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ZIKA RESPONSE in ECUADOR and PERU ANNUAL PROGRESS REPORT USAID ZIKA PROGRAM Period: Y3 – October 1, 2018 to September 29, 2019 Submission Date: December 27, 2019

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ZIKA RESPONSE in ECUADOR and PERU ANNUAL PROGRESS REPORT USAID ZIKA PROGRAM Period: Y3 – October 1, 2018 to September 29, 2019 Submission Date: December 27, 2019 ZIKA RESPONSE IN ECUADOR AND PERU ANNUAL PROGRESS REPORT USAID ZIKA PROGRAM Period: Y3 – October 1, 2018 to September 29, 2019 Submission Date: December 27, 2019 ACRONYMS AND ABBREVIATIONS AMELP Activity Monitoring, Evaluation, and Learning Plan AOR Agreement Officer Representative COR Contract Officer Representative IP Implementing Partner M&E Monitoring and Evaluation MEL Monitoring, Evaluation, and Learning USAID United States Agency for International Development CARE: Cooperative for Assistance & Relief Everywhere CBSS: Community-Based Surveillance System C4D: Communication for development DRR: Disaster Risk and Recovery EW: Epidemiological Week EBA: Evidence-Based Analysis (ABE) EMMR: Environmental Mitigation and Monitoring Report EMMP: Environmental Mitigation and Monitoring Plan FY: Fiscal Year HC3: Information, communication, education and health (USAID) KAP: Knowledge, Attitudes and Practices (KAP) MoH: Ministry of Health (MINSA- Peru, MSP – Ecuador) PAHO: Pan-American Health Organization SBCC: Social and behavior change communication SRMH: Sexual, Reproductive and Maternal Health SRH: Sexual and Reproductive Health USAID.GOV USAID ANNUAL PROGRESS REPORT | ii WHO: World Health Organization UNFPA: United Nations Populations Fund UNICEF: United Nations International Children’s Fund USAID: United States Agency for International Development MC: Monitores comunitarios (community monitors CBSS) ECUADOR DDS: Dirección Distrital de Salud (District Health Department) DDE: Dirección Distrital de Educación (District Education Department) GADM: Gobierno Autónomo Descentralizado Municipal (Decentralized Autonomous Municipal Government) MIES: Ministry of Economic and Social Inclusion MINEDUC: Ministry of Education UTM: Universidad Técnica de Manabí UTMACH: Universidad Técnica de Machala ULEAM: Universidad Laica Eloy Alfaro (Manta) US: Unidad de Salud (Health Unit) MSP: Ministry of Public Health PERU ACS: Agentes Comunitarios de Salud (Community Health Agents) CAD: Ciudadanos al Día (Citizens Informed, Peruvian Non-Governmental Organization) CLAS: Comunidades Locales de Administración en Salud (Local Health Administration Communities) COEL: Centro de Operaciones de Emergencia Local (Local Emergency Operations Center) COER: Centro de Operaciones de Emergencia Regional (Regional Emergency Operations Center) C.S: Centro de Salud (Health Center) iii | USAID ZIKA ANNUAL REPORT USAID.GOV CUNA MAS: Social program of the Ministry of Development and Social Inclusion DIRESA: Dirección Regional de Salud (Regional Health Department) DISA: Dirección de Salud (Health Department) GERESA: Gerencia Regional de Salud (Regional Health Agency) HCE: Health Care Establishment MIDIS: Ministry of Development and Social Inclusion MIMP: Ministry of Women and Vulnerable Populations MINSA: Ministry of Health PREVAED: Programa Presupuestal Estratégico Reducción de la Vulnerabilidad y Atención de Emergencias por Desastres - PREVAED - 068. (Strategic Budget Program: Vulnerability Reduction and Disaster Response – PREVAED-068) P.S: Puesto de Salud (Health Post) UGEL: Unidad de Gestión Educativa Local (Local Education Management Unit) UPCH: Universidad Peruana Cayetano Heredia USAID.GOV USAID ANNUAL PROGRESS REPORT | iv ACTIVITY OVERVIEW ZIKA PROGRAM ACTIVITY DETAILS The project contributed to the strengthening of local actors and communities for the prevention and control of Zika, influencing the knowledge, attitudes, and practices of communities, agents, and community health workers. The project recovered best practices and experiences to strengthen and / or develop community monitoring and control mechanisms. It was emphasized on pregnant women, women of reproductive age, and adolescent women. It also proposed to actively involve communities, strengthen or recover the participation of the population in their health care, for which it promoted the generation of alliances with competent agencies of the national government and with the Regional Governments (Peru) and local Municipalities. Objectives to achieve in two phases over three years: 1. Increase community, local and national capacities to deliver efficient and timely response to the Zika virus outbreak and other vector prone diseases through Disaster Risk Reduction (DRR) and Human Rights approaches based on CARE’s experience in SRMH (Sexual, Reproductive and Maternal Health), sustainable community health systems and empowerment to strengthen the direct involvement of communities, by community health agents, in Zika priority areas (prevention, and vector control). 2. To enhance regional and national efforts to help decrease the rates of Zika transmission by sharing findings, impact results and influencing bi-national policy making through a deep and rigorous evidence-based approach of best practices and lessons learned in community mobilization and participation, to allow fast track, gender sensitive implementation strategies in diverse social and cultural contexts, increase coordination and planning capacities, refine an accurate monitoring system and a well-developed communication and dissemination strategy. Geographic Focus: • Ecuador: 10 cantons belonging to 3 provinces in the coastal region of the country, two of which suffered from varying degrees of damage from the April 2016 earthquake: Esmeraldas (1), Manabi (6) and El Oro (3) • Peru: 20 districts in the northern section of the country: Tumbes (4); Piura (11); Lambayeque (3) and Cajamarca (2) Beneficiaries: The following chart shows the number of beneficiaries, admitted to the CARE monitoring platform, who participated directly in project actions. v | USAID ZIKA ANNUAL REPORT USAID.GOV Project Beneficiaries: Total Country project Reached Y3 Reached Y1-Y2-Y3 % Women Men Total Women Men Total Ecuador 128944 35663 20762 56440 58465 35710 94175 73 Peru 263009 82658 63727 146385 98333 80874 179207 68 Total 391953 118321 84489 202825 156798 116584 273382 70 Source: CARE Monitoring Platform. September 2019. Additionally, by means of communications disseminated through mass and digital media, 320,000 people have been reached in Peru and more than 600,000 people in Ecuador, in the project's intervention cantons in each country. These communications also reached a significant number of people nationwide, thanks to the alliance implemented with the Ministry of Economic and Social Inclusion ANNUAL HIGHLIGHTS/EXECUTIVE SUMMARY • Highlights • The project strengthened community participation in the prevention of Zika and the control of Aedes aegypti through the community-based surveillance system that was extended to 13 of 20 intervention districts in Peru, and 6 of 10 cantons in Ecuador. Studies of these experiences show the positive impact this had on the intervention areas' population. • Prevention and actions were strengthened aiming to influence knowledge and change behavior in adolescents in schools, and influence their families and communities. This is one of the success strategies in the project, as evidenced in the results of the KAP studies. In Ecuador, 88 schools were intervened, and, in Peru, 110 schools were intervened in year 3. • The project promoted the exchange of experiences and learning at a bi-national level, in order to recover learning and provide feedback on the work in the 2 countries. In this framework, bi-national meetings of community monitors, mayors, and project steering committees were developed. In addition, coordinated actions were carried out on the Huaquillas-Tumbes border, between the project and local authorities, which contributed to strengthening Zika and dengue prevention actions within the framework of the Bi-national Border Development Plan. • The results of the work carried out by the project with the local governments, are recognized with the incorporation of prevention actions in the local governments' planning. In Peru, 19 municipalities of the 20 districts were involved and 12 of them allocated budget in item PPR017 (I.30 95 %, 1.31 79%). • In Ecuador of the 10 intervention municipalities, 8 incorporated prevention activities in their planning, and 6 municipalities worked on cantonal plans in year 3 (1.30 60%), that is, they planned actions and committed resources in their budget. • The project sought to consolidate the processes at the local level and strengthen sustainability: community prevention plans for Zika and local communication plans were promoted, involving the different actors at the local level, and -mainly- the communities and their leaders. In Ecuador, local Zika prevention sustainability plans were also developed. USAID.GOV USAID ANNUAL PROGRESS REPORT | vi • During the third year, the international workshop “Learning from the fight against Zika - Community mobilization in response to emergencies and epidemics", was a significant activity carried out by the project, to identify lessons learned and recommendations regarding epidemics and health emergencies. This workshop, organized by CARE in coordination with USAID, convened the implementing partners of the USAID projects in the different countries of the Caribbean, Central and South America, the partners and delegates of the communities of the participating countries. The most relevant contributions were systematized to recover the lessons learned and good practices. • Summary of Results for the Reporting Period and Key Achievements In year 3 the communication actions were strengthened, especially interpersonal communication, seeking influence the behaviors prioritized by the Zika prevention project. The most relevant results regarding knowledge
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