were below the 25% daily target (total target divided among four days) and provided information to supervisors, so they could support and assist with any issues the teams were experiencing. At the end of the round, a one-day session was held at the DPS so all heads of health centers, representatives from communities, and NGO facilitators could present the results of the activities, share lessons learned, and make recommendations for the next round. The results of the fourth round of the campaign are as follows: out of the 357,476 children targeted to receive medication, 355,175 (99%) ages 3–59 months received the SMC doses.
Table 10: Results of the fourth round of FY 2018 SMC campaign in PMI zone Targeted children (3–59 % children who Prefectures Population months) % children covered received all four rounds Gaoual 229,096 45,819 44,996 98% 39,981 87% Koundara 151,675 30,335 29,718 98% 22,729 75% Mali 343,706 68,741 67,765 99% 63,101 92% Tougué 142,421 28,484 28,117 99% 25,294 89% Koubia 112,149 22,430 22,348 100% 20,037 89% Labé 368,929 73,786 75,177 102% 59,837 81%
Lélouma 210,420 42,084 41,524 99% 36,568 87% Dinguiraye 228,985 45,797 45,530 99% 38,857 85% TOTAL 1,787,380 357,476 355,175 99% 306,404 86%
StopPalu+—Quarterly Report—October to December 2018 51 3.4.3 Sub-IR 4.3: Improved providers’ (health facility and CHW) technical and interpersonal skills in effective administration of SMC Activity 4.3.3 Support supervision of SMC campaigns Supervision was an important activity for the success of the campaign. As with previous rounds, StopPalu+ supported a multilayer supervision system consisting of different levels of supervisors: national, regional, prefectural, and health centers. At the level of each health center, the project appointed an NGO facilitator to support the head of the health center with closely monitoring the field teams and collecting, analyzing, and compiling the data. The purpose of this level of supervision was to improve the quality of drug administration, ensure maximum coverage, and promote community mobilization. The supervisors also traveled to the field to observe the field teams. This approach was very helpful because during the daily summary meeting, each supervisor provided updates of the number of teams supervised, the problems encountered, and the solutions provided. During this round, the main weaknesses found were related to the loss of distribution cards by some family members and some errors in the filling out of the cards by distribution agents. The supervisors took the appropriate actions to correct these findings and reinforce the capacity of the teams.
A supervisor verifying the tools of a distribution team A supervisor verifying a distribution card in a household
Cases of adverse effects During the fourth round, one probable side effect was recorded in the sub-prefecture of Guingan in the prefecture of Koundara. On Monday, October 15, 2018, an investigation was conducted for a suspicious case of major adverse event related to SP+AQ uptake in the village of Yangui Lilikimy, a district located 15 kilometers from the sub-prefecture of Guingan. The investigators were composed of a joint team of NMCP, DPS, and StopPalu+ members. Name of the child: Oumou DIALLO Date of birth: 14 / October / 2017 Names of the parents: Ibrahima Diallo (Farmer) and Mariama Diallo (Housewife) Residence: Yangui Weight = 9500 g Medical background The baby was born after a normal pregnancy and a healthy eutocic delivery. She is exclusively breast fed and has not received any medication since birth.
52 StopPalu+—Quarterly Report—October to December 2018 During the year 2018, the child received SP+AQ during the first, second, and third rounds without any minor allergic reactions. Her first allergic reaction was noted on October 15, 2018, at around 11:00 am, when she took her last dose of SP+AQ. Her mother noticed the appearance of macules with itching with a little fever. Sign history The beginning was progressive, marked by the appearance of rashes after the administration of the first dose of SP+AQ. However, the next day the mother continued to administer the rest of the tablets. Given the progression of the lesions and the occurrence of a fever, the father reported the event to the head of Guigan health center, who went to the village to educate and inform the parents about the management of side effects for SP+AQ. The head of the health center also informed the DPS and the project team. Description of the clinical exam At the Gingan health center, the infant was examined by the national supervisor, who is a pediatrician. He decided to refer the child to the prefectural hospital of Koundara with a diagnosis of an allergic reaction to the SP+AQ. The project ensured the transport of the child and her parents. At the Koundara prefectural hospital, on October 16, 2018 around 5 pm, the child was examined by a multidisciplinary medical team. After the clinical exam, the medical team performed some lab exams, which were all normal. The team proposed the following treatment: • Aqueous oesine in local application • Pyocef: 500 mg IV per 12 hours • Dexamethasone 4mg IV • Paracetamol syrup 250 mg: one teaspoon 2 times a day On October 19, 2018, the child was totally cured, and she returned to her village.
The child during the clinical exam The medical team and the family on leaving the hospital
StopPalu+—Quarterly Report—October to December 2018 53
3.4.4 Sub-IR Transversal 1. Increased Community Involvement in and Support for Malaria Prevention and Care During Quarter 1, FY 2019, to increase community involvement and support for malaria prevention and care, StopPalu+, with the support of the national SBCC consultant, finalized the national SBCC and Capacity Strengthening Plans. The project began the implementation of these plans as described below: Activity T1.1 Support implementation of the Community Mobilization Plan Establishment of CAGs During Quarter 1, as part of the community mobilization strategy, the project expanded the CAG strategy to five more districts—Dubréka, Kaloum, Dixinn, Boffa, and Mali—to establish 37 CAGs, one per health center. CAGs represent a concentrated group committed to the improvement of malaria and other health indicators through community education. Each CAG is composed of 10 members, representing various populations and sectors in the community: the social mobilizer of the CSH (youths or women), the head of the health center, a representative of the women’s or youth CBOs, a religious leader, a traditional healer, a representative of the environment, a local elected representative (another advisor different from the head of the CSH), one CHW, an education representative, and a representative of the local child protection committee. The project trained the new CAGs on their roles and responsibilities and on the development of action plans. For this quarter, the CAGs organized 51 community dialogues and 28 group discussions in 5 prefectures where the project has supported their establishment. Training of religious leaders In addition to the CAGs, to increase community participation in the fight against malaria, the project continued to support the implementation of the NMCP “Religious Leaders against Malaria” strategy. During Quarter 1, the project, in collaboration with the DPS, trained imams in the prefectures of Boffa, Boké, and the region of Conakry. As for the other prefectures, because of the high number of mosques (especially in Conakry) and limited funds for the training sessions, the project selected the imams of the largest and more frequented mosques to receive training. To maximize the value of the training, the project also selected imams from the mosques that hold Friday prayers, to allow a broader dissemination of messages about the fight against malaria General objective: To prepare Muslim religious leaders for their involvement in the fight against malaria at the community level
Specific objectives of the training for religious leaders • Clarify religious leaders’ roles and responsibilities in malaria prevention • Obtain basic knowledge about malaria • Identify Islamic instructions (Hadiths) that promote healthy behaviors and link them with malaria prevention (with a focus on correct and regular use of LLINs) • Acquire practical and theoretical techniques for malaria prevention, the advantage of early care-seeking, and interpersonal and mass communication skills in the fight against malaria • Develop an action plan to be implemented to fight against malaria at the community level
The methodology was the same in all the workshops and involved presentations, brainstorming, question-and-answer sessions, group work, role-play, and plenary discussions.
54 StopPalu+—Quarterly Report—October to December 2018 In each prefecture, two 3-day sessions were organized. Facilitators used the Arabic version of the Social Mobilization Guide on Malaria Control, which includes the following modules: 1. General information about malaria 2. Prevention of malaria 3. Case management of malaria 4. Effective communication and mobilization of religious leaders in the fight against malaria Following the facilitators’ presentations, participants were divided in groups to work according to the three major themes discussed in the Guide to develop sermons in Arabic, which were then translated into Susu, Pular, and Madingo, incorporating the Hadiths related to themes of healthy behavior to facilitate the understanding and use of malaria prevention behaviors. In plenary, the sermons about malaria were presented, critiqued, amended, and adopted by the participants. In all the prefectures, the imams and their leaders promised to share the information and knowledge they received during these training sessions with their community members. However, unlike the imams of the prefectures who had given dates to disseminate the sermons on malaria in order to sensitize their communities, those of Conakry said they cannot do the same because the sermons read in the mosques on Fridays come from the General Secretariat of Religious Affairs. To this end, they suggested that the project work with the religious authorities of Conakry to officially send them the sermons in their respective mosques. But they made commitments to raise awareness in mosques during other daily prayers as well as in meeting places (marriages, baptisms, funerals...). The imams and their leaders also promised to share information from the training with their peers who did not have the opportunity to be trained and to provide copies of the sermons to them that were prepared to benefit their communities. In total, 283 religious leaders were trained (Boffa 80, Boké 126, and Conakry 77).
Imams participating in group work during the training Imams during the training
Awareness campaign in mosques After the training of the imams, these religious leaders began to disseminate key malaria control messages in the mosques and during meetings and ceremonies. During the household visits that the project teams conduct in the prefectures, many family members confirmed that they received malaria information through imams in the mosques. Some imams also called project staff to inform them when members of their communities told them that malaria commodities were not available in a health facility or if they paid to receive a malaria service or product. This information helped the project team to take appropriate actions.
StopPalu+—Quarterly Report—October to December 2018 55 3.4.5 Sub-IR Transversal 2: Improved Capacity of NMCP (Central, Regional, District) to Manage, Implement, and Monitor Prevention, Care, and Treatment Activities During Quarter 1, FY 2019, to improve the NMCP’s capacity, StopPalu+ continued to support coordination activities as well as monitoring and surveillance. Activity T2.1 Support NMCP coordination capacity During Quarter 1, StopPalu+ implemented the following activities: • Support and facilitate MOH TWGs’ meetings. The project continued to support and facilitate TWGs’ monthly meetings. The main topic discussed during the quarter was the LLIN mass distribution campaign. Each TWG developed the campaign action plan related to its group. For example, the communication team developed all the communication materials and the key messages to be disseminated during the campaign. In addition, the TWG group reviewed and validated the results of the KAP survey conducted by the project in the PMI zone. • Support the participation of NMCP/MOH officials in international meetings. StopPalu+ supported the participation of the National Director of Disease Control to attend the American Society of Tropical Medicine and Hygiene conference in New Orleans. During the conference, the Director met and had a working session with donors such as PMI and other country representatives. He also had an opportunity to learn new approaches and share lessons learned in the fight against tropical diseases. Activity T2.2 Support M&E surveillance and research. StopPalu+ implemented the following: Improve M&E DQA and use at the national level and among statistical analysts at the regional and district levels. To improve the quality of data collected at the health facility level, the project organizes monthly DQAs in project-supported facilities. Conducting DQAs has helped identify and explain the causes of data discrepancies and improve data quality, and it enables staff to take appropriate action. • In the region of Kindia, the project team conducted DQA in six health centers. Only the health center of Mafoudia had large discrepancies between data reported and those in the primary tools. It is important to mention that this health center is a very busy center, with an average of 3,000 patients per month. • In the region of Labé, six health centers benefited from the DQA. The health facilities of Diatifère and M’Bonet in Dinguiraye had the largest discrepancies. The reasons are that some of the health posts that report to these health centers have very poor data quality. Conduct periodic health facility and community visits in areas with high incidences of malaria. Please see Activity 1.2.4 for more details.
56 StopPalu+—Quarterly Report—October to December 2018
4 PROJECT MANAGEMENT ACTIVITIES
4.1 Project Deliverables In accordance with USAID requirements, during Quarter 1, FY 2019, StopPalu+ revised and submitted the following deliverables: • FY 2019 work plan • Updated Monitoring, Evaluation, and Learning (MEL) Plan The project has received USAID’s approval for both documents. The project submitted revised versions of the Initial Environmental Evaluation (IEE) and the Environmental Monitoring and Mitigation Plan (EMMP) that include the project’s new activities, such as the renovation of the NMCP office and some entomological work that was not in the originally approved IEE. On January 10, 2019, the project received USAID’s comments. The project team will revise the documents based on these comments and resubmit for approval. Procurement During Quarter 1, the project purchased 75 motorbikes for the project NGO partners’ field agents. These motorbikes will facilitate the work of these agents that support project community activities. The project also procured some office furniture and information technology equipment to enable the project staff to be fully operational. However, the project could not procure all the equipment and materials needed (such as the vehicles) because of the delay in receiving the incremental funding. Partnership Collaboration with local NGOs. During Quarter 1, StopPalu+ signed grants with six local NGO partners. These NGO partners will support the project in implementing BCC activities, the mass distribution campaign, and supervision and monitoring of CHWs. The NGOs are the following: Association pour la Promotion des Initiatives Communautaires (APIC) Association pour la Promotion de la Santé en Guinée (APROSAG) Club des Amis du Monde (CAM) Comité des Jeunes Mon Avenir D’abord (CJMAD) Initiatives et Actions pour l’Amélioration de la Santé des Populations (INAASPO) Solidarité Guinéenne pour le Développement (SGPD) Training of NGO field agents and managers During November 2018, as per the implementation of the project capacity building plan, the project organized six training sessions targeting the NGO field agents that support the project’s Specific objectives of NGO training community-level activities and members of the Reinforce their knowledge on: coordination team from the project’s six NGO • Prevention and management of partners. malaria General objective: Strengthen the capacities of • RDT administration technique project field agents and the managers of the • Strengthening good governance NGO partners in malaria prevention and practices and the CAG strategy treatment activities • Supervision of CHWs • SBCC
StopPalu+—Quarterly Report—October to December 2018 57 Methodology: The working methodology was participatory, focused on brainstorming, question-and-answer sessions, and directed reading using a slide projector. Procedure: During the three days of training, the following topics were addressed: • Prevention and management of malaria • The practice of administering RDTs • Strengthening good governance practices and the roles and responsibilities of CAGs • SBCC and advocacy techniques • Anti-corruption practices • Supervision of CHWs and new approaches to community health • The tasks of the facilitators • CHWs’ and field agents’ management tools • Difficulties encountered in the implementation of the activities as well as solutions and approaches All these different themes led to active participation through debates between participants and facilitators. A total of 119 field agents and 27 managers of project NGO partners were trained (Table 11).
Table 11: Summary of NGO training Field agents NGO managers Region NGOs Men Women Total Men Women Total TOTAL Kindia CJMAD 16 4 20 3 0 3 23 CAM 13 3 16 2 1 3 19 Boké INAASPO 14 3 17 3 0 3 20 SOLIDARITE 25 0 25 4 0 4 29 Labé APROSAG 17 3 20 5 0 5 25 APIC 6 0 6 3 0 3 9 CJMAD 7 1 8 2 1 3 11 Conakry INAASPO 6 1 7 3 0 3 10 TOTAL 104 15 119 25 2 27 146
Participants in the NGO training During Quarter 1, the NGO field agents conducted 2,734 group discussions and reached 49,547 people.
58 StopPalu+—Quarterly Report—October to December 2018 5 OTHER ACTIVITIES 1. StopPalu+ DQA From November 21 to 25, 2018, USAID conducted a DQA of the project. The purposes of the DQA were as follows: • Understand data strengths and weaknesses for PPR FY 2018 • Obtain up-to-date information on data quality: − Activity management by USAID − Measure performance for Country Strategy Results • Follow up on previous DQA The approach: • Desk review • Central-level assessment • Intermediate (regions) • Service delivery • Beneficiaries Four indicators were reviewed: # Health workers trained in malaria diagnostics with USG funds # Health workers trained in case management with ACT with USG funds. # Health workers trained in IPT with USG funds # LLINs distributed through routine distribution in PMI regions Sites visited: Region of Conakry: StopPalu+ Central Office and health center of Maciré Region of Boké: StopPalu+ regional office, urban health center of Boffa, and one CHW of Boffa Region of Labé: StopPalu+ regional office, urban health center of Lélouma, and one CHW of Lélouma Positive Findings • Well-functioning system centrally + regions • Routine feedback on reports • Routine DQAs • Minimal variances • System identifying problems and rectifying • Generally good archiving of source documentation • Motivated CHWs with well-maintained records • Aide memoires in facilities Missing Documentation • Written data back-up procedures • Procedure for handling late, missing, incomplete results • Source documents storage and duration
StopPalu+—Quarterly Report—October to December 2018 59 • M&E training plan • PIRS need adapting to Guinea context • Filling record trail/ records management system Main Recommendation: • Consider developing an M&E training plan • Develop separate standard operating procedures / updates to the M&E plan • Revise sections of PIRS on “data collection + construction,” data quality issues • Routine DQA should cover other indicators such as training, etc.
2. Rapid entomological and epidemiological survey for the characterization of malaria transmission in Conakry and Dubréka Main objective: Characterize the local epidemiology of malaria and mosquito entomology in the main conurbation of Guinea (Conakry) and some more rural control sites near the city (Dubréka) Sites selection: The five health districts of Conakry including 2 health centers by DCS Dubréka prefecture (witness) including 4 health centers Health centers and neighborhoods with the highest incidence were targeted. Methodology: Epidemiological component: • Visits to health centers for data verification • Household survey, including malaria RDTs and observation of LLINs • Interviews with community leaders and CHWs Entomological component: • Transects / larval prospection • Capture on human bait • Identification of mosquitoes Population and sites: Selection of households and members: • Directional method for households • Head of household for household questionnaires • Children ˂ 5 years, pregnant women, random choice of adults for RDTs, 4 people per household Entomological component: • Comprehensive search for larval sites in neighborhoods / sectors • Opinion of villagers on potential sites • Household suitability selection for human bait capture
60 StopPalu+—Quarterly Report—October to December 2018 Results 1) Strong evidence of autochthonous malaria transmission in Conakry • Positivity by RDT in people without a travel history • Capture significant amounts of Anopheles 2) Variation in transmission levels in Conakry • Kaloum: 11% RDT + and 21 Anopheles per night • Matoto: 1% RDT + and 0 Anopheles per night 3) Lower LLIN coverage in Conakry • 19% access to LLIN in Conakry (vs 64% in Dubréka) • The same rate of use of LLINs (among people with access) • Same incidence of fever in Conakry and in rural areas • ~ 20% fever in the last 2 weeks (similar to the incidence observed in Macenta and N'Zérékoré) 4) Access and use of the public sector between Conakry and Dubréka • ~ 1/3 of fever cases seek care in the public sector at both sites • There is no reporting bias 5) Good practice of screening for fever cases in all sites 6) Good data quality in all sites (exception: over-estimation at Donka and CMC Flamboyants) Conclusion: The incidence rate reported to Conakry by the system of monthly reports likely indicates a true status of local transmission of malaria in Conakry. Malaria transmission in Conakry is highly variable and diverse among the five communes. Limitations: Limited and non-randomized selection decreases the generalization of results and prevents extrapolation to other time periods and sites. The teams did not find any positive deposits of Anopheles, the sources of Anopheles remain a mystery.
6 MAIN ACTIVITIES FOR THE NEXT QUARTER • Conduct enumeration activities in the 14 prefectures supported by the project • Conduct a training of national SBCC trainers • Validate the NMCP Communication Plan and communication materials • Train hospital and health post providers • Conduct refresher training for CHWs on malaria case management
StopPalu+—Quarterly Report—October to December 2018 61 Annex 1: Performance Report for Q1 FY 2019 (Oct–Dec 2018)
AF19 Data AF19-T1 AF19-T2 AF19-T3 AF19-T4 Target Indicators Source Baseline Actual Actual Actual Actual Annual Notes PROJECT LEVEL INDICATORS This indicator be All-cause mortality rate in DHS) reported next quarter AL1 children under 5 years of age 88 (2016) NA MIS with the final results of (U5) (per 1,000 live births) DHS 2018 Prevalence (children aged This indicator be six to 59 months with reported next quarter 15% (MICS with the final results of AL2 malaria infection confirmed DHS/MIS NA 2016) DHS 2018 by microscopy and/or rapid diagnostic text [RDT]) IR1: Increased use of LLINs by the population This indicator be % of pregnant women who DHS/MIS/ 69.4% reported next quarter 1.1 slept under an LLIN the NA (MICS 2016) with the final results of previous night* DHS 2018 This indicator be % of children U5 who slept reported next quarter under a long-lasting insecticide- DHS/MIS/ 67.6% 1.2 NA with the final results of treated net (LLIN) the previous (MICS 2016) DHS 2018 night* This indicator be Proportion of Population with DHS/MIS/ reported next quarter 1.3 Access to an ITN within their TBD NA with the results of DHS Household 2018 # of LLINs purchased with USG Project 1.4 funds and distributed through a 1,353,825 NA 950000 records mass campaign # of LLINs purchased by other donors and distributed with Project 1.5 2,370,567 NA TBD USG funds through a mass records campaign Health During the reporting # of LLINs distributed through 1.6 facility 376919 69892 200000 period, 69892 LLINs routine distribution (ANC, EPI) reports were distributed in the
62 StopPalu+—Quarterly Report—October to December 2018 AF19 Data AF19-T1 AF19-T2 AF19-T3 AF19-T4 Target Indicators Source Baseline Actual Actual Actual Actual Annual Notes health centers through ANC and EPI services in the 4 regions and the prefecture of Dinguiraye supported by PMI: Boké 15708, Kindia 16466, Labé 15258, Conakry 18899 and Dinguiraye 3561 A total of 575 health workers received training on the # of persons trained in LLIN microplanning of the distribution, micro-planning, Project LLIN distribution 1.7 enumeration, distribution, hang- training 15215 575(71) 13466 campaign Boké up, and/or promotion using records 200(26) USG funds Kindia 115(17) Labé 214(26) Dinguiraye 31(1) StopPalu+ 15(!)
% of persons who recall 1.B hearing or seeing LLIN use and KAP 19,4% (KAP CC. NA maintenance messaging within survey 2015) 1 the last 6 months IR2: Increased use of intermittent preventive treatment of malaria in pregnancy (IPTp) during antenatal visits This indicator be % of pregnant women who reported next quarter received at least three doses of 30% (MIC 2.1 DHS/MIS/ NA with the final results of SP during their last pregnancy* 2016) DHS 2018 (survey)
% of pregnant women who Health received at least three doses of 30% (MIC 2.2 facility NA SP during their last pregnancy* 2016) reports (routine) Project During this quarter the # of health workers trained in 2.3 training 2835 401(187) 781 project trained IPTp with USG funds* records 401poeple including
StopPalu+—Quarterly Report—October to December 2018 63 AF19 Data AF19-T1 AF19-T2 AF19-T3 AF19-T4 Target Indicators Source Baseline Actual Actual Actual Actual Annual Notes 187 women on IPTp: ANC agents 178 (120) Other health providers 153 (63) CHWs 70 (04)
2.B % of persons who recall KAP 34% (KAP CC. hearing or seeing malaria-in- NA survey 2018) 1 pregnancy messaging IR3: Increased prompt care seeking and treatment During the reporting quarter, the project trained 70 new CHWs % of community health workers Project 77,40% including 04 women 3.1 (CHWs) capable of using RDTs training 50% 90% (2105/2720) on RDT use at the household level* records Previously 2035 CHWs had benefited from the training. During the reporting period, in the 14 prefectures and 5 communes of Conakry % of patients (all ages) who 98,19% (project coverage tested positive (via microscopy Health (196122/199 99% area), 199731 people 3.2 or RDT) and who received an facility 99.31% 731) tested positive for effective anti-malarial as reports malaria; among those, reported by health facilities* 196122 received an effective anti-malarial. Please note that these data are collected by health facilities. During the reporting period, in the 14 % of patients with suspected prefectures and 5 Health 98,91% malaria who received a communes of Conakry 3.3 facility 99.21% (373093/377 99% diagnostic test (microscopy or (project coverage reports 212) RDT) * area), there were 377212 suspected malaria cases; among
64 StopPalu+—Quarterly Report—October to December 2018 AF19 Data AF19-T1 AF19-T2 AF19-T3 AF19-T4 Target Indicators Source Baseline Actual Actual Actual Actual Annual Notes those 373093 received malaria tests. Please note that these data are collected by health facilities. During the supervision of project staff and national supervisors in % of diagnostic tests the regions of Conakry (microscopy and/or RDTs) Project 76% and Kindia 120 slides 3.4 89% 89% interpreted correctly (positive– records (91/120) were subjected to negative) * reading. 91 slides were interpreted correctly, so 76% correct detection rate. During the reporting 243(74 period, the project women). trained 243 health 153 other workers and CHWs health including 74 women. # of health workers trained in Project workers 63 On the diagnosis of 3.5 malaria laboratory diagnostics training 2829 2037 women, 20 malaria: with USG funds* records lab 153 Health workers 63 technicians women, 20 lab and 70 technicians (7 women) CHWs) and 70 CHWs (04 women) During the reporting quarter, the project 223(67 trained 223 health women). workers and CHWs # of health workers trained in Project 153 other including 67 Women 3.6 case management with ACT training 1,965 health 1947 On malaria case with USG funds* records workers 63 management women, and 153Health workers (67 70 CHWs women) and 70 CHWs ( 04 Women)
StopPalu+—Quarterly Report—October to December 2018 65 AF19 Data AF19-T1 AF19-T2 AF19-T3 AF19-T4 Target Indicators Source Baseline Actual Actual Actual Actual Annual Notes During this quarter, the # of children under 5 that test Health project supported positive for malaria and receive 10769 3.7 facility 55786 34000 CHWs were able to treatment from a community (5393) reports treat 10769 children health worker (CHW) under 5 # of children under 5 that test During this quarter the positive for malaria and are Health CHWs referred for 3.8 referred by a community health facility TBD 45 (18) TBD treatment 45 children worker for treatment at a reports under 5 years tested facility. positive for malaria
% of respondents who recall 3.B hearing or seeing an early care KAP 17,2% (KAP CC. NA 45% seeking and treatment malaria survey 2018) 1 message During this quarter 689540 people (392371 women) were reached by BCC activities during the home visits conducted by CHWs, group discussions conducted by NGO agents. 3.B # of people reached by NGOs, Project 689540(392 CC. CBOs and CHWs with malaria NGO 3512864 1397428 371 women) The regional 2 prevention and control SBCC records breakdown is: Boké: 220434(122654 women) Conakry 24509(14720 women) Kindia: 135664(74869 Women) Labé: 260725 (152437 Women) Dinguiraye 48208(27691).
66 StopPalu+—Quarterly Report—October to December 2018 AF19 Data AF19-T1 AF19-T2 AF19-T3 AF19-T4 Target Indicators Source Baseline Actual Actual Actual Actual Annual Notes RESULT 4: Full dose of SMC delivered in timely manner increased
% of children U5 who received SMC 74% 4.1 SMC during the first cycle of the project (London NA 85% transmission season records School)
% of children U5 who received SMC 78% 4.2 SMC during the second cycle of project (London NA 90% the transmission season records School)
% of children U5 who received SMC 71% 4.3 SMC during the third cycle of project (London NA 85% the transmission season records School) The fourth SMC cycle % of children U5 who received SMC covered 99% of 4.4 SMC during the fourth cycle of Project 80% 99% 80% eligible children: the transmission season Records 355,175 reached out of 357,476 The four cycles of The % of children from 3 to 59 SMC SMC covered 86% of months of age in target areas 4.5 project 64% 86% 65% eligible children. who received SMC during all records 306,404 reached out four cycles of 357,476 During the four cycles of the SMC campaign, 1,411,811 doses were administered to children: SMC First cycle health # of SMC doses (SP+AQ) 345,225 doses 4.6 facility 1,314,788 1,411,811 1,511,128 administered to eligible children Second cycle 353,449 activity doses reports Third cycle 355,924 doses Fourth cycle 357,213 doses
StopPalu+—Quarterly Report—October to December 2018 67 AF19 Data AF19-T1 AF19-T2 AF19-T3 AF19-T4 Target Indicators Source Baseline Actual Actual Actual Actual Annual Notes
4.B % of people who believe that KAP 90%(KAP CC. SMC reduces the risk of NA 60% survey survey) 1 contracting malaria SUB-IR TRANSVERSAL 1: Increased community involvement in and support for malaria prevention and care The results of the KAP survey showed that % of women aged 15–49 years DHS/MICS/ 70.08% 70.08% of those T1.1 who recognize fever as a KAP NA (KAP 2018) interviewed symptom of malaria survey recognized fever as a symptom of malaria During this quarter, 51 Community dialogues were carried out; Boké 21 Kindia 9 and Labé 21 These dialogues have # of community dialogs enabled exchanges Project T1.2 organized by the community 81 51 198 between local records about malaria control authorities and communities on the problems they face regarding regular and correct LLINs use and sanitation to prevent malaria
% of people who can identify at DHS/MICS/ 78.2% (KAP T1.3 least two ways to prevent KAP NA 2018) malaria survey
68 StopPalu+—Quarterly Report—October to December 2018 AF19 Data AF19-T1 AF19-T2 AF19-T3 AF19-T4 Target Indicators Source Baseline Actual Actual Actual Actual Annual Notes For the reporting period, 550 NGO and # of members of local NGOs, CBOs members were CBOs who have received trained: CAG 392 (81 training in malaria control women) and NGOs activities, monitoring the use of Project 550(98 T1.4 1148 660 (17 women) public services in malaria- records women)
related services, and advocacy with project support in the last reporting period
A total of 52 community actions were carried out by the # of activities conducted by the various groups of community action groups to Project community actions T1.5 N/A 52 284 resolve an identified health records that made it possible issue in their community to find solutions to certain problems that citizens face in the fight against malaria T1 % of people who think that the KAP 97,3% (KAP .BC consequences of malaria are NA survey 2018) C.1 serious SUB-IR TRANSVERSAL 2: Improved capacity of NMCP (central, regional, district) to manage, implement, and monitor prevention, care, and treatment activities During the reporting period, 805 health centers staffs were supervised in PMI area. The project % of health workers nationwide regional team, DRS with malaria-related Project 51,70% and DPS supervised T2.1 responsibilities who received at supervision 93,58% 70% (805/1557) health workers in the least one supervision visit every records regions as follows: three months* Boké 293(161 women), Kindia 115 (58 women), Conakry 180 and Labe 54 (27 women)
StopPalu+—Quarterly Report—October to December 2018 69 AF19 Data AF19-T1 AF19-T2 AF19-T3 AF19-T4 Target Indicators Source Baseline Actual Actual Actual Actual Annual Notes During the reporting quarter, the project # of quarterly coordination supported the meetings held under NMCP's Project T2.2 4 1 4 organization of the leadership with meeting records RBM meeting in minutes distributed* collaboration with the NMCP
# of bi-annual Pause and Reflection sessions held to Project T2.3 N/A NA institutionalize the CLA records 2 approach* # of laws, policies, procedures During this quarter the designed to promote equitable project supported the access, use and quality of revision of the malaria Project T2.4 health services that are NA 1 2 program monitoring records analyzed, drafted or revised, evaluation manual consulted on, proposed and approved with USG Assistance
70 StopPalu+—Quarterly Report—October to December 2018
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