USAID/SENEGAL HEALTH PROGRAM 2016–2021 USAID/NEEMA INTEGRATED SERVICE DELIVERY AND HEALTHY BEHAVIORS
Quarterly Activity Report October 1, 2019–December 31, 2019
USAID/Neema October 1–December 31, 2019 Quarter Report
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The “USAID/Neema” Project is an instrument of the USAID Health Program in Senegal for 2016–2021.
Cooperative Agreement No.: AID-685-A-16-00004
Project Dates: September 1, 2016–August 31, 2021
Submitted to USAID/Senegal by: IntraHealth International
Senegal Country Office
Dakar, Senegal
Email: [email protected]
“USAID/Neema” Project - IntraHealth International/Senegal
Cité Keur Gorgui, Immeuble El Hadji Bara Fall
Dakar, Senegal
Tel.: (221) 33 869 74 94
Fax: (221) 33 825 65 23
This document was prepared with the support of the American people through the United States Agency for International Development (USAID). The contents are the sole responsibility of IntraHealth International/Senegal and do not necessarily reflect the views of USAID or the United States Government.
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LIST OF ABBREVIATIONS AND ACRONYMS
AMTSL ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR
ANC ANTENATAL CARE
ART ANTIRETROVIRAL THERAPY
AYRH ADOLESCENT AND YOUTH REPRODUCTIVE HEALTH
BMWM BIOMEDICAL WASTE MANAGEMENT
BREIPS REGIONAL BUREAU OF HEALTH EDUCATION AND INFORMATION SERVICES
CAC-GBV COMMUNITY ACTION CYCLE ON GENDER-BASED VIOLENCE
CCW COMMUNITY CARE WORKER
CHA COMMUNITY HEALTH AGENT
CHW COMMUNITY HEALTH WORKER
CNLS NATIONAL AIDS COUNCIL
CSC COMMUNITY HEALTH UNIT
CVAC COMMUNITY WATCH COMMITTEE
DCOP DEPUTY CHIEF OF PARTY
DHIS-2 DISTRICT HEALTH INFORMATION SYSTEM-2
DLSI DIVISION OF AIDS/STI CONTROL
DOT DIRECTLY OBSERVED TREATMENT
DPRS DIRECTORATE OF PLANNING, RESEARCH, AND STATISTICS
DSDOM HOME-BASED CARE PROVIDER
DSME DIRECTORATE OF MATERNAL HEALTH AND CHILD SURVIVAL
ECD DISTRICT MEDICAL TEAM
ECR REGIONAL MEDICAL TEAM
EPOA ENHANCED PEER OUTREACH APPROACH
FP FAMILY PLANNING
FSW FEMALE SEX WORKER
GBV GENDER-BASED VIOLENCE
GHSC GLOBAL HEALTH SUPPLY CHAIN PROGRAM
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HD HEALTH DISTRICT
ICP HEAD NURSE iCVAC INTEGRATED COMMUNITY WATCH COMMITTE
IHS INSTITUTE FOR HEALTH RESEARCH
IMCI INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES
IMU INTEGRATED MOBILE UNIT
IPT INTERMITTENT PREVENTIVE THERAPY
ISD-HB INTEGRATED SERVICE DELIVERY & HEALTHLY BEHAVIORS
LLITN LONG-LASTING INSECTICIDE-TREATED BEDNET
LTPM LONG-TERM AND PERMANENT METHOD
MAM MODERATE ACUTE MALNUTRITION
MNCH MATERNAL, NEWBORN, AND CHILD HEALTH
MR MEDICAL REGION
MSAS MINISTRY OF HEALTH AND SOCIAL ACTION
MSM MEN WHO HAVE SEX WITH MEN
ORS ORAL REHYDRATION SALTS
PAFP-AAY POST-ABORTION FAMILY PLANNING ADAPTED TO ADOLESCENTS AND YOUTHS
PECADOM HOME-BASED CARE
PEPFAR PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF
PHF PUBLIC HEALTH FACILITY
PIPE INFECTION PREVENTION AND ENVIRONMENTAL PROTECTION
PLHIV PEOPLE LIVING WITH HIV
PNA NATIONAL PROCUREMENT PHARMACY
PNC POSTNATAL CARE
PPFP POST-PARTUM FAMILY PLANNING
PRA REGIONAL PROCUREMENT PHARMACY
PSNSC NATIONAL COMMUNITY HEALTH STRATEGIC PLAN
RB REGIONAL BUREAU
SBCC SOCIAL AND BEHAVIOR CHANGE COMMUNICATION
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SDP SERVICE DELIVERY POINT
SFE STATE REGISTERED MIDWIFE
SIMS SITE IMPROVEMENT THROUGH MONITORING SYSTEM
SNEIPS NATIONAL EDUCATION AND HEALTH INFORMATION SERVICE
TLD TENOFOVIR/LAMIVUDINE/DOLUTEGRAVIR
VADI INTEGRATED HOME VISIT
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Table of Contents
List of Abbreviations and Acronyms ...... 3
1. Project Overview ...... 7 1.1. Summary Table ...... 7
1.2. Project Description ...... 8 Introduction ...... 8
Background ...... 8
USAID/Neema project objectives and strategies ...... 9 2. Achievements this quarter ...... 1
2.1. Progress on challenges identified last quarter ...... 1 2.2. Achievements this quarter by sub-component ...... 2 Objective 1: Increased access to and utilization of quality health services and products in the public sector ...... 2
Objective 2: Increased adoption of healthy behaviors ...... 23
Monitoring & Evaluation, Research, and Learning...... 26 Project management and coordination ...... 27
UNPLANNED ACTIVITIES ...... 29 MAIN CHALLENGES AND SOLUTIONS ...... 30
3. Cross-cutting issues ...... 30
4. Main activities planned for next quarter ...... 33 5. Annexes ...... 34
Annex 1: Progress on Work Plan/Indicators ...... 35 Annex 2: Financial Report ...... 40
Annex 3: Tutorat 3.0 implementation in intervention medical regions ...... 41
Annex 4: Summary of the implementation of FP-vaccination strategies ...... 44 Annex 5: Summary of results of implementation of integrated mobile units ...... 45
Annex 6: HIV Data summary ...... 46
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1. PROJECT OVERVIEW
1.1. SUMMARY TABLE
Project name: USAID/Neema
Integrated Service Delivery and Healthy Behaviors (ISD-HB)
Project Dates: September 1, 2016–August 31, 2021
Name of Implementing Partner: IntraHealth International
Cooperative Agreement No.: AID-685-A-16-00004
Name of AOR: Fatou Ndiaye
Name of Subcontractors or Consortium National Alliance of Communities for Health (ANCS) Members: ChildFund Helen Keller International (HKI) Johns Hopkins University/Center for Communication Programs (JHU/CCP) Réseau Siggil Jigéen (RSJ)
Geographic coverage (by regions): USAID Health Program Concentration Regions: Diourbel – Kédougou – Kolda – Matam – Saint Louis – Sédhiou – Tambacounda Additional regions with HIV/AIDS hot spots: Dakar, Mbour, Ziguinchor
Reporting period: October 1, 2019–December 31, 2019
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1.2. PROJECT DESCRIPTION
INTRODUCTION
The Integrated Service Delivery and Healthy Behaviors (ISD-HB) project, called “USAID/Neema,” supports the efforts of the Government of Senegal to ensure health services are sustainably improved and effectively utilized to reduce maternal, neonatal, and child mortality and morbidity and contribute to an AIDS-free generation.
The project is implemented in the USAID Health Program 2016– 2021 regions of concentration: Diourbel, Kédougou, Kolda, Matam, Saint Louis, Sédhiou, and Tambacounda. The project is implementing the President's Emergency Plan for AIDS Relief (PEPFAR) program in sites in Pikine, Mbour, Ziguinchor, and at the Institute for Health Research (IHS).
The ISD-HB project is implemented by IntraHealth in partnership with the National Alliance of Communities for Health (ANCS), Réseau Siggil Jigéen, ChildFund, Helen Keller International (HKI), and Johns Hopkins University/Center for Communication Programs (JHU/CCP).
BACKGROUND
Senegal has made notable achievements in health, especially in maternal, newborn, and child health and family planning (MNCH/FP) over the last two decades. It is one of the highest performing countries in reducing mortality for children under 5 years (among infants and children) in Africa, and it has nearly doubled its prevalence rate for modern contraception since 2010, increasing from 12%1 to 21%2 in 2015. These efforts are the result of the Senegalese government’s strong commitment to promote health-sector accountability through policies, strategies, and plans committed to reproductive health (RH) and MNCH/FP, HIV and malaria control, and nutrition.
Despite this progress, challenges remain. These include the unequal use of high-impact interventions aimed at reducing maternal and newborn mortality and their extension at institutional level, ongoing stockouts of essential medicines and commodities, delayed recourse to health care, geographic barriers hindering access
1DHS-MICS 2010–2011 2c-DHS 2015 USAID/Neema October 1–December 31, 2019 Quarter Report
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Also, significant disparities persist in terms of gender and at regional level. The Government of Senegal has an unprecedented opportunity to overcome these challenges and achieve its vision outlined in the Plan for an Emerging Senegal (Plan Sénégal Émergent; PSE) through the USAID/Neema project of the USAID Health Program.
USAID/NEEMA PROJECT OBJECTIVES AND STRATEGIES
The USAID/Neema project’s main objectives by 2021 are:
• Increased access to and utilization of quality health services and products in the public sector • Increased adoption of healthy behaviors
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2. ACHIEVEMENTS THIS QUARTER
2.1. PROGRESS ON CHALLENGES IDENTIFIED LAST QUARTER
Issues/Challenges Solutions implemented this Lessons learned and observations identified last quarter quarter
1) Actual launch of the PEPFAR2) Implementation of the unique PEPFAR program implementation program beginning on identification code improved treatment and care for key October 1st in the 4 sites,3) as Implementation of new approaches populations in the 4 sites: An required (index testing and the Enhanced increased number of positive cases, Peer Outreach Approach (EPOA)) better link to treatment, and 4) Printing and implementation of strengthening of the monitoring- management tools evaluation system Implementation of a data quality auditing system
5) Start of provider training6) on Providers were trained on gender gender mainstreaming and mainstreaming and GBV in the gender-based violence (GBV) districts of Diourbel medical region in care delivery (MR), and district medical teams and regional medical teams (ECDs/ECRs) of the Tambacounda and Kolda MRs were also trained.
7) Inadequate financial 8) Focus on low-performing districts resources for implementing activities and the need to achieve program objectives
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2.2. ACHIEVEMENTS THIS QUARTER BY SUB-COMPONENT
OBJECTIVE 1: INCREASED ACCESS TO AND UTILIZATION OF QUALITY HEALTH SERVICES AND PRODUCTS IN THE PUBLIC SECTOR
SUB-OBJECTIVE 1.1: INCREASED COVERAGE AND UTILIZATION OF EVIDENCE-BASED, SUSTAINABLE, HIGH-IMPACT INTERVENTIONS IN HOUSEHOLDS AND HEALTH FACILITIES
Activities planned for the quarter Achievements: Implementation Outputs or outcomes achieved status
SCALE UP A PACKAGE OF HIGH-IMPACT MATERNAL, NEWBORN, AND CHILD HEALTH PRACTICES IN SERVICE DELIVERY POINTS (SDPS) BASED ON LESSONS LEARNED
Overall, 124 on-site coaching visits were conducted this quarter, including 74 first visits and 50 second visits. During the quarter, 122 service delivery points (SDPs) received on-site coaching, or 20% of SDPs in the intervention area. Since the start of the project, 538 SDPs have received at least one on-site coaching visit, or 86% coverage, and 174 SDPs have received a second on- Support on-site coaching of providers site coaching visit for the same package, or 29% coverage (for details, see Tutorat 3.0 implementation by tutors in the 7 concentration Annex 3). regions Overall, 2307 individuals have been coached on site since the start of on- site coaching, including 1296 qualified providers and 1001 non-qualified providers. The contributions this quarter from various actors involved in implementing the approach are estimated at 32,344,950 FCFA (54,256 USD), with the majority of the funds distributed as follows:13,000,000 FCFA (21,807 UDS) for construction, 10,438,000 FCFA (17,509 USD) for
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renovations/restorations, and 7,965,000 FCFA (13,331 USD) to acquire medicines and commodities. Notable key in-kind accomplishments include: - Construction/renovations/layout: Delivery room in Ndoulo health post and housing for the midwife at Keur Ngana (Diourbel health district (HD)); maternity ward in Diana health post (Diankhé Makha HD) - Equipment/commodity purchases: Poupinel, autoclave, delivery tables, delivery kits - Hiring of one midwife at Keur Mbaye Sarr health post (Diourbel HD)
Supervision of on-site coaching in the 78 tutors reached in 12 districts. After the supervisions, the following key HDs of Diourbel, Médina Yoro Foulah, recommendations were made: Sédhiou, Bakel, Dianké, Tambacounda, For tutors: Kédougou, Saraya, Thilogne, Richard - Write the final report and submit it on the platform on time Toll, Pété, and Podor - Monitor the action plan before the second visit For districts: - Inform SDPs and all relevant stakeholders well in advance for greater participation in meetings to share results
Advocacy sessions in the municipalities of Linkering, Médina Gounass, Advocacy and raising awareness about Diaobé-Kabendou, and Sinthian Koundara in collaboration with GOLD, the malaria at the Vélingara HD level MR, and Vélingara HD
Support the district to train new border home-based care providers (DSDOMs) Support for malaria control 5 new border DSDOMs trained to provide home-based care (PECADOM+)
Participation to develop malaria 2 planning sessions resulted in developing: control action plans for districts and - 14 regional malaria control plans medical regions - 32 malaria control acceleration plans in 32 control districts
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- 36 malaria elimination plans in 36 districts
Support for provider training sessions 12 state registered midwives (SFEs) trained, including 4 from Kolda HD, 5 in on post-partum family planning Vélingara, and 3 in Médina Yoro Foulah. (PPFP)/subcutaneous Depo-Provera In total for this quarter, 3736 clients were enrolled in the 7 concentration via self-injection in the ECDs/ECRs of MRs. Kolda MR
- 58 providers supervised, including 54 SFEs, 2 state registered nurses, and 2 assistant state registered nurses The following strengths were noted: - Availability of insertion kit for long-term and permanent methods (LTPMs) and post-partum intrauterine device (PP/IUD) in visited SDPs in Tambacounda region Support to hold integrated MNCH/FP - The FP file is properly stored in the visited SDPs supervision at HD level in Bakel, - Availability of communication materials, especially Tiahrt amendment Family planning Tambacounda, Kidira, Thilogne, posters and displays, in all SDPs Matam, Kanel, and Ranérou HDs - PPFP services delivery is available in facilities where providers have been trained Areas for improvement are insufficient availability of FP files and cardboard folders to archive FP consultation files. Following the supervision, a plan to address identified gaps and constraints was developed and shared with providers and the ECD.
Support to organize 4 Door Days in the Overall, 216 new users were enrolled, including 92 for LTPMs, distributed as districts of Kédougou (Kédougou MR), follows: 56 new users in Bambey, 54 in Diourbel, 31 in Kédougou, and 75 in Tambacounda (Tambacounda MR), Tambacounda. and Diourbel and Bambey (Diourbel At the same time, 23 women screened for cervical cancer, with the following MR) results: 20 negative results, 1 suspected case referred for a pap smear, and 2 cases treated.
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General recommendations: - Plan for future Open Door Days with providers during coordination meetings - Maximize community-based organization involvement in the planning activities
Support to organize information sessions and delivery of FP services Overall, 268 sessions in 88 SDPs reached 5951 individuals, including 5698 during vaccinations at SDP level in women. Kédougou, Bounkiling, Goudomp, These sessions enrolled 1800 new FP clients, distributed as follows: Pill: 277, Diourbel, Touba, Mbacké, Matam, Injectable: 826, Implant: 566, and IUD: 131. (See Annex 4) Thilogne, and Kanel HDs
Support for implementation of the - The 14 FP acceleration plans for regions for 2019–2020 are available acceleration phase of the National - Targets for FP activities by district are available Strategic Framework for Family - An orientation for ECRs on using FP performance monitoring sheets is Planning (CSNPF) 2019–2020 complete
45 SDPs were visited in the two regions of Tambacounda (20) and Matam (25) Overall, 58 providers were supervised, including 54 SFEs, 2 state registered nurses, and 2 assistant state registered nurses. These findings were reported: Strengths: Support for integrated supervision of - Availability of Policies, Standards and Protocols documents for maternal, newborn, and child health reproductive health and child survival in consultation rooms Maternal and newborn health (MNCH) and family planning in Bakel, - Overall availability of decontamination solutions and a poster specifying Tambacounda, Kidira, Thilogne, the formula for preparing decontamination solution displayed in Matam, Kanel, and Ranérou HDs consultation and delivery rooms - Good availability of step-on trash cans in the visited SDPs - Availability of Syntocinon, magnesium sulfate, and urine dipsticks in almost all visited SDPs - The various skills were evaluated for delivery of focused antenatal care (ANC), essential newborn care, and active management of the third stage
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of labor (AMTSL). Areas for improvement: - Insufficient hand-washing - Shortcomings in the use of standards and protocols when administering care - No ventouse delivery at SDP level - No manual vacuum aspiration syringes at over half of SDPs - No functioning ambulances in some SDPs - Performance continues to need improvement overall in the delivery of newborn resuscitation, obstetric ventouse delivery, manual vacuum aspiration services, and in the filling-out the partograph Recommendations Provide supplies to SDPs with gaps (obstetric ventouse delivery, manual vacuum aspiration) Strengthen SDPs through supervision and on-site coaching to fill skills gaps, especially new-born resuscitation, post-abortion care, and the partograph Plans to resolve gaps were developed and shared with all actors.
Support for the Directorate of Maternal Documentation of best practices and lessons learned for vitamin-A Health and Child Survival (DSME) to supplementation throughout the nationwide routine system is underway. It disseminate the documentation results is based on the WHO 6 pillars of the health system, with support from two and to advocate for increased actor international consultants. engagement in routine vitamin-A The report is being completed, and the project will provide support to supplementation disseminate the results.
Nutrition Overall, 41 facilities (including 5 health centers, 26 health posts, and 10 Continuation of integrated nutrition- health huts) were visited. child-survival supervisions in the 52 health workers (26 women) were supervised, including 39 providers and districts of Tambacounda, Maka 13 community actors. Colibantang, Koumpentoum, Dianké Performance rates reported by the district hover around 60% for the various Makhan, and Goudiry in Tambacounda domains, namely, integrated management of childhood illness (IMCI), MR nutrition, WASH, and commodities/medicines. Strengths:
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- Strong commitment from supervised providers and community groups in districts - Availability of equipment for anthropometric measurements for children (scale, measuring stick, and mid-upper arm circumference (MUAC)) - Mastery of techniques for taking anthropometric measurements in the majority of visited SDPs - Good availability of fortified flour in most SDPs Areas for improvement: - Under-reporting of vitamin A and mebendazole in tools in some SDPs - Stockouts of some medicines and commodities used to treat childhood illnesses Immediate recommendations for the region: Complete supervision in other SDPs in involved districts and fix the plumpy nut stockout
Evaluation of malnutrition screening indicators for children under 5 and Continue support for the pregnant women DSME/Division of Food and Nutrition Performance evaluation of management of acute malnutrition at site level (DAN) in nutritional surveillance Routine surveillance data was reported in the Division of Food and Nutrition through supervision of the Médina model. Wandifa sentinel site (Bounkiling HD) Changes in indicators for the site were assessed.
Supervision was rolled out in Tambacounda region and involved 5 health districts, namely: Tambacounda, Goudiry, Diankémakha, Makacolibantang, and Koumpentoum. Support Tambacounda MR in Overall, supervision took place in 41 facilities, including 5 health centers, 26 Child survival integrated supervision of child survival health posts, and 10 health huts.
and nutrition 52 providers, including 26 women, were supervised, of whom 39 were qualified and 13 were community actors. Performances reported by district in IMCI and drug management are 60% and 59%, respectively.
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- Participation on a Scientific Panel on World Pneumonia and Prematurity Day in Dakar Participation in DSME activities - Participation in online training for national trainers in IMCI (Ministry of Health and Social Action (MSAS) e-learning portal)
- Meeting of the Virtual University of Senegal, the DSME, and USAID/Neema Production of video clips used as on producing teaching videos for the case management guide for teaching tools for the case pediatric emergencies management guide for pediatric - Participation in preparatory days to produce video clips on pediatric emergencies emergencies
Support to train trainers on the case Two training workshops were organized following two tracks: management guide for pediatric - Tambacounda track: 22 individuals trained, including 16 men emergencies - Thiès track: 23 providers introduced, including 18 men
At the 10 new supported posts, 8261 individuals were seen for a primary health care consultation, 727 pregnant women for ANC, 159 assisted births were performed, 339 women who had just given birth received PNC, 1422 Strengthening of services delivery in children were vaccinated, 913 children were supplemented in vitamin A, 132 the HDs of Diankhé Makha, Vélingara, cases of diarrhea and 80 cases of moderate acute malnutrition Support proper functioning of new Médina Yoro Foulah, and Kolda (MAM)/severe acute malnutrition among children age 0–5 years were seen, posts 294 clients were enrolled in FP, 1229 active clients received FP services, and 79 integrated advanced strategies and 95 awareness-raising sessions were conducted.
Branding for new health posts Delivery of 10 identification plaques to the new health posts
ENSURE THAT CHWS OFFER AN INTEGRATED PACKAGE OF HIGH-IMPACT SERVICES COVERING BOTH PREVENTION AND CARE
In this first quarter, facilitators supported head nurses (ICPs) to monitor 117 Complete the system to implement a Monitoring of implementation of the of the 1895 huts and sites (6%) located in 14 districts in the regions of Saint community services package community services package adapted Louis (5 HDs), Matam (4 HDs), and Tambacounda (5 HDs).
USAID/Neema October 1–December 31, 2019 Quarter Report 8 adapted to adolescents/youths in to adolescents/youth in 117 huts and Monitoring results showed that 114 huts/sites have a trained sites and huts sites. adolescent/youth aid, 114 have at least one CHA trained in adolescent and youth reproductive health (AYRH), and activities targeting adolescents and youths are conducted and documented.
ENSURE THAT AN INTEGRATED PACKAGE OF HIGH-IMPACT SERVICES IS AVAILABLE AT THE HOUSEHOLD LEVEL
Supervision is conducted in 13 community facilities, including 8 huts and 5 sites. Also, 29 CHAs were supervised. Continue monitoring the Findings: implementation of essential nutrition Increased delivery of the nutrition package in some SDPs with counseling actions and essential hygiene actions Support to supervise nutrition/WASH on best nutrition practices, the availability of flour in some SDPs, and routine at community level (huts, sites, and activities in Sédhiou HD screening of children in for a consultation. community-based organizations) in However, a stockout of a few medicines (albendazole and oral rehydration synergy with Kawolor and ACCES salts (ORS)) and no growth monitoring were reported, and recommendations were formulated and shared during a restitution meeting attended by the chief district medical officer (MCD).
30 members of 6 community groups were trained in Kouthia Gaidy Continue to support stakeholders Training for stakeholders’ groups on municipality (Koumpentoum HD). groups to ensure availability of flour producing fortified flour at the Koutia After this training, 118 kg of flour was produced. The training was made and management of MAM Gaidy town hall possible when the mayor followed through on his commitment made after the project advocacy activity about the high malnutrition rate in the area.
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Monitoring of flour production in the 39 groups were monitored and produced 1776 kg of flour. districts of Goudomp, Sédhiou, In total, 1894 kg were produced for the quarter. Bounkiling, Kolda, Médina Yoro Foulah, In the Tambacounda area, 87 children 6–59 months with MAM, 56 healthy Maka Colibantang, Koumpentoum, children, 48 pregnant women, 62 breastfeeding women, and 22 women who Bakel, Goudiry, Saraya, Richard Toll, recently delivered received flour. and Ranérou
The USAID/Neema project in synergy with the USAID/ACCES project Completion of installation of hand- completed installation of the remaining 150 hand-washing stations in washing stations in households in Goudiry district in Sinthiou Mamadou Boubou and Sinthiou Bocar Aly Tambacounda region municipalities with support from hygiene services. Continue installation of hand- washing stations Hand-washing station installation 1700 hand-washing stations were installed in vulnerable households in Saint activities and awareness-raising Louis region: 700 in Saint Louis HD, 500 in Dagana HD, and 500 in Richard activities on best hygiene practices are Toll HD. being continued in Saint Louis region.
Continue support for hygiene Monitoring visits in the HDs of 312 households visited: 2496 individuals sensitized on maintaining hand- services to monitor the use of hand- Médina Yoro Foulah, Kolda, and washing stations and best hygiene practices. washing stations Vélingara
Supervision of 10 community-based infrastructure facilities (4 huts and 6 sites) in Kolda district 26 CHAs were supervised, including 12 CHAs (5 women) at health hut level and 14 CHAs (9 women) at site level. Ensure huts and sites remain Supervision of huts, sites, and Key findings: good level of functionality for 3 of the 4 visited huts and 4 of functional community groups in Kolda district the 6 visited sites; good community engagement, as demonstrated by the
communities’ contribution to construct the new hut in Iliyao. Defective Salter scales along with the stockout of some commodities (ORS and misosprostol) were noted as areas for improvement. Recommendations were made to address these gaps.
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Complete the system to implement Monitoring of the VADI approach in VADI monitoring involved 108 health huts and sites, distributed in all 9 HDs the integrated home visit (VADI) Matam and Saint Louis MRs of Matam (52) and Saint Louis (56). approach using the revised methodology and tools in sites and huts
717 members (including 518 women) from 48 iCVACs (or 33% of annual Training for iCVAC members in the forecasts). Trained iCVAC members included: Female leaders (244); trained districts of Saint Louis, Dagana, Podor, CHAs (271); community leaders (78); village heads, public figures, imams, Pété, Kanel, Sédhiou, and teachers, and Koranic school instructors (32); positive male head-of household role models (32); positive female role models (20); Koumpentoum adolescents/youths (20); health development committee and/or health mutuelle members (20).
Implement the iCVAC strategy using CVAC monitoring reached 558 members (including 394 women) from 91 the revised methodology and tools in trained CVACs (67 iCVACs and 24 CVACs for maternal and newborn health). sites and huts The member profiles for those who were met included: female leaders (307); male community leaders (159); CHAs (25); positive female role models (60); Monitoring of CVAC in Saint Louis, health development committee or health mutuelle members (7). Kanel, Kolda, Tamba, Koumpentoum, Follow-up activities involved clarifying members’ roles and responsibilities, Kidira, and Bakel HDs particularly the core network among women leaders, a review of CVAC tools, and discussions about problems encountered. The results show that 85 out of 91 (or 93%) of CVACs are functional (meeting regularly, conducting and documenting completed activities); the 6 low- functioning CVACs are located in Kidira HD.
SUB-OBJECTIVE 1.2: LINKAGE BETWEEN COMMUNITY AND FACILITY PLATFORMS IS STRENGTHENED AND SUSTAINED
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
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IMPROVE OVERALL CHA COVERAGE
Support maintaining a well functioning Update mapping of huts and sites for health Mapping data on community-based actors, services, and CHA network, working in the 29 districts of posts in Tambacounda MR infrastructure for huts and sites of the 36 health posts (of the 53 the 7 USAID/Neema intervention regions planned health posts, or 68% performance rate) are being updated. Data collection and analysis for the remaining 17 health posts is underway.
INTEGRATION OF COMMUNITY HEALTH INTO THE HEALTH SYSTEM
126 out of 443 (or 28%) implemented Referral Management Systems were monitored in 15 HDs: Saint Louis (5), Richard Toll (10), Podor (12), Pété (8), Kanel (5) Ranérou (7), Thilogne (4) Diakhé (5), Goudiry This quarter, 15 districts provided (7), Kidira (5), Bakel (4), Matam (16), Tambacounda (30), Kolda (4), monitoring to ensure the emergency referral and Bounkiling (4). Maintain functioning of emergency referral system implemented by communities in the Results: 95 community members (including 72 women) used the systems implemented in 443 communities, 4 regions of Saint Louis, Matam, implemented systems; half, or 48 women, were pregnant or in labor; distributed in the 29 HDs Tambacounda, and Sédhiou functioned 27 (or 28%) were children 0–5 years; 5 (or 5%) were continuously adolescents/youths (10–19 years); and the remaining were age 20 years and older. Reasons for the referral were related to neonatal and obstetric emergencies, malnutrition, and childhood illnesses, medical conditions, and trauma.
Overall, 24 huts and 9 sites were visited. Strengths noted for this supervision were: compliance with storage conditions, provision of stock sheets by the project, availability of Continued support provided to ECDs/ICPs certain inputs (ACT, rapid diagnostic tests, and Sayana Press), and Support the ECDs/ICPs in logistics for logistics supervision of health huts and on-site strengthening of community care workers’ (CCWs) supervision of health huts and DSDOMs PECADOM sites in Vélingara district knowledge on the guidelines for filling out stock sheets, inventory, and ordering procedures. However, the regularity and effectiveness of logistics supervisions and management of expired products must be improved.
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The following recommendations were formulated: - Provide formal and routine logistics supervision at all health huts and PECADOM sites, conducted by ICPs - Ensure expired inputs are traceable and that they are destroyed (CCWs)
Support the Community Health Unit to implement, coordinate, and monitor the PSNSC at the national, regional, and health district level
- Proofreading and submission of the draft Support the community health unit (CSC) PSNSC 2019–2023 document by the to validate, print, and implement the consultants The “advanced” draft of the PSNSC 2019–2023 document is National Community Health Strategic Plan - Document review by the technical available. Its finalization and validation are planned for next quarter. (PSNSC) 2019–2023 committee for institutional validation is underway
- 3 meetings of local community health management committees were held: 2 in Sédhiou region (Sédhiou district) and 1 in Kolda region (Vélingara district) - 27 people (including 5 women), made up of ICPs, sub-prefects, local officials, health committee members, community-based organizations/civil society organizations, and resource persons participated in the meetings Community health coordination bodies held The main recommendations are: Provide technical support to hold in Sédhiou and Kolda with the participation coordination bodies for community health of administrative officials - Provide huts with: water points, and essential medicines and commodities in visited community facilities - Review the portion allocated to health huts in the distribution of the district endowment fund - Support health posts to motivate CHAs - Advocate among local municipalities to support community health - Strengthen monitoring of commitments taken by elected officials
USAID/Neema October 1–December 31, 2019 Quarter Report 13
Support the CSC to train focal points on Start training sessions in Saint Louis on -Three (3) focal points (including 2 women) and 11 ECR and ECD community health management in the 7 community health management (community members from Saint Louis (including 5 women) introduced intervention regions health concepts, standards, tools, and materials)
Support districts to ensure community access to professional services
The 4 UMIs of Kolda, Sédhiou, Diourbel, and Saint Louis conducted 59 visits and offered 11,086 services (averaging 188 per visit) and an overall quarter performance of 43% (59/144). During these visits, 302 FP clients were seen, including 147 new program enrollees, and 79 adolescents and youths, 10–24 years. 414 pregnant women received their ANC consultation, with 383 (93%) having taken intermittent preventive therapy (IPT) under directly observed treatment (DOT); 83 deliveries included PNC and 22 new mothers received a long-lasting insecticide-treated bednet (LLITN). Support MRs and districts to organize During this first quarter of Year 4, integrated mobile team activities in the regions of mobile units (IMUs) made visits in the MRs of For screening activities, 799 individuals were tested for cervical Diourbel, Kolda, Saint Louis, and Sédhiou Diourbel, Saint Louis, Sédhiou, and Kolda cancer (208), breast cancer (469), and HIV (122). For the target (0–5 years), 1394 children 6-59 months were screened for malnutrition, 998 children 6–59 months received vitamin-A supplementation, 863 children 12–59 months where dewormed, 651 children 0–23 months were vaccinated, and 179 were seen for a pediatric consultation. Overall, 3590 individuals were reached through social and behavior change communication (SBCC) activities. For more details see Annex 5.
Strengthening community and local-municipality participation in community health, especially for youth
Support communities through community action cycles to address specific, local health priorities
USAID/Neema October 1–December 31, 2019 Quarter Report 14
Support covering ICPs and midwives to 27 trainers (including 11 women) were 16 ICPs/midwives (including 8 women) supported by 11 facilitators train 129 community groups at site level to supported to hold training sessions for CAC (including 8 men) organized and facilitated 14 of the planned 129 set up the community action cycle on groups in 14 HDs, from the 3 MRs of sessions (or 11%) in the HDs of Touba (2), Bakel (2), Kidira (6), gender-based violence (CAC-GBV) Diourbel, Tambacounda, and Kolda Mbacké (1), Tambacounda (1), Kolda (1), and Vélingara(1).
During the first quarter, 53 out of 167 planned CAC-GBV groups (or 32%) were trained in the 14 HDs in 4 regions: Diourbel (20), Support the 167 community groups The 14 districts organized training for CAC- Tambacounda (15), Kédougou (15), and Kolda (3). Trained groups selected in the member orientation on GBV groups to implement activities to included: 11 groups for adolescent girls (10–14 years); 14 coed CAC-GBV and implementation of the combat GBV in 4 MRs: Diourbel, adolescent groups (15–19 years); 9 grandmothers’ groups; 4 male strategy Tambacounda, Kédougou, and Kolda heads-of-household groups; and 15 mothers’ groups. Overall, 775 group members (including 602 women) finished with good progress for knowledge on the post test.
Support monitoring and supervision of The ECDs/ICPs/midwives supported by the 24 supervisors (including 7 women), who were mostly providers (18) strategy implementation in 357 CAC-GBV project organized the supervision of groups and facilitators (6), monitored the groups in 54 CAC-GBV sites sites, spread out in 28 districts in the CAC-GBV sites in the 5 regions of Saint throughout the intervention area. Louis, Diourbel, Tambacounda, Kolda, and 4 synergy committees in Tambacounda and 92 groups were Kédougou. monitored in the 54 CAC-GBV sites: 10 groups for adolescent girls Activities are related to evaluating the (10–14 years); 13 coed adolescent groups (15–19 years); 24 functionality of synergy groups and grandmothers’ groups; 20 male heads-of-household groups; and 25 committees and the action plan review to mothers’ groups. assess the status of activity progress. Overall, 1068 group members (including 692 women) finished. Results showed that nearly all the groups are up and running, that a large majority (77 out of 92, or 84%) are on the first cycle, and that the remaining 15 groups have completed the first cycle and should start the second cycle. In Tamba, 39 of the 40 synergy committees are up and running in the CAC-GBV sites.
Collaboration with other projects to strengthen local municipalities’ skills in supervising and supporting health huts
USAID/Neema October 1–December 31, 2019 Quarter Report 15
Technical support for Sédhiou HD to 4 ICPs, 3 sub-prefects, 6 local officials, and 32 resource persons organize 2 joint monitoring visits (including 11 women) participated in the activity. Completed activities: site visits; interviews Results: Commitments from local municipalities to support the with CHAs, leaders, and some beneficiaries operations of community-based structures through financial on community health management, current support and medicines needs, and challenges Provide technical support to organize joint monitoring visits with local officials A good achievement level was noted for commitments: Kolda HD: 500,000 FCFA (839 USD) mobilized by the community to Monitoring of commitments, included as build new premises for the Ilyao health hut. part of supervision in Kolda and Bounkiling Bounkiling HD: endowment of 100,000 FCFA (139 USD) in medicines HDs by the mayor and electrification of the Kandialon hut by the health committee. Tiling and plastering of the Bassada hut by the health committee for 50,000 FCFA (70 USD).
19 of the 60 planned community dialogue sessions (including 3 in Sédhiou, 4 in Matam, 4 in Tamba, 4 in Saint Louis, 1 in Diourbel, 2 in Organize community dialogue sessions to The project supported organization of Kolda, and 1 in Kédougou) were conducted, or a performance rate identify barriers related to health services’ dialogue sessions in the 7 intervention of 31%. quality regions. Major outcomes: hiring of a midwife by the mayor of Bandafassi; involvement of the people from Oudoucar, Bambaly, and Djirédjie in Sédhiou department to oppose home births and late ANC
- 6 of the 60 planned shows were produced with citizens radio clubs Organize shows produced with citizens Production of citizens radio club shows in - Topics covered are: family planning and enrolling women in health radio clubs Saint Louis, Diourbel, and Kédougou mutuelles
Mobilize resources from mayors’ Mobilization of domestic financial resources - In Sédhiou, the mayor of Bona renovated the Soumboudou health commitments from the mayors of Ngoye (Bambey), Bona post for the amount of 4 million FCFA (6709 USD).
USAID/Neema October 1–December 31, 2019 Quarter Report 16
(Sédhiou), Mbane (Dagana), and Bani Israel - In Dagana, the mayor of Mbane provided one million FCFA (1680 (Diankhe Makha) USD) to community-based organizations, dedicated to the organization of two cervical cancer screening days and delivery of FP commodities. - In Bambey district, the mayor of Ngoye provided 1,000,000 FCFA (1680 USD), allocated to the commune’s 6 health huts and the health posts of Batal, Gourgourène, and Ngoye. - In Bani Israël, the mayor issued 500,000 FCFA (839 USD) to the health development committee to purchase an electric battery and to enroll 106 women in the mutuelle.
The supervision of community commitments noted the following results: Provide coordination, monitoring, and - Hiring of a midwife in Bani Israel health post (Dianke Makha by evaluation of interventions implemented Organization of monitoring visits at local the health development committee) to strengthen advocacy and community level in the 7 intervention regions - Training of 32 women on producing fortified flour dialogue - The Orkadiéré mayor’s renewal and commitment of 3 million FCFA (5032 USD)
SUB-OBJECTIVE 1.3: QUALITY SERVICES AT HOUSEHOLD, COMMUNITY, AND SDP LEVELS ARE IMPROVED AND SUSTAINED
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
STRENGTHEN CAPACITIES OF HEALTH WORKERS AT HEALTH CENTERS, HEALTH POSTS, AND HEALTH HUTS TO IMPLEMENT PROCESSES TO IMPROVE SERVICES QUALITY
26 individuals, including 21 women, participated in this session. The audit reported 8 cases of maternal death. For this grouping, 7 deaths Support regions to conduct maternal and A session for maternal death audits were definitely preventable and were due to hemorrhage, and 1 non- newborn death audits at health district and supported at Ndamatou PHF level in preventable death was caused by infection. public health facility (PHF) level Touba in Diourbel region The definitely preventable deaths were secondary to dystocia (2 cases of uterine rupture), postpartum hemorrhage (3 cases), and preeclampsia complications (2 cases of retroplacental hematoma).
USAID/Neema October 1–December 31, 2019 Quarter Report 17
Contributing factors to the deaths were a delay in care delivery related to a poor initial assessment at admission, a delayed referral, a late diagnosis of dystocia during labor, and postpartum hemorrhage after delivery. An action plan was developed and solutions to identified problems were proposed along with someone to oversee monitoring. Strengths: - Audit sessions held regularly - Heads of medical services who are involved attend all audit sessions - Audit files filled out and available for each case of death - Mbacké and Touba districts attend the meeting to share results Areas for improvement: - Presence of pediatricians during audits - Presence of other representatives from facilities that have referred deceased patients - Audit of cases of newborn deaths Recommendations were formulated for monitoring the action plan and sharing audit results during district coordination meetings (Mbacké and Touba)
STRENGTHEN CAPACITIES OF THE PUBLIC HEALTH AND LOCAL GOVERNANCE SYSTEMS TO SUPPORT AND MONITOR HEALTH SYSTEM PERFORMANCE AND Q UALITY
Grant subawards to medical regions and The selection and validation process for Selected deliverables are: districts in concentration areas to ensure deliverables for Year 4 began during this Health districts: On-site coaching and supervision of tutor visits availability of high-impact quality services quarter. conducted by ECD members Medical regions: regional Tutorat 3.0 reviews and supervision of providers in health huts upgraded to health posts in Kolda and Tambacounda
Support the Directorate of Human Preparatory phase for setting up a Development of strategic documents to set up national accounts and Resources (DRH) to set up a national health national health workforce account with submission to officials for signatures: steering committee, technical workforce account the Directorate of Human Resources, the committee, and an order to appoint a country focal point Directorate of Planning, Research and Statistics (DPRS), WHO, and the
USAID/Neema October 1–December 31, 2019 Quarter Report 18
USAID/Neema project
SUB-OBJECTIVE 1.4: KEY POPULATIONS IN TARGET AREAS ARE TESTED, ENROLLED ON ANTIRETROVIRAL THERAPY, AND PROVIDED QUALITY CARE IN ALIGNMENT WITH THE “90-90-90” GOALS
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
1.4.1. MONITORING-EVALUATION OF THE CARE CASCADE AND TREATMENT OF INDIVIDUALS FROM KEY POPULATIONS AND THEIR PARTNERS (M&E)
Organize a monthly mission to supervise, 15 supervisions, including 12 by the Overall, 63 actors, including 26 women, were supervised. collect, and check data quality for community peripheral level and 3 by the central level, Data were checked and validated after corrections. Coaching was actors organized in the sites provided to 4 supervisors and to mediators with the goal of improving interventions. The key recommendations were: - Ensure management tools are properly filled out - Coach mediators on risk assessment - Verify clients’ eligibility for testing
Supervision of the EPOA campaign combined with a data quality audit was conducted in each site. This supervision made it possible to reach 10 providers, including 5 men, and 21 community actors and resulted in: Organize missions to supervise, collect, and Supervision and audit of data quality and - Fixing shortcomings in coupon distribution and in check data quality for sites conducted by the management of the EPOA campaign in communication and counseling for mediators and peer central and regional level PEPFAR sites mobilizers - Checking and completing the collected data - Strengthening actors’ and providers’ capacity to fill out tools, code and send files, and to enter data in the “Tracker” format
USAID/Neema October 1–December 31, 2019 Quarter Report 19
33 weekly coordination meetings were held in sites in the IHS/Division of AIDS/STI Control (DLSI) (9), Pikine (9), Mbour (9), and Ziguinchor (6)
These meetings were an opportunity to share and: - Synthesize and validate testing data for care facilities and for Support the coordination and weekly tests conducted by mediators Weekly meeting to analyze, check, and monitoring of interventions, and support - Discuss the index testing strategy validate key populations cascade data activity planning at each site - Discuss the problems and constraints noted in patient care and treatment and find solutions for them - Formulate recommendations for the monitoring and analysis of mediators’ performance, monitoring patients, and data management Also, two coordination meetings on PEPFAR interventions were held at central level.
Organize regional workshops every 6 months 3 planning sessions for micro-plans and an Overall, 4 micro-plans were developed in the Pikine, Mbour, on activity micro-planning with mediators and introduction for actors on the management Ziguinchor, and the IHS sites, and the capacities of 39 an introduction to management tools (M&E and collection tools were organized in the community actors, including 14 women, were strengthened. and financial tools) sites.
1.4.2. PREVENTION AND TESTING FOR INDIVIDUALS IN KEY POPULATIONS AND THEIR PARTNERS (1ST 90)
A national planning workshop for the EPOA campaign was held, and 4 plans were developed. The EPOA campaign reported: - 80 peer mobilizers recruited, or a 77% performance rate compared to the goal Support the 4 sites to organize quarterly EPOA Planning and implementation of an EPOA - 800 coupons distributed (or a 70% performance rate) campaigns in their intervention areas campaign - 479 coupons returned (or a 60% performance rate) - 478 individuals from key populations tested (or a 46% performance rate), including 55 positive cases, or a 12% yield - 52 HIV-positive individuals from key populations put on ARVs (39% performance rate; 95% linkage rate)
USAID/Neema October 1–December 31, 2019 Quarter Report 20
The following results were achieved: - 93 index clients were offered services, including 59 men - 66 index clients agreed to testing, including 25 women Support health districts in the intervention area - 151 contacts were listed, including 137 men Implementation of index testing in the 4 to organize boosted inclusion days (one - 67 contacts tested, including 52 men sites session per quarter) for index case testing - 29 contacts tested positive (45% yield), including 23 men - 27 contacts put on ARVs, including 23 men (93% linkage). The 2 remaining positive cases are in the interview stage, preparing to initiate ARV treatment.
The training gave trained staff various techniques to estimate the Map (PLACE methodology) of hot spots with Participation in the international course on size of key populations and to conduct mapping. A project staff the estimated size of key populations for each estimating the size of key populations in member was trained for this event, and one recommendation is region every 6 months Saint Louis training for other project staff members.
Organize training workshops for new Organization of 4 training workshops for 37 mediators, including 12 women, were trained: 12 at the DSLI, mediators on community-based demedicalized mediators on demedicalized screening 12 in Pikine, 10 in Mbour, and 5 in Ziguinchor. screening
Following the visits, these results were noted: Support mediators to conduct 2400 visits in hot - 1030 individuals from key populations received the prevention spots to offer prevention services (proposed package, including 771 men who have sex with men (MSM) 475 mediator outreach visits conducted testing, distribution of lubricated condoms, and 259 sex workers among their peers following identification of referrals for health and family planning - 1016 individuals from key populations were tested, including hot spots services) to 24,000 individuals from key 762 MSM and 254 sex workers populations - 120 cases tested positive (11% yield), including 116 MSM and 4 sex workers
1.4.3 TREATMENT FOR KEY POPULATIONS AND THEIR PARTNERS (2ND 90)
Support the on-site implementation of Organization of community-based By the end of the quarter: psycho-social activities by mediators to ensure monitoring activities conducted on site by - 6 discussion groups were organized, reaching 60 PLHIV, people living with HIV (PLHIV) stay on mediators including 20 women antiretroviral therapy (ART) (discussion group, - 34 home visits conducted to improve adherence
USAID/Neema October 1–December 31, 2019 Quarter Report 21 home visit, tracking down patients lost to follow-up)
Organize consultation and screening Planning visits and sharing the mobile Launch of mobile clinic activities was effective in December at campaigns and night visits alongside rmobile clinic’s standard operating procedures Mbour site level. clinics for key populations (SOPs) in Mbour 4 night visits resulted in testing 20 MSM, including 5 positive cases who were put on ART (25% yield; 100% linkage). Also, 2 other cases tested by outreach mediators were confirmed and put on treatment at clinic level; the mediators also referred 5 sex workers for STI treatment.
Support the enrollment of individuals testing Enrollment of PLHIV into health mutuelles During the reporting period, 81 PLHIV, including 28 sex positive and their families, in health mutuelles to facilitate care and treatment workers, 27 MSM, and 26 individuals from the general to facilitate their medical care. population wee enrolled in health mutuelles. Overall, 217 beneficiaries, including 136 family members, were enrolled into mutuelles.
Overall, 14 treatment education sessions and 28 sessions to track down patients lost-to-follow-up were held in the Mbour, Pikine, and IHS sites. Strengthen the support system for PLHIV under Support for treatment education sessions The capacities of 150 patients, including 62 men, were treatment (tracking down patients lost to and sessions to track down patients lost-to- strengthened on using condoms, taking ARVs, treatment follow-up, therapeutic education) follow-up sessions in sites adherence, and membership in health mutuelles for good medical care and treatment. Of the 55 patients lost to follow-up, 46 were found, 3 died, and 6 were not found.
1.4.4. VIRAL LOAD MEASUREMENTS FOR INDIVIDUALS IN KEY POPULATIONS AND THEIR PARTNERS (3RD 90)
Support quarterly transport of viral load Support to conduct viral load measurements - 220 viral load measurements were conducted in the sites, samples to the laboratory for priority treatment in sites including for 164 patients (or 75%) whose viral load was sites every two months by site suppressed. - With the Mbour point-of-care site, a campaign helped measure viral load for 160 patients, of which 119 were suppressed.
USAID/Neema October 1–December 31, 2019 Quarter Report 22
Intervention 1.4.5: Favorable policy and human rights environment for key populations
Support the DLSI to implement the transition Provider training on the treatment protocols After the 4 training sessions, the capacities of 114 providers, to tenofovir/lamivudine/dolutegravir (TLD) in for the new national guide on PLHIV care including 63 men, were strengthened on the care and treatment the 4 sites and treatment, including transition to guide, the TLD transition, national procedures for viral load dolutegravir measurement, and care differentiation. After the training, the TLD transition was launched in all sites, and 171 patients were put on TLD, including 85 at the DLSI, 51 in Pikine, 15 in Mbour, and 20 in Ziguinchor.
SUB-OBJECTIVE 1.5: INSTITUTIONAL SUPPORT IS PROVIDED TO MSAS ENTITIES
ACTIVITIES PLANNED FOR THE QUARTER ACHIEVEMENTS: IMPLEMENTATION OUTPUTS OR OUTCOMES ACHIEVED STATUS
SUPPORT IN HUMAN RESOURCES
Participation in the 20th International Support is provided to 3 MSAS staff (3 treatment physicians) Provide institutional support to partners and MSAS Conference on AIDS and STI in Africa for their participation in the 20th ICASA Conference. (ICASA) from December 2–7, 2019, on the entities for specific events and activities (World The 20th edition of ICASA enabled the team to keep up to date theme, “AIDS FREE AFRICA - Innovation, Days, etc.) on scientific advances and to share new approaches and Community, and Political Leadership” experiences with actors in the AIDS response at global level.
OBJECTIVE 2: INCREASED ADOPTION OF HEALTHY BEHAVIORS
SUB-OBJECTIVE 2.1: HIGH-QUALITY, TARGETED SOCIAL AND BEHAVIOR CHANGE COMMUNICATION (SBCC) INTERVENTIONS ARE SCALED UP TO PROMOTE HIGH-IMPACT SERVICES AND HEALTHY BEHAVIORS
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
USAID/Neema October 1–December 31, 2019 Quarter Report 23
Sub-Objective 2.1: High-quality, targeted social and behavior change communication interventions to promote high-impact services and healthy behaviors delivered at scale
INTERVENTION 2.1.2: LOCAL PROMOTION OF ESSENTIAL HOUSEHOLD HEALTH BEHAVIORS
Implement a signage campaign promoting the Campaign billboards are displayed in the The second phase of contract signing with Flyfly began and Jàpp naa cì campaign themes intervention regions will continue until next quarter. The poster topics are FP, handwashing, AYRH, and GBV. In total, 45 TATA buses were enrolled in the regions, distributed as follows: Kolda 7; Tambacounda 8; Diourbel 10; Touba 13; and Saint Louis 12.
Broadcast radio and TV programs to promote Contracts are drawn up with TV and radio Contracts with national radio and TV stations (RFM, TFM, RSI, behaviors in the national campaign stations to broadcast spots and shows RTS1, Zik FM, and SenTV) have been signed. In total, 267 radio spots and 95 TV spots were broadcast, distributed as follows: - 105 radio spots and 36 TV spots on FP - 102 radio spots and 42 TV spots on GBV - 60 radio spots and 17 TV spots on AYRH
Support organization of a national forum for Activity fully completed Technical support was provided to the DSME to prepare and Bajenu Gox organize the national forum for Bajenu Gox.
INTERVENTION 2.1.3: IMPLEMENT GENDER-FOCUSED SBCC STRATEGIES
Organize an extensive awareness-raising campaign on gender and the effects of GBV Broadcasting of spots began this quarter and Nationally, 102 radio spots and 42 TV spots on GBV were on families and youth, based on a diagnosis will continue. broadcast. of the social determinants of GBV
SUB-OBJECTIVE 2.2: PUBLIC SECTOR CAPACITY TO COORDINATE, DESIGN, AND ADVOCATE FOR SBCC IMPROVED AT THE NATIONAL AND REGIONAL LEVELS
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Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
INTERVENTION 2.2.1: PROVIDE INSTITUTIONAL SUPPORT TO THE SNEIPS AND BREIPSS
The process has begun with collecting information from the Support the communication managers of directorates, services, programs, MRs, National Education and Health Inform technical partners, and other ministry sectors in order to have: ation Service (SNEIPS) to develop a • A database on available communication plans reference guide to develop the This activity is underway. • A health survey directory following: a communication plan, an • A directory of all health information sites, hotlines, emergency advocacy plan, and a tool telephone numbers, information platforms, and informational development plan magazines • A directory of health communication managers at all levels
SUPPORT FOR KNOWLEDGE MANAGEMENT IN SOCIAL AND BEHAVIOR CHANGE COMMUNICATION (SBCC)
Maintain an electronic portal for Ongoing activity The portal has been developed and is regularly updated. knowledge management
USAID/Neema October 1–December 31, 2019 Quarter Report 25
MONITORING & EVALUATION, RESEARCH, AND LEARNING
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
Strengthening supervision systems at the district, SDP, and community level
Overall, 92 SDPs were reached, including 6 health centers, 47 health posts, and 39 huts. 125 individuals were supervised, including 62 qualified providers (11 women), and 63 community actors (13 women). Organize quarterly supervision missions to Performance monitoring plan supervision The following recommendations emerged from this supervision: document project indicators in the 4 HDs in Diourbel region - Improve use of the partograph, focusing on moulding the head, assessing respiration, urine output, protein, and components of surveillance - Equip bins with different colored plastic bags coordinated to their contents - Check for proper sorting and final disposal of waste
DOCUMENTING AND SHARING HIGH-IMPACT APPROACHES
- Information on training and activities has been collected for 1386 groups, distributed as follows: Saint Louis (375), Data collection to document the CAC- Matam (300), Kédougou (116), Sédhiou (95), Document key project interventions GBV strategy at regional level in the 7 Tambacounda (157), Kolda (118), and Diourbel (225) regions - 135 focus groups held at the 7 intervention regions to collect information on changes brought about by the intervention A results analysis is underway.
USING ICT SOLUTIONS
USAID/Neema October 1–December 31, 2019 Quarter Report 26
Organize technical meetings with telecom Preparation of ToRs for workshops with 2 meetings and discussions were held. operators to deploy surcharge rate mobile telecom operators to reduce SMS charges 2 of the 3 telecom operators were met with 1 Unstructured solutions. Supplementary Service Data (USSD) communication contract with the operator Orange. Maintenance plan for project database is An archive server is deployed. Develop a secure and accessible online database developed for ISD program data management and maintain it
Set up documentation of technological An implementation manual has been produced. Project technological interventions for drug 2 user guides have been produced, including 1 for ICPs and 1 for approaches and prepare the transfer to the IT stock management and stockout warnings community health actors on using the mobile application. Unit. at hut level have been documented.
SUPPORT FOR THE DSME TO PLAN, MONITOR, AND EVALUATE ITS PROGRAMS
Provide technical support to the DSME to plan, Support the technical process to establish 27 investment file indicators have already been defined regionally monitor, and evaluate its programs the regional definitions of targets to (for 2018 to 2020) based on the projection model validated at achieve indicators as part of the national level.
performance of the investment file for the For the most part, the pending indicators refer to human
2018–2022 period resources, finance, civil status, and medicines and commodities.
Support for the process to analyze the - The analysis found that: Postnatal consultations, spacing determinants of neonatal mortality in interval between births, and birth order are decisive factors Senegal affecting neonatal mortality. - A policy brief for decision-makers was developed following the process.
PROJECT MANAGEMENT AND COORDINATION
USAID/Neema October 1–December 31, 2019 Quarter Report 27
MR and district coordination meetings were supported. Participation in coordination meetings in Meetings have generally focused on monitoring recommendations from Participate in district and regional the regions of Tambacounda, Kolda, previous meetings, sharing general information, monitoring of Annual coordination meetings Sédhiou, Saint Louis, Matam, and Diourbel Work Plans (AWPs), and implementation of various projects and programs at MR level.
• Courtesy call from the DCOP to the Medical region: Discussions with the chief regional medical officer (MCR) Deputy Chief of Party (DCOP) mission on deploying the mobile unit in Pété and implementing priority activities chief regional medical officer (MCR) at Saint Louis RB Regional Bureau: Sharing information on priority activities and aspects • DCOP meeting with Saint Louis RB staff related to monitoring-evaluation, especially project documentation
During this review: Review of the FY20 Malaria Operational - The main project achievements for malaria control were presented Planning malaria control activities Plan (MOP) - Constraints and challenges related to implementation were identified - Directions for the next Malaria Operating Plan were laid out
This mission determined that the PEPFAR sites were ready for the actual Monitoring mission for PEPFAR Meeting with the implementation partner, start of activities. implementation conducted by Office the National AIDS Council (CNLS), and the The following recommendations were formulated: of the U.S. Global AIDS Coordinator DLSI was held, and a site visit (to Mbour) - Implementation of key strategies (index testing and EPOA) (OGAC) were made. - Organization of a viral load measurement campaign - Documentation of user fees
Participation in monitoring bodies for Participation in 2 Chief of Party meetings Share FY20 action plans with the various implementing partners USAID Health Program Participation in the program steering Monitoring of implementation status of the short-term recommendations implementation committee meeting of the health program mid-term evaluation
COORDINATION AND SYNERGY
Preparation of the USAID/Neema Organization of a workshop for consortium The project’s Year-3 annual report was prepared and submitted. project Year-3 annual report members to develop the annual report
USAID/Neema October 1–December 31, 2019 Quarter Report 28
Participation in the round table on WASH WASH component achievements were shared with USAID, implementing at USAID agencies, and the USAID Global WASH coordinator.
The meeting covered logistics data collection and issued these Meeting to build synergy around PEPFAR recommendations: Coordination with partners with the Global Health Supply Chain - Include distributors in weekly coordination meetings at site level and Program (GHSC) have GHSC cover them - GHSC proposal for a logistics data entry model for Neema
Meeting with the Key Population Development of a concept note to accompany the Neema project Investment Fund (KPIF) interventions
UNPLANNED ACTIVITIES
Unplanned activities Outputs or outcomes achieved
Workshop to share final evaluation results The final evaluation of the approach showed that the use of PAFP-AAY increased by 12 percentage points of post-abortion family planning adapted between the situational analysis (16%) and final evaluation (28%). to adolescents and youths (PAFP-AAY) Recommendations from the workshop were: - Share outcomes and recommendations from the workshop - Continue implementation of PAFP-AAY in existing sites - Scale up in the other districts: Diourbel, Bambey, and Touba
Participation in the annual workshop to - Presentation of the project’s progress assess strategies and channels to - Sharing challenges and best practices by partners to promote the link to treatment administer HIV self-testing as part of the - Identification of arenas for synergy with PEPFAR, particularly in training for providers and actors involved in ATLAS project screening index cases
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MAIN CHALLENGES AND SOLUTIONS
Issues/Challenges Recommended solutions Going forward identified this quarter
Implementation of project Prioritization of activities and Targeting low-performing interventions in a context of intervention areas districts resource reductions Strengthening synergy with other Meetings to build synergy with program components and other other components and technical technical and financial partners and financial partners working in the health domain Pooling resources within the consortium
Increasing testing of Develop and implement sex- Collaborate with civil society positive cases among sex worker-specific plans in the sites organizations (Enda Santé, etc.) workers in all sites to target clandestine sex workers Work with security and defense forces to focus on clandestine sex workers
Continue improving data Organize an internal Site quality at PEPFAR site level Improvement Through Monitoring System (SIMS) audit Continue activities to implement SENCAS (an electronic reporting system for HIV-positive cases) in sites Organize performance reviews in sites at all levels
3. CROSS-CUTTING ISSUES
GENDER MAINSTREAMING The key activity this quarter was the celebration of the 16 Days of Activism.
Celebration of the 16 days of activism:
As part of the 16 Days of Activism celebration, Saint Louis medical region, with project support, organized a panel on December 10, 2019, to discuss: Ending gender-based violence in the workplace: Issues and solutions in the health sector. Activity participants included 43 individuals (including 22 women), made up of care providers from various districts, government officials, representatives of decentralized technical
30 services, representatives of women’s movements, and social partners in the region. The labor inspector for the region moderated a panel that delivered the following presentations:
✓ GBV in the context of health work: how it arises and avenues for eliminating it ✓ GBV in the context of midwifery: challenges and pathways to solutions ✓ GBV in the education sector: how it arises and avenues for eliminating it ✓ Update on GBV in the workplace: Conceptual framework and recent legal instruments
Ensuing discussions helped formulate recommendations to better handle the problem of GBV in the health care workplace. The main recommendations are summarized as follows:
✓ Establish mechanisms to detect GBV at community level ✓ Measure and evaluate the problem at community level and propose appropriate solutions ✓ Eradicate forms of violence in the domestic sphere ✓ Advocate among the various ministerial sectors so that Senegal ratifies Convention no. 190 of the Geneva Declaration, dated June 21, 2019
In addition, spots on the GBV campaign were broadcast during the 16 Days of Activism, with 41 TV spots and 95 radio spots.
COMPLIANCE WITH ENVIRONMENTAL REGULATIONS
MONITORING OF COMPLIANCE WITH ENVIRONMENTAL REGULATIONS As part of environmental protection, the project supported supervisions of infection prevention and environmental protection (PIPE) measures in Diourbel MR.
In total, 91 SDPs, including 39 health huts, were supervised. Supervision activities checked provider and CCW training on PIPE, the availability of a sheet or aide-mémoire on PIPE, and the availability of equipment for biomedical waste management (BMWM).
Supervision in health centers, health posts, and PHFs showed several positive aspects: the existence of an individual responsible for BMWM (88%), and the availability of site cleaning supplies (98%) and decontamination and cleaning products (98%). However, a low percentage of SDPs have categorized bags (33%) to sort waste, and few staff responsible for BMWM have been trained in risks (36%).
Strengths noted at community level included waste packaging of sharps using safety boxes along with proper waste disposal methods (burners/burial pits), with performance rates of 90% and 91%, respectively. However, decontamination supplies availability must be improved (64%).
COMPLIANCE WITH FAMILY PLANNING LEGISLATION AND REGULATIONS
SURVEILLANCE OF FP COMPLIANCE As part of monitoring, supervision conducted in 91 SDPs, including 39 health huts in Diourbel MR, verified that facilities are complying with family planning legislation and regulations. At the health center, health post, and PHF level, supervision results show that: • 87% of visited SDPs have a Tiahrt or equivalent poster
USAID/Neema Quarter Report - October 1–December 31, 2019 31
• 79% of providers in visited SDPs have been trained in the Tiahrt Amendment and other US government legislative regulations and policies regarding FP • The principles of full information and voluntary client access are followed in over 96% of visited SDPs • Staff are complying with the principle of non-coercion in all visited SDPs Results at the health hut level show that: • In 95% of the visited huts, CHAs use posters describing the various methods or equivalent informational materials (flip charts or displays) to provide clients with clear and complete information on the chosen FP method • 97% of CHAs from visited huts are trained in the US government legislative regulations and policies regarding FP (Tiahrt Amendment) • The principles of full information and voluntary client access are followed in 97% of visited huts offering FP services • 87% of visited huts offer a range of FP methods authorized at the community level to ensure a free choice from among approved methods • The principle of non-coercion is followed in all the visited huts In response to previous supervision recommendations, 190 Tiahrt posters were delivered to the 4 districts in Saint Louis MR.
USAID/Neema Quarter Report - October 1–December 31, 2019 32
4. MAIN ACTIVITIES PLANNED FOR NEXT QUARTER
Activities planned for the next quarter Expected outcomes
Objective 1
Continued implementation of new approaches (EPOA 50 positive cases through index testing and index testing) 40 positive cases through EPOA
Conduct an internal SIMS audit 4 SIMS audit missions organized
Continuation of on-site supervisions 283 visits organized in 7 MRs
Continued extension of PPFP in Kolda and Sédhiou MRs Increased delivery of PPFP services in the SDPs of the 2 MRs
Support implementation of the IPT approach to increase IPT approach is implemented in Diourbel and third-dose-IPT (IPT-3) coverage in Diourbel and Sédhiou Sédhiou HDs regions
Objective 2
Continue activities with media outlets at national and The contractual package with media outlets regional level has been signed and implemented at regional level
Implement community-based activities to encourage Organization of a Jàpp naa cì show in each community engagement and changes in social norms: region has occurred in all regions Jàpp naa cì Show
USAID/Neema Quarter Report - October 1–December 31, 2019 33
5. ANNEXES Annex 1: Progress on Work Plan/Indicators
Annex 2: Financial Report
Annex 3: Tutorat 3.0 implementation in intervention medical regions
Annex 4: Summary of the implementation of FP-vaccination strategies
Annex 5: Summary of results of implementation of integrated mobile units
Annex 6: HIV Data summary
USAID/Neema Quarter Report - October 1–December 31, 2019 34
ANNEX 1: PROGRESS ON WORK PLAN/INDICATORS
Data used to prepare the Performance Monitoring Plan for this quarter are from the following sources:
1. The DHIS-2 (District Health Information System-2) platform for services data. The quarterly data completion rates in the DHIS-2, measured on January 27, 2020, are shown in the table below.
Medical region DSR/SE: Monthly report Child nutrition and health
Diourbel 94.0 79.5
Kédougou 96.0 89.4
Kolda 100.0 95.2
Matam 95.8 82.5
Saint Louis 99.2 87.8
Sédhiou 100.0 96.0
Tambacounda 93.0 79.2
Overall rate 96.9 87.1
2. Program archives for the training indicator.
USAID/Neema Quarter Report - October 1–December 31, 2019 35
ACHIEVEMENT Pro- Comments COLLEC REP. BASE- FY19 gress DESCRIPTION OF INDICATORS -TION FRE DESAG. LINE TAR- Q1 Q2 Q3 Q4 FY19 SOURCE Q GET Goal: Support the efforts of the Government of Senegal to ensure health services are sustainably improved and effectively utilized to reduce maternal, neonatal, and child mortality and morbidity and contribute to an AIDS-free generation. Objective 1: Increased access to and utilization of quality health services and products in the public sector 1 Couple-years of protection (CYP) Diourbel 31,780 58,889 PRA data for Q1 are not Regional through a program supported by Kédougou 20,883 16,205 available yet. The circuit for
Procure the US government Kolda 40,781 49,897 receiving these data is quite ment HL.7.1-1 Matam 25,408 31,859 long. (PRA- National Pharmac Saint Louis 69,375 61,997 Procurement Pharmacy y (PRA) Quarterly Sédhiou 21,960 26,934 (PNA)-PRA (validation)-PNA distributi Tambacounda 53,700 43,516 (synthesis)-DSME-USAID on data Neema) TOTAL 263,887 289,297 2 Number of children under 5 years with Diourbel 27,633 17,216 2674 16% pneumonia receiving antibiotics Kédougou 5380 3831 599 16% recommended by providers and CHAs This quarter, of the 14,808 Kolda 33,085 22,697 4682 21% trained through a program supported by cases of children with 3.1.9.2- the US government Matam 7254 4842 602 12% pneumonia, 14,808 received DHIS-2 3 Saint Louis 17,148 14,414 2769 19% the recommended
Quarterly Sédhiou 12,838 5254 710 14% antibiotics, achieving 17% Tambacounda 15,528 16,475 2772 17% for the annual target. TOTAL 118,866 84,729 14,808 17% 3 Number of children under 5 years with Diourbel 33,325 42,033 7630 18% diarrhea treated according to national Kédougou 5937 6191 1024 17% guidelines (ORS/zinc) through a Kolda 27,025 15,956 2193 14% This quarter, 24,500 (84%) program supported by the US
government DHIS-2 Matam 17,116 16,498 2617 16% were treated with ORS/zinc, HL.6.6-1 Saint Louis 32,754 34,769 5806 17% or 16% progress for the
Quarterly Sédhiou 12,665 12,527 1758 14% annual target. Tambacounda 15,557 24,220 3472 14% TOTAL 144,379 152,195 24,500 16% 4 Number of qualified community Diourbel 154 72 12 17% 93 providers, including 54 providers trained in nutrition Kédougou 48 50 6 12% women, were trained in
through a program supported by Kolda 44 55 3 5% nutrition this quarter. HL.9-4 the US government Project Matam 0 40 0 0% archives Saint Louis 372 105 0 0%
Quarterly Sédhiou 91 51 9 18% Tambacounda 0 106 63 59% TOTAL 709 478 93 19% 5 Percentage of providers who comply Diourbel 33% 75% 64% 84% Supervision that collects
with standards and protocols related to erly 75% Quart Kédougou 44% data for this indicator was
36
ACHIEVEMENT Pro- Comments COLLEC REP. BASE- FY19 gress DESCRIPTION OF INDICATORS -TION FRE DESAG. LINE TAR- Q1 Q2 Q3 Q4 FY19 SOURCE Q GET the management of labor and delivery in Kolda 33% 75% not done this quarter in the facilities funded by the US government Matam 29% 75% other MRs. Supervisi 3.1-7 Saint Louis 38% 75% on Sédhiou 50% 75% Report Tambacounda 52% 75% TOTAL 43% 75% 6 Number of service delivery points Diourbel 60 97 88 91% Supervision that collects providing basic life-saving maternal Kédougou 23 34 data for this indicator was
care (basic emergency obstetric and Kolda 51 62 not done this quarter in the neonatal care) supported by the US Supervisi Matam 58 91 other MRs. government on Saint Louis 89 115
Custom Report Quarterly Sédhiou 53 59 Tambacounda 61 100 TOTAL 386 557 7 Number of service delivery points Diourbel 11 65 13 20% Supervision that collects providing vacuum-assisted vaginal Kédougou 4 23 data for this indicator was
delivery supported by the US Kolda 14 42 not done this quarter in the government Supervisi Matam 8 61 other MRs. on Saint Louis 15 76
Custom Report Quarterly Sédhiou 5 37 Tambacounda 10 67 TOTAL 67 370 8 Diourbel 100% 100% 100% 100% All SDPs offer FP services or
Kédougou 100% 100% 100% 100% counseling.
Supervisi Percentage of service delivery Kolda 100% 100% 100% 100% on points offering counseling and/or Matam 100% 100% 100% 100% Report PF services supported by the US Saint Louis 100% 100% 100% 100%
HL.7.1-2 government Quarterly Sédhiou 100% 100% 100% 100%
Tambacounda 100% 100% 100% 100%
TOTAL 100% 100% 100% 100% 9 Percentage of service delivery Diourbel 0.17% 3% 3.0% 100% The stockout rate is 3.8% in points assisted by USAID that Kédougou 1.06% 3% 3.6% 99% the concentrations MRs.
experienced stockouts of Kolda 0.15% 3% 2.1% 101% PNA contraceptive products during the Matam 0.28% 3% 2.7% 100% data/DH reporting period Saint Louis 0.21% 3% 4.7% 98% IS-2 Quarterly Sédhiou 0% 3% 11.6% 91%
HL.7.1-3 Tambacounda 1.06% 3% 1.7% 101% TOTAL 1% 3% 3.8% 99%
USAID/Neema Quarter Report - October 1–December 31, 2019 37
ACHIEVEMENT Pro- Comments COLLEC REP. BASE- FY19 gress DESCRIPTION OF INDICATORS -TION FRE DESAG. LINE TAR- Q1 Q2 Q3 Q4 FY19 SOURCE Q GET 10 Percentage of individuals who Behavior Diourbel 77% 90% Annual frequency. remember hearing or seeing a Surveilla Kédougou 51% 77%
specific message on FP/RH, with nce Kolda 65% 90%
support from the US government Study/S Matam 65% 89%
pecial Saint Louis 86% 90% Yearly HL7.2-1 collectio Sédhiou 59% 79% n/nation Tambacounda 59% 83% al survey TOTAL 67% 85% 11 Number of community health Diourbel 794 1356 Annual frequency. workers supported by the US Kédougou 539 692
government who provide Kolda 1655 1837
information about FP, FP referrals, Project Matam 639 1402
and/or FP services during the year archive Saint Louis 1153 1503 Yearly Sédhiou 1229 1014 HL7.2-2 Tambacounda 1976 2738 TOTAL 7985 10,542 12 Number of women receiving Diourbel 39,062 55,597 12,718 23% 38,594 deliveries were AMTSL through a program Kédougou 3781 5260 1474 28% performed under AMTSL,
supported by the US government Kolda 12,377 17,974 4628 26% Achieving a 34% of the Matam 10,236 12,234 3954 32% annual target. DHIS-2 Custom Saint Louis 21,902 25,980 7448 29%
Quarterly Sédhiou 7186 8207 2200 27% Tambacounda 13,469 17,723 6172 35% TOTAL 108,013 142,974 38,594 27% 13 Number of children under 5 years Diourbel 65,779 85,557 19,865 23% This quarter, 66,685 children who received a nutrition Kédougou 8037 11,331 2233 20% under 5 years received
intervention in a program Kolda 16,353 39,873 8354 21% growth monitoring and supported by the US government Matam 25,137 17,687 7601 43% promotion, or a DHIS-2 Saint Louis 47,579 75,682 15,341 20% performance rate of 21% for
Quarterly Sédhiou 9574 34,338 5965 17% the annual target. HL.9-1 Tambacounda 22,927 51,009 7326 14% TOTAL 195,386 315,476 66,685 21%
14 Number of children 0–23 months Diourbel 48,135 65,705 16,969 26% 52,026 children 0-23
old who received a nutrition Kédougou 6075 8960 1663 19% months old received growth intervention in a program DHIS-2 Kolda 16,525 34,021 6108 18% monitoring and promotion
supported by the US government Matam 15,831 10,278 5316 52% services, achieving 34% of Quarterly Saint Louis 36,600 56,715 11,945 21% the annual target.
USAID/Neema Quarter Report - October 1–December 31, 2019 38
ACHIEVEMENT Pro- Comments COLLEC REP. BASE- FY19 gress DESCRIPTION OF INDICATORS -TION FRE DESAG. LINE TAR- Q1 Q2 Q3 Q4 FY19 SOURCE Q GET HL.9-2 Sédhiou 23,497 22,942 4491 20% Tambacounda 20,318 38,463 5534 14% TOTAL 144,466 237,083 52,026 22% 15 Percentage of SDPs that have a Diourbel 48.0% 90% 89% 99% Supervision that collects functioning referral/counter- Kédougou 54.0% 91% data for this indicator was
referral system from the community Kolda 54.0% 91% not done this quarter in the Report to the health post Matam 43.0% 89% other MRs. Supervisi Custom Saint Louis 45.0% 89% on Quarterly Sédhiou 83.0% 97% Tambacounda 67.0% 93% TOTAL 54.5% 91% 16 Number of individuals of key Dakar (IHS) 827 1805 498 28% 1319 individuals tested; 222 populations who were tested and Pikine 150 1122 369 33% are positive, or a 17% yield.
received their results Mbour 124 2011 There are 1232 tested District 225 11% 2614 individuals from key reports Ziguinchor 295 227 9% HTS_TS Quarterly populations, including 803 TOTAL 1396 T 7552 1319 17% MSM.
17 Number of persons (adults and Dakar (IHS) 65 293 93 32% Of the 222 from key
children) newly enrolled on ARVs Pikine 8 176 51 29% populations who tested District Mbour 8 293 58 20% positive, 217 were put on reports
TX_NEW Ziguinchor 9 401 19 4% ARVs, or a 98% linkage rate. Quarterly TOTAL 90 1163 221 19% 18 Percentage of patients on ARVs Dakar (IHS) 0% 90.0%
Of the 376 viral load with an undetectable viral load District Pikine 15% 90.0% 86% 96% measurements done, 319 reported in registers in a treatment reports Mbour 24% 90.0% 83% 92% were suppressed, or an 85% center or laboratory information 90.0% Ziguinchor 0% 89% 99% suppression rate. HIS data system in the last 12 months Quarterly TOTAL 3% 90% 85% are being finalized. TX_PVLS 94%
Percentage of households that have DHS Diourbel 43.8% 72% Annual frequency. 19 a designated space for hand reports Kédougou 52.8% 67%
washing with soap and water that is c-DHS Kolda 46.5% 65%
used frequently by family members Behavior Matam 93.2% 90%
HL.8.2-5 Surveilla Saint Louis 94.9% 90% Yearly nce Sédhiou 47.0% 77% Study Tambacounda 17.2% 63% TOTAL 53.9% 75%
USAID/Neema Quarter Report - October 1–December 31, 2019 39
ANNEX 2: FINANCIAL REPORT
Recipient: IntraHealth International, Inc. Program Name: Integrated Service Delivery & Healthy Behaviors Cooperative Agreement Number: AID-685-A-16-00004 Report Name: Budget Tracking Table by Program Element For the Period Ending: 12/31/2019
Redacted
USAID/Neema Quarter Report - October 1–December 31, 2019 40
ANNEX 3: TUTORAT 3.0 IMPLEMENTATION IN INTERVENTION MEDICAL REGIONS
Situational Analysis On-Site Coaching
SDPs that received at least SDPs that received at Private # Medical region District Available one package least two packages Public Total Action Private/semi- Plans Completed Number % Number % public
Diourbel YES 25 1 26 24 26 100% 8 31%
Touba YES 27 0 27 27 27 100% 13 48%
Diourbel Bambey YES 28 1 29 28 25 86% 1 3%
Mbacké YES 24 0 24 24 22 92% 9 38%
MR Total 4 104 2 106 103 100 94% 31 29%
Saraya YES 18 0 18 18 18 100% 9 50%
Kédougou YES 14 0 14 14 9 64% 6 43% Kédougou Salémata YES 7 0 7 7 8 114% 5 71%
MR Total 3 39 0 39 39 35 90% 20 51%
Kolda YES 27 1 28 28 26 93% 5 18%
Médina Yoro Foulah YES 14 0 14 14 9 64% 4 29% Kolda Vélingara YES 22 0 22 22 18 82% 7 32%
MR Total 3 63 1 64 64 53 83% 16 25%
USAID/Neema Quarter Report - October 1–December 31, 2019 41
Kanel YES 45 0 45 0 25 56% 4 9%
Matam YES 30 0 30 0 21 70% 6 20%
Matam Ranerou YES 17 0 17 0 9 53% 1 6%
Thilogne YES 13 0 13 0 15 100% 3 23%
MR Total 4 105 0 105 0 70 67% 14 13%
Podor YES 35 2 37 37 43 100% 5 14%
Saint Louis YES 19 6 25 25 25 100% 2 8%
Dagana YES 13 2 15 15 13 87% 5 33% Saint Louis Pété YES 28 0 28 28 25 89% 13 46%
Richard Toll YES 25 0 25 25 11 44% 10 40%
MR Total 5 120 10 130 130 117 90% 35 27%
Goudomp YES 15 2 17 17 15 88% 9 53%
Bounkiling YES 23 0 23 23 21 91% 8 35% Sédhiou Sédhiou YES 23 1 24 24 22 92% 13 54%
MR Total 3 61 3 64 64 58 91% 30 47%
Bakel YES 20 0 20 20 15 75% 6 30%
Diankhe Makha YES 9 0 9 9 12 133% 3 33%
Goudiry YES 17 0 17 17 15 88% 0 0%
Tambacounda Kidira YES 17 0 17 17 15 88% 4 24%
Koumpentoum YES 18 0 18 18 17 94% 3 17%
Maka Coulibantang YES 11 0 11 11 10 91% 5 45%
Tambacounda YES 25 0 25 25 21 84% 7 28%
USAID/Neema Quarter Report - October 1–December 31, 2019 42
MR Total 7 117 0 117 117 105 90% 28 24%
TOTAL 29 609 16 625 517 538 86% 174 28%
USAID/Neema Quarter Report - October 1–December 31, 2019 43
ANNEX 4: SUMMARY OF THE IMPLEMENTATION OF FP-VACCINATION STRATEGIES
No. of individuals New users of FP methods No. reached No. of No. of PNC No. of Enrollment DISTRICTS of children consultations Standard sessions rate SDPs M W T vaccinated conducted PILL INJECTABLE IMPLANT IUD Days TOTAL Method DIOURBEL MEDICAL REGION Diourbel 6 21 6 474 480 471 100 73 71 46 2 0 192 41% Touba 18 65 13 1266 1279 1723 720 95 228 63 17 0 403 32% Mbacké 8 42 30 793 823 811 236 54 177 53 16 0 300 38% MR Total 32 128 49 2533 2582 3005 1056 222 476 162 35 0 895 35% SEDHIOU MEDICAL REGION GOUDOMP 15 31 76 449 525 788 217 1 63 110 55 0 229 51% BOUNKILING 15 21 76 442 518 506 123 3 54 91 29 0 177 40% TOTAL 30 52 152 891 1043 1294 340 4 117 201 84 0 406 46% MATAM MEDICAL REGION Thilogne 4 6 0 253 253 263 26 19 22 19 2 0 62 25% Matam 5 10 4 255 259 516 61 3 19 16 3 0 41 16% Kanel 10 18 48 591 639 580 60 21 43 39 2 0 105 18%
MR Total 19 34 52 1099 1151 1359 147 43 84 74 7 0 208 19% Kédougou HD 7 54 0 1175 1175 2257 530 8 149 129 5 0 291 25% GRAND 88 268 253 5698 5951 7915 2073 277 826 566 131 0 1800 32% TOTAL
USAID/Neema Quarter Report - October 1–December 31, 2019 44
ANNEX 5: SUMMARY OF RESULTS OF IMPLEMENTATION OF INTEGRATED MOBILE UNITS
# of Total # # of visits of adoles plann adoles # of cents/y # of ed children # of # of cents/y # of children # of # of # of ouths 6–59 # of LLIT # of new persons ouths childre 6–59 children Cervical Breast persons children # # of users 10–24 months persons # of Ns FP users reached 10–24 n 0–23 months 12–59 cancer cancer reached seen in a DISTRICT PNC of FP years who screene visits distri in the by an years months screened months screeni screeni through pediatric visits methods who received d for bute program IEC who vaccin for deworm ng ng another consultati Performance receive vitamin A HIV #of #of ANC visits d activity receive ated malnutriti ed service on d FP supplemen # # of underIPTs DOT d on service tation service s s
Diourbel 19 76 70 0 31 48 103 1313 118 34 189 487 443 405 17 0 105 369 51
Bambey 36 7 32 25 0 10 16 31 387 29 8 66 114 107 88 13 0 0 115 15 72% MR TOTAL 26 108 95 0 41 64 134 1700 147 42 255 601 550 493 30 0 105 484 66
Podor 34 29 0 8 25 34 440 3 9 35 285 261 261 27 0 68 49 0 36 6 MR TOTAL 6 17% 34 29 0 8 25 34 440 3 9 35 285 261 261 27 0 68 49 0 Kolda 6 39 32 0 2 8 27 292 40 4 89 147 27 12 12 0 0 33 10 Médina Yoro 6 83 71 0 8 18 28 370 66 9 99 87 62 32 22 84 50 14 9
Foulah 36 42% Vélingara 3 44 69 0 9 15 29 392 81 4 62 67 31 14 2 105 54 24 16 MR TOTAL 15 166 172 0 19 41 84 1054 187 17 250 301 120 58 36 189 104 71 35
Goudomp 4 26 23 0 3 5 24 130 27 9 14 60 10 7 0 0 57 55 15
Bounkilin 4 42 31 8 6 6 10 156 19 1 82 102 52 40 6 0 62 52 41 g 36 33% Sédhiou 4 38 33 14 6 6 16 110 18 1 15 45 5 4 23 19 73 70 22
MR TOTAL 12 106 87 22 15 17 50 396 64 11 111 207 67 51 29 19 192 177 78 Grand 41 144 Total 59 % 414 383 22 83 147 302 3590 401 79 651 1394 998 863 122 208 469 781 179
45
ANNEX 6: HIV DATA SUMMARY
Community level Health Facility level Total Indicator Key pop Key pop General pop Total Total MSM FSW MSM FSW Male Female Male Female Total KP_PREV 771 259 1030 214 227 441 985 486 1471 HTS_TST 762 254 1016 46 170 43 44 303 851 468 1319
HTS_TST_POS 116 4 120 32 10 25 35 102 173 49 222
TX_NEW 114 4 118 32 8 25 34 99 171 46 217 YIELD 15% 2% 12% 70% 6% 58% 80% 34% 20% 10% 17% LINKAGE 98% 100% 98% 100% 80% 100% 97% 97% 99% 94% 98%
USAID/Neema Quarter Report - October 1–December 31, 2018 46