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Feed the Future Tajikistan Health and Nutrition Activity

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Feed the Future Tajikistan Health and Nutrition Activity FEED THE FUTURE TAJIKISTAN HEALTH AND NUTRITION ACTIVITY Year 5 Annual Progress Report October 1, 2019–August 30, 2020 Re-submitted September 2, 2020 Table of contents ACRONYMS AND ABBREVIATIONS ................................................................................................................ 3 ACTIVITY IMPLEMENTATION SUMMARY ...................................................................................................... 4 IR1: Improved quality of health care services for MNCH .............................................................................. 6 Outcome 1.1: Improved quality of health care services being provided in the FTF ZOI .......................... 6 Outcome 1.2: Improved patient access to health care services in the FTF ZOI due to improved quality ...................................................................................................................................................... 12 Outcome 1.3: Stronger facility and provider networks .......................................................................... 19 IR2: Increased access to a diverse set of nutrient-rich foods throughout the year .............................. 21 Outcome 2.1: Diversified food consumption during the growing season and beyond .......................... 21 Outcome 2.2: Nutrition integrated into agriculture-focused programs and linked to value chains supported through FTF activities ............................................................................................................ 25 IR3: Increased practice of healthy behaviors around MNCH ...................................................................... 25 Outcome 3.1: Increased consumption of nutrient-rich foods among adolescent girls, women, and children six to 24 months of age ............................................................................................................. 25 Outcome 3.2: Improved sanitation and hygiene-related behaviors ....................................................... 31 Outcome 3.3: Increased use of health care services for MNCH, including nutrition, sanitation, and hygiene .................................................................................................................................................... 36 IR4: Institutionalized evidence-based MNCH services through national-level policies and standards ...... 47 Outcome 4.1: Cadres of academics and national/regional clinical trainers are skilled in teaching evidence-based clinical practices for MNCH ........................................................................................... 47 Outcome 4.2: Evidence-based approaches for MNCH, including nutrition, sanitation, and hygiene, are sustainable ........................................................................................................................................ 47 MONITORING, EVALUATION, AND LEARNING ............................................................................................ 48 GENDER ....................................................................................................................................................... 51 STAFFING & MANAGEMENT ....................................................................................................................... 51 BUDGET vs. EXPENDITURES ANALYSIS ........................................................................................................ 53 SUB-AWARDS .............................................................................................................................................. 53 COORDINATION WITH OTHER FTF ACTIVITIES ............................................................................................ 55 COMMUNICATION AND KNOWLEDGE MANAGEMENT .............................................................................. 55 ENVIRONMENTAL COMPLIANCE ................................................................................................................. 58 LIST OF ANNEXES ......................................................................................................................................... 61 THNA Year 5 Annual Progress Report: October 1, 2019–August 30, 2020 2 ACRONYMS AND ABBREVIATIONS ANC Antenatal Care IT Information Technology BTN Beyond the Numbers IYCF Infant and Young Child CDH Central District Hospital Feeding CE Community Educator MNCH Maternal, Newborn, and CHP Community Health Promoter Child Health CIP Centro Internacional de la MOHSPP Ministry of Health and Social Papa (“International Potato Protection of the Population Center”) PHC Primary Healthcare Center CME Continuing Medical PPE Personal Protective Education Equipment DOH Department of Health QI Quality Improvement DQA Data Quality Assessment SBCC Social and Behavior Change EG Economic Growth (USAID Communication indicator) TAWA Tajikistan Agriculture and EmONC Emergency Obstetric and Water Activity Newborn Care THNA Tajikistan Health and EPC Effective Perinatal Care Nutrition Activity FTF Feed the Future TOT Training of Trainers GMP Growth Monitoring and TWG Technical Working Group Promotion UNICEF United Nations Children’s HCW Health Care Worker Fund HL Health (USAID indicator) USAID United States Agency for HLSC Healthy Lifestyle Center International Development ICATT IMCI Computerized USG United States Government Adaptation and Training Tool VDC Village Development IEC Information, Education, and Committee Communication VIP Ventilated Improved Pit IMAM Integrated Management of WASH Water and Sanitation Acute Malnutrition Hygiene IMCI Integrated Management of WFP World Food Programme Childhood Illness WHO World Health Organization IR Intermediate Result ZOI Zone of Influence THNA Year 5 Annual Progress Report: October 1, 2019–August 30, 2020 3 ACTIVITY IMPLEMENTATION SUMMARY IntraHealth International and its partner, Abt Associates, are pleased to submit to the Tajikistan Mission of the United States Agency for International Development (USAID) the Quarter Four (Q4, July 1–August 30, 2020) of Year Five (Y5, October 1, 2019–September 28, 2020) quarterly report, which also serves as the Y5 annual progress report for the Feed the Future (FTF) Tajikistan Health and Nutrition Activity (THNA). THNA was implemented in partnership with the Ministry of Health and Social Protection of the Population (MOHSPP) of the Republic of Tajikistan. THNA’s goal was to improve the health status and nutrition of women and children who live in 12 southwestern districts of Khatlon Region, known as FTF’s zone of influence (ZOI). This progress report is consistent with the structure and content of THNA’s approved Y5 workplan. As activity highlights for Y5, THNA: • Fully completed 31 out of 43 program activities (72%) scheduled for Y5 (Annex 1), with limitations and adaptations due to the COVID-19 pandemic. The remaining activities were partially completed before the COVID-19 pandemic was recognized by the Government of Tajikistan on April 30; • Improved the professional knowledge and skills of a total of 5,998 health care workers (HCWs) and community volunteers (355% of the quarterly target, allowing for double counting) through online and in-person training on nutrition topics; • Reached 169,406 children under five with clinical and community-based nutrition interventions (98% of the annual target despite the COVID-19 pandemic); • Reached 67,203 pregnant women with clinical and community-based nutrition interventions (86% of the annual target due to the COVID-19 pandemic); • Reached 431,005 individuals with food security programs (80% of the annual target due to the COVID-19 pandemic); • Engaged 4,050 school students on the topics of life skills; food security; nutrition; agriculture; and water and sanitation hygiene (WASH) (151% of the annual target despite the COVID-19 pandemic); • Exposed 1,530 community members (85% of the annual target due to the COVID-19 pandemic) to social marketing messages on WASH and ventilated improved pit (VIP) latrines through 40 outreach events; • Conducted a growth monitoring and promotion (GMP) campaign through community volunteers, reaching 94.6% of all children six to 59 months of age and identifying 2.2% of them as having signs of wasting, compared to 6.2% reported in the demographic health survey of 2017; • Helped HCWs identify and refer a total of 5,381 children under five with malnutrition who received treatment at different levels; and • Identified and referred to primary healthcare centers (PHCs) 3,632 pregnant women not registered for antenatal care (ANC), 2,782 children with signs of malnutrition, and 786 children with diarrhea through 194,908 household visits by community health promoters (CHPs) (108% of the annual target despite the COVID-19 pandemic). THNA Year 5 Annual Progress Report: October 1, 2019–August 30, 2020 4 THNA also faced the following challenges due to the COVID-19 pandemic: • Since April, THNA has suspended all in-person clinical trainings by national-level consultants and transitioned to online support for trainers at district nutrition resource centers and for quality improvement (QI) committees. • Since April, THNA has suspended all community-based group activities, allowing volunteers to make household visits only if they observed the rules for physical distancing, handwashing, and wearing face masks. Since May, THNA has suspended all volunteer activities, except for the individual counseling of community members by phone. THNA staff supported community volunteers by phone and Internet-based communication,
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