AKSYON Kominotè Nan Sante pou Ogmante Nitrisyon (AKSYON) Quarterly Report PY1-Q2 January 1– March 31, 2017

Submission Date: April 29, 2017

Contract/Agreement Number: AID-521-A-16-00002

Activity Start Date and End Date: August 24, 2016 – August 23, 2021

COR/AOR/Activity Manager Name: Dr Olbeg Desinor

Submitted by: Dr Florence Jean-Louis, Chief of Party Fonkoze 119, Ave. Christophe, Port-au-Prince, Haïti Tel: (509) 3702-1105

Email: [email protected]

This document was produced for review by the United States Agency for International Development Haiti (USAID/Haiti)

Screening session in Fond Verettes

This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID).The contents are the responsibility of Fonkoze and do not necessarily reflect the views of USAID or the United States Government

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Table of Contents Acronyms ...... 4 1. PROGRAM OVERVIEW / SUMMARY ...... 5 1.1 ProgramDescription ...... 6 1.2 Summary of Results to Date ...... 7 2. ACTIVITY IMPLEMENTATION PROGRESS ...... 9 2.1 Progress Narrative ...... 9 2.2Implementation status ...... 15 2.3 ImplementationChallenges ...... 20 2.4 PMP update ...... 20 3. MANAGEMENT AND ADMINISTRATIVE ISSUES ...... 21 4. PLANNED ACTIVITIES FOR NEXT QUARTER INCLUDING UPCOMING EVENTS ...... 21 5. FINANCIAL MANAGEMENT ...... 22 6. Tables and figures Table 1. Summary of results-AKSYON-PY1Q2………………………………………………………………………………………7 Table 2. Number and results of children screened by commune………………………………………………….……11 Table 3: Sales of Nutrition sensitive products in communities served by AKSYON in PY1Q2……………...14 Fig 1:Distribution of malnourished children by sex……………………………………………………………………………12 Fig 2: Distribution of malnourished children by age group……………………………………………………………....12 7. Annexes…………………………………………………………………………………………………………………………………………………23 Annex 1: List of localities covered by AKSYON Annex 2: success story

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Acronyms

AKSYON – AKSYON Kominotè Nan Sante pou Ogmante Nitrisyon

CHE – Community Health Entrepreneur

CTN – Comité Technique de Nutrition (Technical Committee for Nutrition)

EMMP – Environmental Mitigation and Monitoring Plan

HE – Healthy Entrepreneurs

HR – Human Resources

M&E – Monitoring and Evaluation

MAM – Moderate Acute Malnutrition

MMIS – Malnutrition Management Information System

MOU – Memorandum of Understanding

MSPP – Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population)

MUAC – Mid-Upper Arm Circumference

NUPAS - Non US-Organizations Pre-Award Survey

PNS – Programme de Nutrition Supplémentaire (Supplementary Nutrition Program)

PTA – Programme Thérapeutique Ambulatoire (Outpatient Therapeutic Program)

SAM – Severe Acute Malnutrition

SFF – Sèvis Finansye Fonkoze (Fonkoze Financial Services)

SSQH – Services de Santé de Qualité pour Haïti (Quality Health Services for Haïti)

UCPNANu – Unité de Coordination du Programme National d’Alimentation et Nutrition

UNICEF – United Nations Children’s Fund

USAID – United States Agency for International Development

USG – United States Government

WASH – Water, Sanitation, and Hygiene

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1. PROGRAM OVERVIEW / SUMMARY

Name of Prime Implementing Fonkoze Partner:

Name of Subcontractors/ Dimagi, Inc. Subawardees (if applicable): Healthy Entrepreneurs Icahn School of Medicine at Mount Sinai Program Name: AKSYON

Contract/Agreement Number: AID-521-A-16-00002

Activity Objective: To decrease the number of women and children under age five who suffer from malnutrition

Geographic Coverage(cities Haiti And or countries):

Activity Start Date and End August 24, 2016 – August 23, 2021 Date: Total Estimated $18,000,000.00 Agreement Amount:

Current Obligation: $6,000,000.00

Cash Disbursements per $434,626.80 Standard Form425:

Estimated Expenditure $454,206.23 Next Quarter:

Report Submitted By: Florence Jean-Louis

Submission Date: April 29, 2017

Reporting Period: January 1 – March 31, 2017

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1.1 Program Description AKSYON is a five-year program that will decrease the number of women and children under age five who suffer from malnutrition in rural Haiti—reinforcing the sustainability of these gains through knowledge and skill building around nutrition, hygiene, sanitation, and food security strategies. AKSYON addresses malnutrition in rural Haiti through Fonkoze’s existing infrastructure, network, and health program. Fonkoze is the largest microfinance institution in Haiti. The 60,000 clients in its core lending program constitute a network of unprecedented scale in the country. At its heart are “Solidarity Groups” of up to five women; six to ten of these groups meet twice a month in “Credit Centers” led by an elected “Center Chief.” Critically, they serve as a reliable mechanism for education and outreach to the entire Fonkoze client network. Information is transmitted from Fonkoze’s head office in Port-au-Prince through its 45 branch offices through its 2000 credit centers, and vice versa. Fonkoze Foundation is leveraging this network to address the lack of reliable and affordable health products and services in rural Haiti. Boutik Sante (Community Health Store) is an innovative, self-sustaining social franchising initiative. Fonkoze Foundation’s staff, including registered nurses, provides monthly trainings to representatives from each Center, many of whom are Center Chiefs, who become “Community Health Entrepreneurs” (CHEs). The registered nurses train them to administer basic health screenings; deliver monthly community health education sessions in their Center meetings; and to explain product specifications to their clients. CHEs purchase over-the-counter health products from Fonkoze to sell in their microenterprises, establishing a boutik sante. AKSYON enables Fonkoze Foundation, through its Boutik Sante Program, to deepen its malnutrition interventions. CHEs, with support from registered nurses, will conduct community screening campaigns to identify cases of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM). Each case will receive appropriate care, referral, and/or follow-up, as dictated by Ministry of Health protocol. These activities will be reinforced by community health and nutrition education and by improving livelihoods opportunities for families affected by food and nutritional insecurity, through sustainable home gardening, livestock rearing, and access to financial services. By 2021, AKSYON will reach full-scale, with 1,800 entrepreneurs serving over two million Haitians. One of the key aspects of the Boutik Sante social enterprise is that, after initial start-up costs, it will be fully sustainable and perpetuated by the market, itself. Upon attaining sustainability, the program will no longer need to rely on additional donor investment. Researchers from the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai are monitoring the program roll-out to assess sustainability and impacts on health outcomes. The program goal is to decrease the number of women and children under age 5 who suffer from malnutrition, as measured by the following indicators: decrease, by 20%, the number of children under age 5 who are stunted; and reduce and maintain childhood wasting to less than to 5%.

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1.2 Summary of Results to Date

Table 1. Summary of results-AKSYON-PY1Q2 Indicators Annual Q1 Q2 Q3 Q4 Target PY1 PY1 PY1 PY1

Number of children under 5 screened 114,750 304 2,856

Number of children 0-23 months screened 45,000 118 1,025

Number of pregnant/lactating women 36,000 62 666 screened Number of MAM identified 3,440 13 125

Number of MAM treated* 3,440 9

Number of MAM recidivists TBC

Number of SAM identified 1,145 1 23

Number of SAM referred 1,145 1 23

Number of SAM treated* 1,145 1

Number of SAM who abandoned TBC 0 institutional treatment Number of SAM recidivists TBC

Number of home visits 13,755 0 105

Percentage of SAM/MAM households 100% with increased dietary diversity Percentage of SAM/MAM households 100% with positive nutrition-health-wash behavior changes Percentage of SAM/MAM households 100% participating in livelihood interventions Number of CHEs trained to screen, refer 600 377 391 and follow-up, and identify malnourished individuals Number of community members trained 12,000 332 1,348 on WASH and nutrition sensitive topics Number of participants receiving 200 sustainable home garden training Number of participants receiving proper 200 care of livestock training Number of home gardens improved 50

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Indicators Annual Q1 Q2 Q3 Q4 Target PY1 PY1 PY1 PY1

Number of home gardens created 50

Number of households with improved 50 livestock care practices Number of households with increased 180,000 access to nutrition-sensitive products Number of new microcredit clients 2,000

Number of children under 5 receiving 114,750 221 2,532 multivitamins Number of children under 5 receiving 114,750 221 2,396 albendazole Number of pregnant women receiving 36,000 41 628 prenatal vitamins Number of children under 5 receiving 96 939 Vitamin A *=cured in relation to children found malnourished the precedent quarter

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2. ACTIVITY IMPLEMENTATION PROGRESS

2.1 Progress Narrative During the second quarter of the project, AKSYON operations were being implemented in 10 branches, 6 departments, 18 communes and 53 localities and the project was presented in an additional 7 branches. During this time, 259 CHEs finalized their training to conduct malnutrition screenings by measuring the mid-upper arm circumference (MUAC). They also learned to refer, counsel and follow up on children under five as well as pregnant and lactating women in their respective communities. 132 additional CHEs are currently in training to organize screening sessions. The initial nutrition training program is a cycle of three topics: 1) Introduction and general concepts on nutrition; 2) the local food pyramid; and 3) MUAC measurement technique and logistics of a rural screening session. Once CHEs complete this cycle, they are able to begin with screening in their communities, and they continue to deliver nutrition and WASH education in their communities on a monthly basis. Among the 259 CHEs who finalized their initial training during Quarter 2, 56 have already organized a screening session and have contributed to the initial results presented in this report. The others start screening in April and May 2017. At the central level, the effort to establish procedures and systems for effective operations has moved forward, The Procedures Manual is being finalized and Fonkoze received a positive report from the USAID financial audit team confirming that all recommendations of the Non-US Organization Pre-Award Survey (NUPAS) were followed. The AKSYON M&E team, together with the technical team, tested the newly created information tools and finalized them in accordance with feedback from the field nurses and supervisors. The information system is being developed with the input of two institutions with which Fonkoze has formalized agreements and who have already begun their work. Dimagi, Inc., a software development company, has already worked with malnutrition programs in Haiti and is developing a program for AKSYON to digitally track activities at the field level. During the reporting period, Fonkoze worked with Dimagi to conduct numerous activities toward the development of the mobile ICT system component of the AKSYON project. As the project was still in its inception in this quarter, the activities undertaken were designed to contribute substantially to the goal of launching a complete application and system in Q3 2017. Fonkoze and Dimagi were able to develop the application design and content in Q1-2017 in order to test a prototype of the application with users in Q2. The quarter’s activities included: a two-week scoping visit, in which all Fonkoze AKSYON stakeholders met with Dimagi staff regarding the application’s design; a completed app design that was reviewed internally by Dimagi; completion of the prototype-app’s skeleton and content; recommendations for device specifications and a process for Fonkoze to evaluate devices; establishment of supervision and performance metrics; and troubleshooting and feedback content added to the prototype. Each of these activities constitutes a requisite step toward the near-term goal of user testing a prototype app that includes all of the features required by AKSYON. The other important institution for our information system is the Icahn School of Medicine at

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Mount Sinai. Researchers at the Icahn School of Medicine are supporting the AKSYON evaluation process and have already submitted the baseline protocol to the USAID team for review; they have received comments which they have integrated, and they have resubmitted for a final opinion. Also during this quarter, Fonkoze finalized the printing of didactic and marketing materials, making sure that they are aligned with the USAID branding and marking policy. Material was distributed to trained CHEs in order for them to advertize the screening campaigns and to deliver training sessions in their credit centers or during home visits. Each month, the field teams have been visited by at least one member of the central office for supervision and support purposes. They receive support to implement their activities but also to establish a good management system at the branch level, integrating administrative, financial, M&E, logistics and technical coaching. As a result, AKSYON has been able to produce monthly branch reports and to consolidate them in one AKSYON “dashboard” supporting management decisions at the leadership level. At the end of Q2, the project was obtaining information from 18 locations. By the end of this quarter, we had launched AKSYON in ten branches, and significantly expanding our presence in the country. (Please see Annex 1 for a detailed table of AKSYON presence on the national territory). In the first quarter, Fonkoze had established links with various nutrition partners in the country and was in regular communication with the USAID project management team. Good relationships have been maintained during the reporting period and links with the MSPP have been reinforced with meetings at local offices and participation in a MSPP-held nutrition training.

IR1: Operations to screen, refer and treat malnourished children Following the AKSYON protocol, 259 CHEs have completed the three requisite monthly training sessions that prepare them to conduct malnutrition screening. 132 CHEs are still in training but will be ready to begin screening in the next quarter. Among the recently trained CHEs, 56 already conducted their first screening session in their communities. They have screened 2,856 children for malnutrition to date, of which 125 were moderately malnourished (MAM) and 23 suffered from severe malnutrition (SAM). The SAM cases were immediately referred to a health institution in order to receive proper care. All malnourished children received follow-up home visits except for those detected at the end of March, they will receive their first visit in the beginning of April. In total, CHEs conducted 105 follow-up home visits for MAM and SAM children. CHEs also screened 666 pregnant/lactating women for malnutrition, of which six were malnourished, received nutrition counseling and were referred to health centers.

The results of the screening sessions during this first part of the year have been analyzed by geographical area, sex and age group as a means of detecting any patterns and adjusting strategic priorities accordingly.

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The following table presents the levels of malnutrition of screened under-5 children by commune Table 2. Number and results of children screened by commune Commune Total % global children malnutrition screened Ganthier 475 3.36 Cornillon 51 1.96 Croix des Bouquets 45 0 Fond Verrettes 798 7.89 Cap Haitien 61 4.91 Milot 78 11.53 Plaisance 364 5.76 Limbe 154 0.64 Acul du Nord 175 1.71 Savanette 28 21.42 Lascahobas 39 30.76 Sainte Suzanne 9 0 Trou du Nord 102 4.9 Mont Organise 368 2.44 Carice 109 0 TOTAL 2,856 5.18

Since screening is still in its early phases, it is difficult to draw any strong conclusions at this stage. Total numbers are not really comparable nor representative. However, it is logical that numbers in Savanette and Lascahobas are higher, because for now, the program is primarily being implemented with households participating in Fonkoze’s “graduation approach” program for the ultrapoor (Chemen Lavi Miyò, or CLM, Pathway to a Better Life). Among malnourished children detected in the first quarter of the project, the only SAM that we had found has now fully recuperated, as well as all the MAM (9) that were confirmed in the medical care center and pursue treatment. The four other detected MAM during the first quarter were not confirmed at the care center because they did not fit other than MUAC medical parameters to be considered MAM cases.

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Though still early in the life of the program, the team is already beginning to draw lessons as to the kind of support that can be provided to malnourished children and their families. The figures below show the distribution of malnourished children by sex and by age group:

Fig 1. Distribution of malnourished children by sex 140 120 100 80 Female 60 Male 40 20 0 SAM MAM

Of the identified 23 SAM and 125 MAM cases, 57% of SAM cases and 51% of MAM cases are girls, respectively. The project will continue to disaggregate data by sex in order to determine if a gender focus is needed in the prevention activities.

Fig 2. Distribution of malnourished children by age group 140 120 100 80 24-59 months 60 6-23 months 40 20 0 SAM MAM

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Children under the age of two-years old are particularly impacted by malnutrition, as illustrated by the data above. They constitute 52% of the 23 identified SAM cases and 74% of 125 identified MAM cases. The team will continue to monitor this data; at present, we speculate that the discrepancy is caused by the lack of information at the household-level about complementary feeding and special needs of children in the weaning phase. Currently, most AKSYON nutrition material already focuses on the feeding of children under two. IR2: Operations to improve knowledge, skills and support to prevent undernutrition AKSYON’s livelihood strategies were designed in order to support dietary diversity, food security and sustained positive behavior change. During the reporting period, the AKSYON team received authorization from USAID to begin a selection process in order to choose a technical partner capable of managing the technical and administrative aspects of the livelihood component of the project. After a successful call for proposals and a multilevel selection process, we were able to choose a candidate and we received approval to sub-contract in April. In the next quarter, we will proceed with the rural and family food production component of the project. WASH and nutrition-sensitive strategies are being implemented in the ten branches where Fonkoze has already launched AKSYON. Through Boutik Sante, Fonkoze’s existing health program, CHEs have distributed a 6-month provision of multivitamins to 2,532 children under 5, one dose of albendazole to 2,396 children under 5, one dose of Vitamin A to 939 children under 5, and prenatal vitamins to 628 pregnant/lactating women. In addition,12 nurses have received continuous nutrition training on breastfeeding from Fonkoze senior nutrition trainer; and on the use of a new nutrition education material for CHEs from SUCO, the creator of the material approved by MSPP and 391 CHEs and 1348 Fonkoze clients have received nutrition related training on: 1) General nutrition concepts, 2) The local food pyramid, 3) Screening techniques with MUAC, 4) Breastfeeding from the trained CHEs.

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Through Boutik Sante, CHEs have also increased the number of nutrition sensitive products available to the communities served by AKSYON by 25% in comparison with the preceding quarter as seen below in Table 2:

Table 3: Sales of Nutrition sensitive products in communities served by AKSYON in PY1Q2 Nutrition-sensitive product Quantity Q1 Quantity Q2 Alcohol pads 162 225 Antibacterial soap 14,978 13,389 Baby hygiene commodities 4,151 5,126 Benzoate de Benzyle 25 48 Calamine 40 28 Cereals 8,518 10,107 Condoms 1,480 1,090 Cough syrup 175 210 Diapers 94,328 127,800 Gauze 213 182 Hand sanitizer 250 252 House hygiene products 1,835 4,322 Ibuprofen 860 1,311 Intimate wash 821 942 Iodized salt 5,645 11,580 Laundry soap 12,143 20,423 Mosquito repellent 300 138 Mouthwash 477 626 Oxygenated water 97 116 Paracetamol 1,622 1,674 Provit 36 41 Sanitary pads 3,314 3,871 SATO 21 45 Sel lavi (ORS) 2,907 922 Toilet paper 2,610 2,894 Toilet soap 10,284 17,625 Toothbrush 2,579 2,416 Water Bucket 15 6 Water purifiers 2,279 982

Source: Boutik Sante sales report October 2016- March 2017

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2.2 Implementation status This report covers the period October 1, 2016 – March 31, 2017. The following table outlines the activities, as planned, per the Year 1 workplan submitted in September and approved on December 16:

2017 RESULTS Q2 STATUS Activities Q1 January February March

Recruitment is Recruitment: Nurses- complete with the Nutrition Specialist- M&E exception of the Advisor-M&E Officer-IT Data Livelihoods In part Manager- Livelihoods Coordinator, which Coordinator will happen in next quarter. Development of first Completed in Q1 workplan and PMP Will be developed once we hire the Development of EMMP Not completed livelihoods coordinator Design and development of Information system: database-reference system- Reporting form for CHEs- Reporting form for nurses- The full set of M&E Completed Reporting form for tools is operational livelihood activities- Reporting form for field visits-Quarterly reporting form Revision of administrative Various and financial procedures: components of the Specific AKSYON operational manual are In part manual, Finalize Log and complete but have Admin manual, Finalize HR not been compiled manual yet Launching staff workshop Completed in Q1

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2017 RESULTS Q2 STATUS Activities Q1 January February March

SFF: A final agreement is pending Livelihood partner: Upon deciding to identify a new livelihood partner, Fonkoze launched a selection process which included a Partnership formalization: call for proposals, SFF-HE-Makouti-CommCare- in compliance with Mount Sinai Institute- our USAID In part (assessment, MOU and Cooperative detailed specific workplans) Agreement. We will be able to proceed in Q3. Commcare: Completed Mount Sinai Institute: Completed Healthy Entrepreneurs: Completed The team is actively communicating Mapping of with various actors resources/potential partners Ongoing in the field but in each area mapping has not yet been completed

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2017 RESULTS Q2 STATUS Activities Q1 January February March

Coordination with the MSPP and participation as Development of links with active member of key stakeholders at central the Comite and field level: MSPP- Ongoing Technique Organizations working in National (CTN) development in target areas meetings to combat malnutrition Staff and partners training on administrative and Completed In Q1 financial procedures Staff and partners training Completed in Q1 on information system USAID reviewed the baseline Baseline survey protocol and development and collection provided feedback. Ongoing (sub-contract) We are now awaiting the final approval. The material has Conception, development been printed and and distribution of Ongoing distributed to our promotional material remote locations Continuous monitoring and Ongoing and Ongoing supervision effective The second report Quarterly financial and was submitted in Complete technical reporting January as planned The meetings are Semiannual planning and organized on a Ongoing performance meetings regular basis as planned

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2017 RESULTS Q2 STATUS Activities Q1 January February March

AKSYON was launched in 10 Launching and orientation branches during training for CHEs in 18 Q1. In Q2 we branches starting with the launched in 7 following 10: Cabaret- additional Complete Ganthier-Fond-Verrettes- La branches: Jacmel- Vallee- Aux Coteaux- Les Miragoane- Cayes- Limbe- Milot- Trou Beaumont-Boucan du Nord- Mont Organise Carre-Saut d’Eau- Saint-Raphael- La Gonave Screening Ongoing screening campaigns and campaigns and SAM SAM referrals took Ongoing referrals place in the initial ten branches Home visits took place in all Home visits follow-up for screening settings Ongoing MAM and SAM following project procedures

Identification and replication Material is of existing training material Complete available for trainers and for CHEs

All the nurses have Training of trainers on been trained to Complete nutrition/WASH use the education material Monthly training of CHEs at Ongoing as Ongoing branch level planned Monthly Nutrition/WASH Ongoing Ongoing training at community level Regular field supervision Ongoing Ongoing

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2017 RESULTS Q2 STATUS Activities Q1 January February March

Ongoing in Vitamin and albendazole association with Ongoing distribution the screening campaigns CHE procurement of nutrition Increased access to sensitive products Ongoing nutrition-sensitive products has increased (see p.14) A preliminary information (Makouti) Livelihood meeting around partner administrative and contractual has technical preparation for been held. A field operation: Incomplete training session is recruitment, training, planned once material purchase, USAID has procedures revision... approved the contract. Launch of Livelihood activities: sustainable home Standing by to gardening and animal begin once sub- breeding training sessions, contract is Incomplete increased access to quality approved by seeds and cattle, and to USAID agricultural tools Standing by to Sustainable home begin once sub- gardening/animal breeding contract is Incomplete training sessions approved by USAID Increased access to quality Standing by to seeds and cattle, and to begin in next Incomplete agricultural tools quarter After the second quarter of Implementation, Fonkoze was able to implement most of the Component 1 activities and to move forward with the next period plan, in spite of various challenges faced in the process.

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2.3 Implementation Challenges

Performance The principal challenge AKSYON faced during this quarter was the inability to proceed with livelihoods activities that will improve the nutritive value of rural agricultural production. Together with the USAID team, we worked through this challenge which is now almost solved as we received permission to sub-contract ITECA in April just before finalizing this report. We anticipate that the next quarterly report will feature the first AKSYON livelihoods activities.

The average number of screened children per CHE is lower than anticipated; rural localities are smaller than the national average on which calculations were made. The team will therefore intensify mobilization efforts and ask CHEs to complete at least one additional screening session during the project year. In addition, Fonkoze staff will organize screening sessions directly in places that are not served by CHEs.

Treatment The lack of treatment solutions at the national level for MAM cases remains a significant issue. In a search for a sustainable solution, Fonkoze/AKSYON will spend the next two quarters analyzing the value of Ready To Use Food (RUTF). Specifically, the team will study the probability of recuperation and recidivism for MAM children who do not receive Ready To Use RUTF treatment vs. MAM children in the South department who received RUTF as part of the Hurricane Matthew emergency response initiatives in this area. Results of this analysis will help to inform a strategy toward MAM treatment and recuperation.

Tools Because of the emergency situation in the South, UNICEF, from which we had planned to source MUAC tapes, is no longer able to procure them for areas other than the affected departments. We have had to delay screening in other areas until MUAC tapes are available in the country. A purchase order has been delivered and AKSYON will be able to screen new areas in Q3.

External risks The risk of having to delay or cancel operations because of political instability or natural disaster is real but fortunately, it did not cause delays during the reporting period.

2.4 PMP update From January to March 2017, upon the request of the mission, the AKSON PMP has been revised to align the Project’s indicators with the USAID key indicators comprise in the mission document named “IRS_Category3_Health”. The revised indicators and new names are as follows: 1. % population using an improved drinking water source. This indicator is replaced by the “Percentage of households in target areas practicing correct use of recommended household water treatment technologies”, code HL.8.2-6

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2. % population using an improved sanitation facility: This indicator is replaced by the “% of people gaining access to a basic sanitation service as a result of USG assistance”. 3. Number of children under two (0-59 months) reached with community-level nutrition interventions through USG-supported programs is revised to become: Number of children under five (0-59 months) reached with nutrition specific interventions through USG- supported nutrition programs. 4. Number of children under two (0-23 months) reached with community-level nutrition interventions through USG-supported programs become Number of children under two (0-23 months) reached with community-level nutrition interventions through USG- supported programs 5. Number of pregnant women reached with nutrition interventions through USG-supported programs is slightly revised to become Number of pregnant women reached with nutrition specific interventions through USG-supported nutrition programs.

3. MANAGEMENT AND ADMINISTRATIVE ISSUES Staffing: By December, 2016, the team completed recruitment, with the exception of the position linked to our livelihood component. We plan to hire our new livelihood coordinator in the coming quarter since we are expecting USAID’s final approval to sign the sub-grantee contract. Systems and procedures: All administrative procedures have been updated in order to reflect and comply with USG recommendations under NUPAS. The verification began in December and auditors have closed all the recommendations. Procurement: AKSYON has had to procure one of the project cars (purchase authorized by the Agreement Officer) without franchise because of lack of clear guidance for the tax exemption procedure which changed during this period.

4. PLANNED ACTIVITIES FOR NEXT QUARTER INCLUDING UPCOMING EVENTS During the coming quarter, AKSYON will continue with its ongoing activities of monthly training of CHEs in 18 branches with the objective to have screening activities in all targeted branches; nutrition/WASH training in credit centers; screening and home visits in localities; vitamin distribution; and links with local MSPP and care centers to guarantee their effective support for malnourished children and women. In collaboration with Dimagi, AKSYON will test the first prototype for the digital registration system and prepare the final version to be used for the whole program. In partnership with the Arhold Institute of the Icahn School of Medicine at Mount Sinai, the baseline data collection process will also take place in the coming quarter and the project will have additional information on the people it serves and the level of effort needed to reach the desired results. Also, in the coming quarter, a livelihood partner will be identified and will finalize the

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AKSYON livelihood support pilot strategy to be tested and monitored in select branches. AKSYON will also recruit the livelihoods coordinator who will be the main liaison with this new partner. Another key activity during this quarter will be a performance review of team members. This will serve to motivate the team, reinforce the quality control of AKSYON operations, and collectively define effective strategies to achieve the project’s target goal and objectives.

5. FINANCIAL MANAGEMENT 1 The AKSYON team monitors financial conditions in order to effectively and efficiently manage the received funds. This information is used to make strategic decisions to maximize the project impact. Within the first seven monthsof implementation (the start-up phase), Fonkoze has strictly followed and complied with financial procedures as a USAID grantee. The first disbursement was received on November 8, 2016 from USAID administration for an amount of USD 500,000 of which almost the totality has been expended. Current expenditures are under provisional because, as explained in section 2.3, “Implementation Challenges,” our principal partner has just been identified and sub-contracts constitute a significant portion (almost half) of AKSYON’s expenditures. Furthermore, Fonkoze has allocated a significant portion of its direct expenses to support the capacity of its partner to deliver desired results. Fortunately, as stated in the implementation status, most of the sub-contracts have been signed this quarter and relative expenditures will be posted in next quarter report. The SF-425 form is sent as an attachment to this report.

1Note: the financial data provided in this section is an estimate of the financial condition, and does not constitute the contractually required financial reporting as defined in the Award Notice.

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ANNEX 1- List of localities covered by AKSYON

Departement Commune Section communale Localite Branche Sud Aux Coteaux Despas Centre-ville d'aux Coteaux Sud Chardonieres Randel Randel Sud Chardonieres Dejoie Dejwa Sud Chardonieres Bony Centre-ville de Chardonnieres Sud Chardonieres Dejoie Disap Sud Chardonieres Randel Demapou Sud Les Anglais Cosse Konstan Sud Les Anglais Cosse Senjou Aux Coteaux Sud Les Anglais Cosse Labesyè Sud Les Anglais Verone Kas Sud Les Anglais Cosse Déboche Sud Port-à-Piment Paricot Centre-Ville de Port-à-Piment Sud Port-Salut Barbois Felix Sud Saint-Jean-du- Sud Debouchette Debouchet Sud Saint-Jean-du- Sud Trichet Senjan-madan Pyè Sud Tiburon Loby Centre-ville de Tiburon Sud Arniquet Arniquet Bènabe Sud Arniquet Arniquet Kafou Anri Sud Arniquet Arniquet Chato Sud Cavaillon Gros-Marin Piron Sud Cavaillon Gros-Marin Gwo Maren Sud Cavaillon Mare-Henri Bòn Fen Sud Cavaillon Laroque Ravin Sab Sud Cavaillon Laroque Tet Sous Sud Cavaillon Martineau Suzon Les Cayes Sud Cavaillon Mare-Henri Twa Mango Sud Cavaillon Mare-Henri Pliche Sud Cavaillon Mare-Henri Loran Sud Cayes Mercy Trikon Sud Cayes Bourdet Sou Woch Sud Cayes Morency Moransi Sud Cayes Bourdet Mase Sud Cayes Bourdet Fogas1 Sud Cayes Bourdet Fogas2 Sud Chantal Melonière Vil Chantal

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Branche Departement Commune Section communale Localite Sud Chantal Fond-Palmiste Chantal Sud Chantal Melonière Laplace Sud Chantal Melonière Joslen Sud Chantal Carrefour-Canon Platon Sud Chantal Carrefour Canon Le Prete Sud Île-à-Vache Île-à-Vache K-Nobe Sud Île-à-Vache Île-à-Vache Gran Barye Sud Île-à-Vache Île-à-Vache Madan Bena Sud Île-à-Vache Île-à-Vache Bwa Bouton Sud Île-à-Vache Île-à-Vache Pwentes Sud Île-à-Vache Île-à-Vache Gran Sab Plaisance ou Ti Nippes Plaisance du Sud François Gotye Plaisance ou Ti Dagou Nippes Plaisance du Sud François Nippes Plaisance du Sud Anse-aux-Pins Lewa Sud Saint-Jean-du- Sud Trichet Nan Kafe Sud Torbeck Boury Bwalandri Sud Torbeck Solon Tifet Les Cayes Sud Torbeck Solon Posdwa Sud Torbeck Moreau Gwo Mòn Sud Torbeck Moreau Lahat Sud Torbeck Moreau K-Pwou Sud Torbeck Boury Graset Sud Torbeck Berault Lomon Sud Torbeck Boury Maya Sud Torbeck Boury Tibouchi Sud Torbeck Boury Mawo Sud Torbeck Boury Tobek Sud Torbeck Boury chalet Sud Torbeck Solon Boval Sud Torbeck Boury Redon Sud Torbeck Boury Pralen Sud Torbeck Boury Jog Sud Torbeck Okay Lakwa Sud Torbeck Boury Valè Sud Torbeck Bérault Dubreuille Sud Torbeck Boury Vil Torbek Quarterly report PY1-Q2 (January 1 – March 31, 2017)| 24

Branche Departement Commune Section communale Localite Sud-Est Bainet La Vallée-de-Bainet Larevwa Sud-Est Bainet Bas-des-Gris-Gris Sorel La vallée de Jacmel Ouest Grand Goave Grande-Colline guichon Ouest Grand Goave Grande-Colline Pilat/Boden Sud-Est La vallée de Jacmel Ternier Bwa nef Ouest Cornillon Celeste Onavil Ouest Croix des bouquets 1ere Varreux Nouailles Ouest Croix des bouquets Petit-Bois Bouzi Ouest Croix des bouquets kwadebouke Tomazo Ouest Ganthier Mare-Roseaux Ba Mawozo Ouest Ganthier Pays Pourri Balizaj Ouest Ganthier Balan Bonet Ouest Ganthier Mare-Roseaux Davis Ouest Ganthier Mare-Roseaux Ste Therese Ouest Ganthier Mare-Roseaux Bouk Gantye Ouest Ganthier Mare-Roseaux bwa galet Ouest Ganthier Balan Bwa leje Ganthier Ouest Ganthier Fond-Parisien Bwapen Chal Ouest Ganthier Galette Charbon Galette Dume Ouest Ganthier Fond-Parisien Gobe Ouest Ganthier Fond-Parisien Fond Dieu Ouest Ganthier Fond-Parisien Lewoch Ouest Ganthier Fond-Parisien nan cite Ouest Ganthier Fond-Parisien nan moulen Ouest Ganthier Fond-Parisien Nan plezi Ouest Ganthier Fond-Parisien nan vilaj Ouest Ganthier Galette Charbon Dame Marie Ouest Ganthier Galette Charbon Turbe Ouest Ganthier Balan wo bonet Ouest Cabaret Chenchiron Ouest Cabaret Kouyo Ouest Cabaret Doko Ouest Cabaret Source Matelas BADAGOCH Cabaret Ouest Cabaret Boucassin Sabourin Ouest Cabaret ODITO Ouest Cabaret Fonds-des-Blancs Cazale Ouest Cabaret MONRI Quarterly report PY1-Q2 (January 1 – March 31, 2017)| 25

Branche Departement Commune Section communale Localite Ouest Cabaret Source-Matelas DESAB Cabaret Ouest Croix des bouquets 1ere Varreux Bon repos Ouest Fonverettes Fonverettes Barasa Ouest Fonverettes Fonverettes beyanos Ouest Fonverettes Fonverettes Bonom Ouest Fonverettes Fonverettes Boukanchat Ouest Fonverettes Fonverettes Boulay Ouest Fonverettes Fonverettes Bwanegres Ouest Fonverettes Fonverettes Bwapen Ouest Fonverettes Fonverettes Chapoten Ouest Fonverettes Fonverettes Dapre Ouest Fonverettes Fonverettes Fore de Pen Ouest Fonverettes Fonverettes Gumby Ouest Fonverettes Fonverettes Gwo cheval Fond Verettes Ouest Fonverettes Fonverettes Kazo Ouest Fonverettes Fonverettes Mabef Ouest Fonverettes Fonverettes Oryani Ouest Fonverettes Fonverettes Palmistanpe Ouest Fonverettes Fonverettes Ponago Ouest Fonverettes Fonverettes Senlwi Ouest Fonverettes Fonverettes Simeyon Ouest Fonverettes Fonverettes Solyet Ouest Fonverettes Fonverettes Sou Lans Ouest Fonverettes Fonverettes Tefwad Ouest Fonverettes Fonverettes Toman Ouest Fonverettes Fonverettes Twama Ouest Fonverettes Fonverettes Yati Centre Cerca la Source La Mielle Acajou Nord-Est Carice Bois-Gamelle Savane sale Nord-Est Carice Bois Laurince Nord-Est Carice Rose-Bonite Lapis Mont-Organisé Nord-Est Carice Dupon

Nord-Est Mont Organise Bois Poux Laree Nord-Est Mont Organise Bwa rouj

Nord-Est Mont Organise Bwalouvens

Nord-Est Mont Organise Savanne Salee

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Branche Departement Commune Section communale Localite Nord Acul du Nord Bas de l'Acul Belotes Nord Acul du Nord Bas-L'Acul Kanyet Nord Acul du Nord Bas-L'Acul joli Nord Acul du Nord Bas-L'Acul Makati Nord Acul du Nord Grande Ravine Plombard Nord Acul du Nord Camp-Louise Kokoye Nord Bas-Limbé Bas-Limbé Norman Nord Limbé Camp-Coq blondo Nord Limbé Desroches Fremon 2 Limbe Nord Limbé Chabotte Chabotte Nord Limbé Camp-Coq Inyon Nord Limbé Camp-Coq Moro Nord Limbé Camp-Coq Tamasse Nord Limbé Camp-Coq Camp Coq Nord Plaisance Grande Riviere Chatard Nord Plaisance Grande-Rivière Kalbasye Nord Plaisance La trouble Saint Antoine Nord Plaisance Champagne Beudoret Nord Plaisance Champagne Libo 1 Nord Labadie

Nord Fayette

Nord Saint Jean

Nord Cap-Haitien Petite-Anse Terre Rozie Nord Cap-Haitien Petite-Anse Madeline Nord Dondon Brostage La paix Nord Grande Riviere du Nord Jolitrou Jolitrou Nord Grande Riviere du Nord Gran rivye Kano Nord Grande Riviere du Nord Solon Zepini MILOT Nord Milot Perches-du-Bonnet Dubre (Des plant) Dubre (Kfou Nord Milot Perches-du-Bonnet Bernard) Carrefour des Nord Milot Genipailler peres(Site Joj) Nord Plaine du Nord Bassin Diamant Larevoir(Bastini) Nord Plaine du Nord Basse Plaine Suisse (Balanyen) Nord Plaine du Nord Basse Plaine Suisse (Fobo) Quarterly report PY1-Q2 (January 1 – March 31, 2017)| 27

Branche Departement Commune Section communale Localite Nord Est Caracol Kayes Nord Est Caracol Vilaj la diferans Nord Est Caracol Loumba Nord Est Limonade Roucou Pister Nord Est St suzanne Fond Bleu Roke Nord Est St Suzanne Cotelette Nord Est St suzanne Sarasen Nord Est St suzanne Chalsek

Nord Est Terrier Rouge Trou du Nord Nord Est Trou du nord Bwapen Bwapen Nord Est Trou du nord Desvarennes Nord Est Trou du nord Roche plate Roche plate Nord Est Trou du nord Savanne au Camp Nord Est Trou du nord Garcin Garcin Jaquesil (Trou du Nord Est Trou du nord Roche-Plate Nord) Nord Est Trou du nord gadchanpet Écrevisse (ou Grosse- Nord Est Vallieres Grosse Roche Roche) Centre Savanette Savanette Maroliere CLM-Mirebalais Centre Lascahobas Juampas Bodren

(highlighted lines are localities that have already participated in at least one screening session) This list is to be updated on a regular basis

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ANNEX 2: Success story (attached in the submission mail)

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