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 and behavior change, detected by KAP studies, showed the following:

o In Peru, 73.05% and in Ecuador, 59% of pregnant and childbearing-age women said that they applied prevention and care practices to Zika, according to the KAP III study.

o Adolescents who apply prevention and care practices to Zika in Peru reached 95%; and, in Ecuador, at 55.31%. (I.29). In Peru the goal was exceeded in indicators I.28 (knowledge) and I.29 (apply best practices). In Ecuador, the goal was exceeded in the I.27 (increase in risk perception). The evolution of these indicators is presented in chart No 1.

In the project's year 3 the community-based surveillance system was consolidated. In Peru, the system was implemented in 13 intervention districts, with the participation of 106 community monitors. By means of the software developed for the CBSS, 19,999 homes visited were reported, 51 533 people registered; in selected areas of 13 intervention districts, and 3 widened regions among the 4 intervention regions. The project trained 336 local government workers (I.19 = 134%), reached 114 reporting community monitors (I.13 = 100%) and 405 health officials (I.18 = 135%) at the CBSS.

In Ecuador, the system was consolidated in selected areas of 6 municipalities: 5461 home visits were made, 24 824 deposits were inspected; of which 2156 were positive and 1305 deposits were destroyed. In total, in the year 3, 250 new community monitors and municipal officials were trained in the CBSS (I.19> 100%), 500 people reported in the CBSS (I.12> 100%), exceeding the goal set for year 3, and 80% of monitors generated valid reports (I.13 100%).

In Peru, the Project trained 185 people, among obstetricians, nurses and other health professionals, in a guide concerning "Counseling pregnant women and individuals of childbearing age in the context of Zika virus". In Ecuador, 425 people were trained to provide counseling to pregnant and childbearing-age women (2A, 95% and more than 100%).

In Peru, the results of work with local governments are evidenced in the elaboration of 19 district plans and budget programming (PPR017) in the municipalities trained (I.31 79%), and in 12 districts that allocated budget in item PPR017 (I.33 54%), to give continuity to the system, cover the payment of the incentives of the community monitors, and give continuity to the actions promoted by the project.

In Ecuador, during year 3, 8 municipalities were involved in planning prevention activities, and 6 municipalities worked on cantonal programming (1.30 60%), planned actions, and allocating resources.

vii | USAID ZIKA ANNUAL REPORT USAID.GOV The Ministry of Health certified two Municipalities of Ecuador as Health Promotion Municipalities: Arenillas and Las Lajas, which prioritized Zika prevention actions in their planning. Other 2 municipalities, developed the process of information gathering and verification of compliance with indicators, and are waiting for certification. The Healthy Municipalities program of the Ministry of Health is what allows an articulated work with the municipalities to join efforts in prevention. The exchange of experiences and learning at national, bi-national and international level, allowed the following: strengthening capacities; recovering the best experiences and practices of community monitors; analyzing and strengthening experiences with the contributions of local government authorities such health, municipality and education officials, plus other experts in technical aspects related to behavioral change and community-based surveillance system.

• Problems Encountered/ Lessons Learned

In Ecuador and Peru, the government period of the local authorities ended during the third year. In Ecuador, this happened in the third quarter of year 3. This change resulted in delays in some work plans, requiring greater advocacy actions with the new local authorities to secure commitments and continue the work plans. In Peru, an exchange of experiences with new authorities was developed, with field visits to the CBSS that contributed to more authorities getting involved in this program.

In Peru, there was political instability and a high turnover of officials at the hierarchical level, such us ministries of health and education. Faced with this, the political incidence at regional and local level was strengthened to involve stakeholders in the adoption of the intervention model designed by the project.

In Peru and Ecuador, the KAP III study identified required improvements: first, the need to strengthen the strategy that addresses interpersonal communication, and, second, to enhance efficiency in the transmission of information. These components were strengthened in year 3, however, behavior change requires sustained actions over time, which in part exceeds the project's capacities.

Though strategies were developed to involve men in both countries, this challenge in the implementation of Zika virus prevention and control practices persists. The Ecuador KAP study showed a slight decrease in the gap. However, this challenge has its origin in the sexual division of labor: in the tasks of home care and health that are commonly assigned to women. Modifying these behaviors demands more sustained interventions.

USAID.GOV USAID ANNUAL PROGRESS REPORT | viii ACTIVITY IMPLEMENTATION

During year 3, the project's implementation sought the following: to consolidate the main contributions and the best experiences, which were related to social and behavioral change; to consolidate the community-based surveillance system; to develop the investigations corresponding to the period; and strengthening the capacities of partners and counterparts for the sustainability of prevention actions.

PROGRESS NARRATIVE • Communication for social and behavioral change

Results

In the third year of the project, edu-communication actions were strengthened concerning childbearing- age population, adolescents and pregnant women, aiming to influence 3 prioritized behaviors: cover containers with water (behavior 4), eliminate standing water (behavior 3 for control and elimination of hatcheries), and use of condoms (behavior 2).

The knowledge about the sexual transmission of the Zika virus, both in Ecuador and in Peru, increased during the third year of the project; pregnant and childbearing-age women are reported to know the most. The increase reported represented 8% in Peru and 7% in Ecuador. (Indicator.25). The accumulated increase in knowledge in the 3 years is 23% and 21.6% respectively.

Regarding the application of Zika prevention and care practices by pregnant and childbearing-age women, in the KAP III study it was found that, in Peru, 73.05% of women responded affirmatively about adopting such practices, and in Ecuador, 59% did, exceeding the goal set by the project in Peru (Indicator.26 = 73% in Peru and 58% in Ecuador).

In Peru, the percentage of adolescents who apply preventive measures against Zika reached 95%; and 55.31% in Ecuador (I.29). In Peru, the goal was exceeded in indicators I.28, knowledge, and I. 29, best- proven practices application. In Ecuador, the goal was exceeded in indicator I.27, risk perception increase. The following graph No.1, shoes the evolution of these indicators.

ix | USAID ZIKA ANNUAL REPORT USAID.GOV Graphic 1: Modification of knowledge, attitudes and practices in adolescents. Ecuador-Peru. Y2 - Y3. Zika Response in Ecuador and Peru Project

101% 98% 95% 83% 80% 76% 80% 77% 70% 70% 56% 60% 60% 45% 46%

28% 28% 19%

PERU ECUADOR PERU ECUADOR PERU ECUADOR I.27 % Increased I.28 % Knows I.29 % apply better awareness practices

Goal Y2 Progress Achieved Y3 Progress Achieved

These results in adolescents' behavior are the product of a major intervention in schools. In Peru, during year 3, the project worked in 111 schools, with 1191 peer educators, and 1330 teachers who were trained in the use of the comprehensive guide for the promotion of a culture of prevention and control of Zika virus in the educational community. In Ecuador, we worked with 88 educational units, and with an estimated coverage of 20,000 students, between basic and high school education (indicator 9a).

In Ecuador, CARE made an alliance with the Ministry of Economic and Social Inclusion to work in Zika prevention with the families that use the services of this ministry: emphasis was given to gender-based violence prevention, and sexual violence prevention, in order to reduce the risks of congenital syndrome associated with Zika. With this alliance the impact of the project escalated nationwide. In total, 9,000 MIES service officials were trained, and the actions reached 288,000 representatives of families using the services. Of these 14,400 corresponded to the areas of intervention of the project. This was a strategy to scale up health promotion and prevention actions to avoid the risks of Zika.

The project promoted the development of local communication plans to enhance community and partner participation, at local level, in the implementation of actions appropriate to the local context, to encourage behavioral change. In Peru, 20 communication plans were prepared and in Ecuador 5 cantonal communication plans were developed (I.16 100 and 71%).

Communication messages disseminated through mass media, interpersonal communication activities (such as murals), radio broadcasted spots, theater performances, and informative fairs reached 322,314 people in Peru. In Ecuador, in addition to the aforementioned activities, dissemination was carried out by digital media, billboards, messages placed in motorcycle taxis, in garbage trucks and through the official media of 2 municipalities. These messages reached 1,000,000 people (indicator 6A).

USAID.GOV USAID ANNUAL PROGRESS REPORT | x In both countries the KAP III study showed an increase of people who took preventive actions in the last 30 days.

Graphic 2: Percentage of people who implemented prevention practices in the last 30 days.

91 89 100 74,2 74 64,9 80 58 60

0 2017 2018 2019

Ecuador Peru

Difficulties and Challenges

• The KAP III study in Ecuador and Peru identified that interpersonal communication is the best strategy for people to know and apply knowledge about Zika control and prevention. Although progress has been made toward changing men’s attitude in relation to the implementation of Zika virus prevention and control practices, there is still a significant gap between men and women participation, on which work should continue. From the project, various activities were promoted to disseminate prevention messages among men: in the case of Peru, activations were intensified in the whereabouts of motorcycles and in Ecuador in football matches, by placing messages in motorcycle taxis, and in garbage collection cars.

• Achieving direct coverage of beneficiaries both Ecuador (128,945 people) and Peru (260,010 people) was a great challenge. In both countries, various strategies were promoted, the most effective being the work with schools, and then with universities and communities. In the three years, between the two countries, it was possible to reach 70.5% beneficiaries who participated directly in promotional activities; the rest of the beneficiaries received the messages through mass media.

• Among the difficulties in achieving the proposed goal, the most significant were the following: the extension of the territories (especially in Peru), the limited technical staff of the project, the instability of authorities in the health and education sector at local level, the little knowledge of the municipal authorities on its responsibilities regarding prevention of diseases transmitted by arbovirus, and the homologation of computer platforms for the registration of users in the 2 countries.

• Low adherence to the use of condoms to prevent Zika during pregnancy persists. Influencing the change in this behavior requires longer-term strategies, which demand influencing persistent gender roles and preconceptions around sexuality.

xi | USAID ZIKA ANNUAL REPORT USAID.GOV • Vector Management

Results

The project emphasized its work in the consolidation of the community-based surveillance system in both countries. The system was developed considering the regulations of each country, the institutional competencies of Ministries of Health and municipalities, as well as the policies or programs of vector management and epidemiological surveillance, which generated especific experiences in each country.

In Peru, the system used ovi-traps, developed software for community work and employd community monitors who received an economic stipend as an incentive for their participation. In Ecuador, the surveillance system defined by the Ministry of Public Health (the only institution that has competence in this area) was adapted for the work of community monitors: physical control of the vector was carried out through the inspection of homes and containers, to determine the vector indices and to eliminate hatcheries. In both countries, the “10 minutes against Zika” strategy was used to promote prevention and control in homes.

The following table shows the results of the main indicators:

Table 1: Progress of R3 indicators in Year 3. Zika response in Ecuador and Peru project. October 2018-september 2019

Planned Indicator Y3 Progress Indicators COUNTRY Y3 Number Achieved Target # of local governments using the CBSS in the PERU 10 13 I.11 planning of actions against Zika and make decisions ECUADOR 6 6 Number of community monitors dully providing PERU 305 207 I.12 periodic surveillance reports to local health services. ECUADOR 175 500 % of community monitors who collect PERU 80% 100% I.13 information and generate valid reports of community surveillance through the CBSS ECUADOR 80% 100% % of people (Health Workers, Local Authorities) PERU 80% 63% I.14 who have (provided) used information valid from CBSS ECUADOR 80% 81% Number of health personnel trained in CBSS. I.18 PERU 300 405 (Peru)

Number of local governments and community PERU 250 336 I.19 monitors trained in CBSS. ECUADOR 100 250

In Peru, the Community-Based Surveillance System (CBSS) was implemented in selected communities of 13 intervention districts (I.11, 130%) and scaled up to 3 additional communities. Entomological surveillance was carried out through the 404 ovi-traps installed and monitored weekly by the community monitors. In addition, multi-sectorial health committees led by local governments activated 16 multi-sectorial prevention and control plans for community monitoring using computer software. All this contributed to consolidate a community early warning system.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xii The software developed to register CBSS activities has a mobile and a web version. During the third year, 336 local government workers (I.19 = 134%), 114 reporting community monitors (I.13 = 100%) and 405 health personnel members (I.18 = 135%) were trained. Climbing to 163 more allies in the use of the system, the free use of the application has been authorized to be implemented in various areas after the closure of the project.

At the close of the project, there is information of 404 ovi-traps, 2338 inspection records of ovi-traps and 368 registers of references and counter-references, incorporated in the software developed. In addition, 228 people were trained in vector control protocols in the intervention zones (I.4 = 100%), generating conditions for the transfer of the project to the health sector and the local government.

Community entomological surveillance shows a downward trend in egg density in the areas operated with the CBSS initiated in Q3-Y2 and implementation of communication actions for behavior change (1d indicator).

Graphic 3: Egg density in ovi-traps. Year 2 and year 3 tendency. Peru.

60,00 CBSS 50,00

40,00

30,00

20,00

10,00

0,00 Q1/Y2 Q2/Y2 Q3/Y2 Q4/Y2 Q1/Y3 Q2/Y3 Q3/Y3 Q4/Y3 Baseline total number of eggs 42,06 42,61 43,64 31,82 53,17 24,49 24,44 24,44 Current total number of eggs 53,17 24,49 24,44 16,42 30,38 28,14 24,88 14,46

The Project, in Peru, systematized the experience of the pilot carried out in Tumbes, in year 2, which served for replication in other intervention districts.

In total, 106 women community monitors participated in the CBSS, and were recognized by their local authorities as community managers. In exchange for developing Zika virus prevention and control activities in the communities, along the year, the community monitors received a monthly economic stipend.

The involvement of authorities of the 4 regional governments and the 20 municipalities where the Project intervened was achieved through political advocacy and training. Such efforts resulted in the elaboration of 19 district plans and budget allocation for the item (PPR017) (1.31 79%). Budget allocation in the item PPR017 served to strengthen the system, stipends for the community monitors, and continue with the actions promoted by the Project, in 12 districts (plus three CBSS districts -I.33 54%).

xiii | USAID ZIKA ANNUAL REPORT USAID.GOV In Ecuador, the Project extended the community-based surveillance system experience to selected areas of six cantons (I.11, 100%). The system was adapted in Huaquillas, a border city with commercial flow and urban area, where the Project could not achieve the adequate participation of the community. Through the inter-institutional efforts of the Ministry of Health, the Municipality, CARE and the Technical University of Machala, community leaders were involved as coordinators. The coordinators, or community monitors, made up of 143 university students and 11 community leaders, gathered to carry on virus surveillance and control activities, through brigades supervised by its leaders. Through greater involvement of community leaders, inhabitants were less worried when the community monitors carried out home visits. In addition, the schedule was modified, so that visits were performed in the afternoon. This task is risky and requires safety measures.

In year 3, a total of 250 new community monitors and municipal officials were trained in the CBSS (I.19> 100%), and 500 people reported in the CBSS (I.12> 100%) exceeding the goal set for year 3. 80% of monitors generated valid reports (I.13 100%). Evidence gathered on the community-based surveillance experience, shows a positive impact on the practices of people from the communities intervened by the Project. Moreover, neighboring communities that were also involved show a positive change on practices as well.

Regarding indices, during year 3 the trend increased from Q2, due to the rainy season in Ecuador. During Q3 and Q4, a considerable reduction in vector control equipment in the Ministry of Health directly affected the control and elimination of breeding-sites in the communities (indicator 1e). This poses a challenge regarding sustainability.

Graphic 4. Aedic index. Year 2 and year 3 Trends – Ecuador.

8 7 6 5 4 3

2 CBSS 1 0 Q1/Y2 Q2/Y2 Q3/Y2 Q4/Y2 Q1/Y3 Q2/Y3 Q3/Y3 Q4/Y3 Baseline Index Value 5,4 5,40 5,40 5,40 5,40 5,40 5,40 5,40 Current Index Value 4,7 5,21 5,34 4,63 4,26 7,12 5,72 5,55

Difficulties and Challenges

The main challenges relate to the sustainability of the community-based epidemiological surveillance system.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xiv • In Ecuador, the community monitors worked as volunteers. The stipends given to them were more symbolic than monetary, such as community recognition, a work kit, and training certificates; however, their daily needs make it difficult to work indefinitely as volunteers for the community. Nevertheless, the Project made alliance with local Universities, to involve students as community monitors, which had positive results in consolidated urban cities, where finding volunteers for community work is even more difficult.

• In Peru, the community monitors received a payment, which allowed their permanent participation in prevention activities. Thus, the continuity of the system depends on the financing from the municipalities. Although some municipalities allocated budget in item PPR017, the Municipality of Zarumilla did not assume the payment of stipends for the community monitors who worked on the successful experience developed by the Project in Campo Amor since year 2, which evidences budget difficulties.

• In Peru, the ovi-trap efficiency study allowed to identify the importance of generating quality assessment mechanisms for the activities carried out by the community monitors, because in some cases we found deficiencies regarding the explanation of some protocols and other activities. Consequently, after exchanging information with Save The Children, we redesigned our quality assurance tools, which allowed us to improve the quality of the intervention.

• Generally speaking, indicators related to the community-based surveillance system have satisfactory compliance. For the Project was challenging to obtain vector-borne diseases’ indicators from the Ministries of Health of both countries, however, the incidence actions allowed us to comply with indicator reports 1d in Peru, and 1e in both countries.

• Considering the sustainability and acceptance of the CBSS by the Ministry of Health in Ecuador, the system was an adaptation of the vector control program of the MoH. It worked with the container and housing indexes. Community monitors and vector control brigades of the MoH worked together, and were linked to the local health committee. However, in year three, the MoH dismissed vector control personnel, and such affected the Project's monitoring actions. Moreover, the Project’s database showed some limitations regarding the quality of the information available on virus control actions.

• Sanitary interventions and service provision for mothers and children

Results

With its "Counseling for pregnant women and childbearing age individuals on Zika virus" guide, the Project trained 185 people among obstetricians, nurses and other health professionals in Peru. In Ecuador the Project trained 425 people to provide counseling for pregnant and of childbearing age women (2A, 95% and more than 100%).

86% of childbearing age women in Peru, and 80% in Ecuador were able to identify the risks of Zika infection during pregnancy (Indicator 2b, complied with). Knowledge on the sexual transmission of the virus in pregnant and of childbearing age women increased by 8% in Peru, and by 7% in Ecuador, when compared to year 2 (indicator I.25). On the other hand, the

xv | USAID ZIKA ANNUAL REPORT USAID.GOV application of preventive measures against Zika, reached 73.05% in Peru, and 59% in Ecuador, which exceeded the goal set by the Project in Peru (I.26 = 73% in Peru and 58% in Ecuador).

Difficulties and Challenges • In Ecuador, turnover rate is high, due to the yearly internships that med school students have to comply as part of the curriculum, so the need for training is permanent. Additionally, the Ministry of Health has not reported cases of Zika since April 2018 (Q3-Y2); thus, there is a lower perception of risk among the population, and consequently a lower prioritization of Zika intervention in health services.

• Research

Results

As established in R1, the Project conducted three studies in each country, complying the goal set for the year.

Country PERU

Type of research Summary

Best practices on the The Third Best Practices Contest was held in partnership with prevention and Ciudadanos al Día organization. The Project identified 29 good control of Zika virus practices. Information on the winning practices can be found in the Award following link: http://bit.ly/2kLFQOS

The Cuchareta Health Center, in the Tumbes region, won an award in the category “Community citizen participation”, for its “Community agents surveilling the Zikario 1 ” campaign, that highlighted the importance of implementing community-based surveillance systems, which involve all the actors in the community. The Provincial Municipality of Chiclayo won the award in the Cooperation between Public and / or Private Agents category, for its joint and institutionalized action, through the conformation of the Multisectoral Committee of Chiclayo, and budget allocation for the Program in the year 2019. Knowledge, The results showed a remarkable increase in indicator 6e (Childbearing Attitudes and age individuals that carried out actions against Zika in the last month) Practices (KAP III) going from a value of 73.96% in 2018, to 86.19% in 2019. In addition, the percentage of knowledge on Zika among Childbearing age women

1 Sicario in Spanish means Hitman in English; thus, Zicario is a play on words that alludes to the Zika virus.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xvi (I.25) rose by 8%, from 86.11% in 2018 to 93.08% in 2019. Similarly, the percentage of CAW that apply the best prevention and control practices against Zika (I26) tripled, from 17.89% in 2018, to 73.05% in 2019. Indicators on adolescents’ knowledge on Zika (I.28) increased by 19%, from 82.5% in 2018, to 98.13% in 2019; while the percentage of adolescents who apply the best prevention and control practices against Zika (I.29) went from 76.88% in 2018, to 95% in 2019.

Ovi-trap studies The Project carried out two studies on ovi-trap efficiency, one in Campo Amor (district and province of Zarumilla) and its control community, and another in 28 de Julio locality (Aguas Verdes district, Zarumilla) and its control community. Which evidenced better results when compared to the first ovi-trap study carried out in Campo Amor in 2018, and showed important findings in the 28 de Julio community, where the CBSS was implemented a year later than in Campo Amor.

Country ECUADOR

Type of Research Summary

Year 3 EBA study was complemented with the integration of the edu- communicational axis in the analysis, to strengthen the approach from an integral perspective.

The activities and practices related to the elimination of breeding-sites, such as proper water tank cleaning and covering, have persisted and Evidence Based improved during the execution of the Project. The community of the Analysis (EBA) intervened group showed their joint responsibility.

Although behavioral changes take time and rely on constant edu- communicational campaigns, the Project had a greater impact on the intervened group compared to the control group, regarding the best- proven practices to eliminate vector breeding-sites.

xvii | USAID ZIKA ANNUAL REPORT USAID.GOV In the three years the participants consider that Zika is an important problem for their community (85% in 2017, 82.7% in 2018, 85.8% in 2019).

It can also be affirmed that the risk perception gender gap narrowed in 2019, while in previous years, a greater number of women than men felt at risk. However, focus groups showed that women still are the ones who take the most preventive measures, and who visit health centers the most.

In 2017, 71.1% of people surveyed considered that Zika contraction Knowledge, risk was medium to high. This data fell to 60.07% in 2018 and rose to Attitudes and 74.93% in 2019. In all cases, participants considered the appearance of Practices (KAP III) mosquitoes in their neighborhood as the main cause of the risk. Risk perception among adolescents and pregnant women was the highest in 2019, and rose by 15% and 20% respectively since 2018.

The study showed that water tank covering is a widely adopted practice, more than what is reported by survey respondents (76%). The population has incorporated this practice.

Although gender roles prevail, and women take on greater responsibility for preventive measures against virus, the Project managed to involve men in various activities such as tank cleaning, breeding-site elimination, use of repellent, and use of mosquito nets.

The study showed that CBSS relies on three main things: a certain level of organization within the Community, intervention of the MoH, and Community leaders. The other actors that circumstantially take part should also be involved from the start; these usually are the ADG, NGOs, and educational institutions, among others. Community Based Surveillance System Empowerment is key for the implementation process. It is probably (CBSS) necessary to promote this aspect among the official health system staff, in addition to the community and leaders.

Data management must be carefully organized, since continuous analysis and decision making are crucial for sustainability. Clarity on the monitoring subject is also key, since it helps to keep the CBSS active.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xviii Other

• Ecuador - Healthy Municipalities

In Ecuador, by constitutional provision, municipalities do not have specific health competencies. Their role focuses on the provision of water services, sewerage, solid waste management, public space management, cemeteries, plazas and markets. Among their responsibility is seeking a healthy environment and habitat, which is linked with the Healthy Municipalities program of the Ministry of Health.

In year one all municipalities signed the letter of adhesion to the MoH program, to work for the certification process as a healthy municipalities. In year 3, the Municipalities of Arenillas and Las Lajas, with support from CARE, were certified as a Health Promotion Municipalities, the first step of the certification process. For this, the Project trained the municipal team, and provided technical assistance; and selected the indicators and means of verification, incorporating those that affect Zika prevention and gender violence. With this process, cantonal plans were drawn up, and the Guide for the certification of Healthy Municipalities, committed to the prevention of diseases such as Zika, Dengue and Chikungunya, was created.

The municipalities of Sucre and San Vicente in the Manabí province carried out the entire certification process. At the end of the Project, only the evaluation of the indicators and means of verification by the Ministry of Health was pending.

• Difficulties and challenges

Some local authorities do not understand their role in the prevention of diseases such as Zika, more work is required to improve their knowledge and involvement.

REPORTING PROJECT IMPLEMENTATION DATA In Ecuador and Peru, the Project used the results of the KAP studies to reinforce or redefine its strategies and actions, especially those related to knowledge strengthening through workshops and campaigns. In Ecuador, the gender approach and the prevention of sexual violence were highlighted, to influence preventive practices to avoid sexual transmission of the virus. In both countries, the Project carried out actions to engage men more.

xix | USAID ZIKA ANNUAL REPORT USAID.GOV Graphic 6: Changes on knowledge, attitudes and practices in adolescents. Ecuador - Peru.

1 101% 98% 95% 1 83% 76% 80% 80% 77% 1 70% 70% 56% 60% 60% 1 45% 46%

0 28% 28% 19% 0

0 PERU ECUADOR PERU ECUADOR PERU ECUADOR I.27 % Increased I.28 % Knows I.29 % apply better awareness practices

Goal Y2 Progress Achieved Y3 Progress Achieved

In Peru, year 3 milestone was the increase in individuals of childbearing age, indicator (6E = 86.19%), in the intervention zone, who implemented Zika virus prevention and control practices in the last 30 days2.

In Ecuador, KAP III study showed that through communication campaigns participants acquired knowledge on two subjects: the risks for pregnant women, and the elimination of breeding-sites, as shown in Table 2, the sexual transmission of the virus is only partially known by participants.

Table 2: acquired knowledge through communication campaigns. Ecuador, 2019.

Acquired - In pregnant women, Zika virus can cause serious issues for the baby's knowledge health, such as microcephaly.

- The best and most effective preventive measure against Zika virus is the elimination of Aedes aegypti mosquito breeding-sites.

Partial knowledge - The bite of the Aedes aegypti mosquito transmits Zika.

- ZIka is also transmitted through semen in sexual intercourse. After infection, the Zika virus, remains in the semen for up to 6 months, and in the woman for up to 8 weeks.

2 Source: KAP study year 3. Together against Zika Project.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xx

Peru: Egg density number decrease in the in CBSS ovi-traps

In year 3, the Project consolidated the community-based surveillance system in the targeted districts. When comparing the entire period of execution, the community-based entomological surveillance actions showed a downward trend in egg density numbers in the areas intervened by the Project. This is due the fact that through vector control actions and communication campaigns to change behavior, the Project managed to involve community members and local authorities in promoting a prevention culture.

In Campo Amor community, in the Tumbes region, the Project implemented the CBSS as a pilot, which started in the third quarter of year 2. The following graph shows the egg density number decrease in the in CBSS ovi-traps.

Graphic 7: Quarterly Average Number of Eggs per Ovi-trap Trend in Campo Amor. Tumbes. Peru. September 2016 - September 2019

100

90 79,31

80 CBSSS 67,98 66,07 65,36 70 62,97 trap -

60 51,50

50 44,38 38,88 40

30 Average Number of Eggs per Ovi

20 7,80 10 3,50 0,31

Q1-Y1 Q2-Y1 Q3-Y1 Q4-Y1 Quarter Q2-Y2 Q3-Y2 Q4-Y2 Q1-Y3 Q2-Y3 Q3-Y3 Q4-Y3

Activity planning and budget allocation on Zika prevention

In year 3 the leadership of local governments was key to promote Zika virus prevention and vector control; they obtained resources from the general state budget for awareness raising and prevention actions, and involved other actors in the prevention and response to vector-borne diseases.

In Peru, the technical assistance provided by PJAZ during the third year for budget planning of actions to prevent the Zika virus (I.30 = 95%) resulted in an increase in the budget. The following graph shows the results and impact of technical assistance and accompaniment in the annual planning following the PPR 017 training program.

xxi | USAID ZIKA ANNUAL REPORT USAID.GOV Graphic 8: Budget allocated (PPR 017) versus local governments trained by PJAZ in PPR 017, in regions intervened by the project. Piura, Lambayeque, Tumbes and Cajamarca. Years 2016 to 2019

200000 184570 20 19 150000 15 15

100000 89811 10

50000 6 5 # Loc gob 19467 6000 0 0 0

Peruvian soles 2016 2017 2018 2019 Año

BUDGET PPR LOC GOB

Ecuador: aedic indexes evolution

The indicator on aedic indexes (official data of the Ministry of Health), during year 3 the trend showed an increase from Q2. The increase in Q2 was due to the rainy season in Ecuador. In Q3 and Q4, the scenario worsened due to a considerable reduction of vector control equipment in the Ministry of Health, which directly affected the control and elimination of breeding-sites in the communities.

Graphic 9: Aedic index Trend Year 2 and Year 3 - Ecuador.

8 7 6 5 4 3

2 CBSS 1 0 Q1/Y2 Q2/Y2 Q3/Y2 Q4/Y2 Q1/Y3 Q2/Y3 Q3/Y3 Q4/Y3 Baseline Index Value 5,4 5,40 5,40 5,40 5,40 5,40 5,40 5,40 Current Index Value 4,7 5,21 5,34 4,63 4,26 7,12 5,72 5,55

In Ecuador, the work carried out with the communities, allowed acceptance of preventive practices such as removing standing water, and properly capping water containers and brushing its inner walls. (Graphic 10). The KAP III study observed that 70% of respondents had the tanks properly capped. Meaning that most people incorporated the practice.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xxii

Graphic 10: Ecuador best-proven practices for vector control in areas intervened by the JAZ project. EBA 2018-2019

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Apply Removing standing Capping water Brushing walls mosquitoesrepellent water containers containers

EBA 2 EBA 3

Additionally, the third EBA determined that 36% of respondents from the areas intervened by the Project use a condom to prevent the sexual transmission of Zika virus, compared to 20% of people in the control communities.

IMPLEMENTATION CHALLENGES AND MODIFICATIONS MADE During this reporting period, no relevant modifications were made to the Project planning.

Work Plan Y2-Y3, corresponding to the second phase of the Project, was implemented in the two countries.

Year 3 faced some setbacks; however, these did not affect the fulfillment of goals and objectives:

• For the Project was challenging to unify data regarding beneficiaries who directly took part in the activities, which allows assessing progress in coverage, in both countries. Since year two data from Ecuador was entered in I-form Builder, while in Peru this was achieved in year three. Keeping track of data regarding beneficiaries was a great challenge for the technical team because of the amount, but the nominal registry allowed quantifying and monitoring coverage of beneficiaries and differentiating how frequently each person participated in any given activity. At the end of the Project, 70.3% of direct beneficiaries are registered in a database with nominal information.

• In Peru the assessment of indicators’ progress, was carried out directly at the regional headquarters (on-site monitoring) during years 1 and 2. In year 3, the registration of the evidence of indicators complemented the online POA. That way, the Project’s central team had online information, but the on-site team, who had to enter all the data, was overloaded with work, which hindered having the

xxiii | USAID ZIKA ANNUAL REPORT USAID.GOV evidence-based information in a timely manner. In Ecuador, from the second year onwards, the Project used the CARE Monitoring Platform, which allowed having online evidence of the development of the POA, and national-wide indicators.

• Behavioral changes regarding prevention of the sexual transmission of the Zika virus faced important challenges, especially linked to the hegemonic patriarchal culture, the gender division of care-giving work, the ongoing discrimination and violence against women; and men’s and women’s roles about sexuality and their sexual life. The project strengthened training and sensitization activities with a gender approach, and in Ecuador, it incorporated the prevention of gender violence and sexual violence. According to the KAP study, resistance to condom use persists in Ecuador and Peru, and it is greater during pregnancy, because people assume that no condom is needed if the woman is pregnant. (KAP III Ecuador and Peru); this poses a challenge for the Project. Moreover, in Ecuador the Project evidenced some specific barriers, such as “shame”, in the case of adolescents, and the belief that it is ineffective by adults. Women continue to be held responsible for the use of contraception. (KAP III study).

COLLABORATION

COLLABORATION WITH OTHER USAID OR USG ACTIVITIES

USAID- Breakthrough Action and Breakthrough Research Community Mobilization International Workshop in response to health emergencies and epidemics: learning from the fight against Zika. The binational Project Together against Zika, in coordination with USAID, held on June 4, 5 and 6 in Quito, Ecuador, the International Workshop; in which participated seven USAID partners who implement community mobilization projects against Zika. In the meeting also participated USAID delegates from the Global Health office, the advisor for South America of the Ecuador and Peru project, and the offices of Central America and the Caribbean; and delegates from other USAID-funded programs, such as Breakthrough Action and Breakthrough Research, who helped designing the methodology and the execution of the workshop. Participants reflected on four subjects: Community mobilization in response to public health emergencies; Community-based epidemiological surveillance for the prevention and response of public health problems: learnings from the response against Zika; and, challenges and good practices for social and behavioral changes for the development of Zika preventive measures.

ASSIST- Zika Project

In Ecuador, the binational Project Together against Zika and ASSIST Project joined their efforts, and carried out work meetings, and workshops and field trips with their technicians.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xxiv CARE Ecuador participated in the workshop “Gender Integration in Zika Programs”, organized by ASSIST Project, with WI.HER, LLC’s consultancy, which strengthened knowledge on the inclusion of the gender approach in the vector control communication campaigns carried out in communities, especially in home visits.

Additionally, staff from the Project Together against ZIKA and health personnel from the intervened districts of Esmeraldas and Manabí, took part in training workshops on counseling for pregnant women and service quality improvement, which allowed for nation-wide coordination, especially in Manabí, because some of the intervened zones were shared by the two projects.

In Peru, coordination meetings and complementary joint counseling workshops on Zika were held in Tumbes and Piura. In addition, the two Projects worked on the elaboration of counseling guides for pregnant women, in conjunction with the Regional Health Directorates. The two Projects formed a committee to follow up on the approval of regulations that ratify the Zika Counseling Guide for health personnel, whose approval is in process in the Tumbes and Piura regions.

Globe Mosquito Program:

In year 3 the Project Together against Zika in Peru, continued its coordination with Globe Mosquito Program. They held meetings to assess the impact of the actions carried out in year 2, and examine the records kept by schools that received Globe Mosquito kits, with the Go mosquito habitat mapper app. Please visit the following link to study the records made in Tumbes, Piura and Lambayeque. https://vis.globe.gov/mosquitohabitats

Save The Children:

Save the Children shared with the JAZ Project its knowledge on quality assurance and the tools developed to monitor community interventions’ quality. To ensure the quality of community interventions, JAZ Peru adapted its tools to the local context, and implemented a quality assessment process for the interventions carried out by community monitors and other actors.

LEARNING FOCUSED COLLABORATION AND ENGAGING IN LEARNING APPROACHES

• During the International Workshop, participants analyzed the experiences of community mobilization in the response to Zika developed in the Caribbean, and in Central and South American countries with support from USAID. Lessons and good-proven practices were identified, which may be applicable in response to other epidemics. The workshop highlighted the result of contributions made in the response to Zika. Such were the basis for preparing the systematization document that was published and distributed among the attendees, delivered to USAID and its partners.

• The international workshop recommends carrying out activities aimed to promote and strengthen community participation and mobilization in Zika response. Additionally, communication and education actions that motivate social and behavioral change towards effective Zika prevention

xxv | USAID ZIKA ANNUAL REPORT USAID.GOV activities; tools to include gender and disability approaches; and, guidelines to ensure the quality control of interventions (CARE 2019, Systematization of the international workshop)

• The coordination with Globe Mosquito Project / The Globe Program allowed the Project to strengthen its capacities in pedagogical techniques used to educate on Zika control and prevention, particularly in schools.

• Working with the Zika Assist Project strengthened the capacities of health professionals, especially in the field of counseling. Moreover, it allowed the articulation of community components with health services in the response to Zika.

CHALLENGES OF THE COLLABORATION

• Planning, developing a methodology, and executing the International Workshop that brought together delegates from communities of different countries, constituted an important methodological challenge for the Project, which was solved with the technical advice of USAID, BA and BR. The sum of CARE Ecuador’s local capacities, with those of international expertise allowed the workshop to meet the proposed objectives.

COLLABORATION AND/OR KNOWLEDGE SHARING WITH PARTNER ENTITIES IN HOST GOVERNMENT AND OTHER DONOR AGENCIES

Project Steering Committee

The Project Steering Committee met in August 2019, in Quito (Ecuador). It gathered Regional UNICEF delegates, personnel from the Ministry of Health of Peru, a mayor of Peru and a community leader of Ecuador, the Directors of CARE Ecuador and CARE Peru, and as a special guest, the official USAID representative for the Project. The Committee evaluated progress made, especially regarding the sustainability strategy, and issued recommendations, such as sharing with the Ministries of Health experiences on the community-based epidemiological surveillance systems developed in the two countries, to clarify that urban and rural applications are different. In Peru, the Committee recommended the Project to spread among local governments the app that records the scanning of ovi-traps and alerts regional governments and the local Ministry of Health about the appearance of vectors in homes.

Prevention actions should be planned for the outbreak, during the emergency, and for the post-endemic phase, and should be flexible based on the analysis of studies, field visits and the quality assessment of interventions. Regarding communication campaigns, the Project must analyze how to deal with risk perception’s decrease. In addition, the Committee recommended creating an open access virtual platform or virtual library, so that other institutions or people can revise and continue with the work done.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xxvi Subnational Governments: Peru

The project held discussions with specialists from various public, private and cooperation institutions, and recommended actions based on lessons learned from the intervention on Zika prevention regarding: entomological surveillance, vector control and communication campaigns for social and behavioral change. The recommendations issued are as follows:

Subnational governments should ensure that the analysis of qualitative and / or quantitative information of KAP and risk studies are used to design or refine multisectoral health plans, community plans; and in that framework, also the strategic communication campaigns for behavioral and social change.

Allocate resources from PPR 017 to replicate the experience of the CBSS as a tool that prompts the mobilization of the community and of key institutional actors, for the strengthening of preventive and control behaviors on Zika and other vector-borne diseases.

Subnational governments and the Healthcare sector should promote the use of the Counseling Guide on Zika for pregnant and childbearing age women, to promote prevention and protection behaviors among this target group.

The Project recommends the National and Regional Governments and the Ministry of Education, to institutionalize the preventive guide: i) designing learning sessions for pre-school, primary and high school students, aimed at strengthening prevention and control behaviors against Zika; ii) training peer educators (adolescent to adolescent); iii) capacity building for teachers and principals.

Municipalities: Ecuador

In Ecuador, the municipalities do not have specific competences in healthcare, so the Project linked the prevention of Zika with the Healthy Municipalities Program of the Ministry of Public Health. In year 3, the Municipalities of Las Lajas and Arenillas received the "Health Promotion Municipality" certification from the Ministry of Public Health, thanks to the work done alongside the Project. This is an important achievement, because it implies that the authorities included Zika prevention activities in their planning. Additionally, authorities carried out an articulated work with other local actors, involved the population and their leaders, and selected indicators of the Healthy Municipalities Program to maintain and comply with, to hold their current certification or reach other levels of certification.

The Municipalities of Sucre and San Vicente, carried out the information gathering process and completed the certification process. At the end of the Project, the two municipalities were waiting for the Ministry’s call for the approval of the indicators prior to certification.

Ministries and government entities

In Ecuador, the agreement with the Ministry of Economic and Social Inclusion allowed the development of training modules for trainees in the Family School Program of that Ministry, on gender issues, sexual violence prevention and Zika prevention. These modules are part of the Ministry's nationwide training

xxvii | USAID ZIKA ANNUAL REPORT USAID.GOV program for technicians. This allowed 14,000 MIES services’ users, from the areas intervened by the Project, to take part in prevention activities directly, and learn from the “10 minutes against Zika” campaign. The Ministry’s nation-wide intervention trained 288,000 users in the topics of the 4 modules, and trained approximately 90,000 users specifically on the Zika prevention module.

Working with the Ministry of Education in Ecuador, allowed the development of prevention guides for children and adolescents with a disaster risk-reduction approach. These guides were incorporated into the school’s curriculum. In Peru, the Guide that promotes a Zika prevention culture in schools was promulgated as public policy in the Piura and Tumbes regions.

Universities

In Ecuador, the alliance with Eloy Alfaro Lay University of Manta, and the Technical University of Machala, allowed to develop the CBSS in urban areas, where community participation is minimal, since the general population works to meet their needs. In year 3, more than 250 students were involved in the campaigns.

KEY HIGHLIGHTS OF THE COLLABORATION

• In Peru, the project adapted the home visit and breeding-site elimination methodology developed by the Fio-Cruz Institute of Brazil, called “Ten Minutes against Zika”. In year 3, the Ministry of Health (MoH) incorporated said methodology in its institutional work, delivering the implementation to eight regions of the country, which also resulted in reaching eight other regions.

• In Ecuador, the alliance with the Ministry of Economic and Social Inclusion, allowed to strengthen knowledge on sexual transmission prevention and the risks of congenital syndrome, through the development of training modules for trainees in the National Family School Program, on gender issues, sexual violence prevention and Zika prevention. This allowed diffusing prevention actions nation-wide, and reaching all territories at risk due to the appearance of Aedes Aegypti.

• In Ecuador, the alliance with universities allowed the development of community-based surveillance experiences in consolidated urban areas, where motivating community participation is complex.

CHALLENGES OF THE COLLABORATION

In Ecuador and Peru, the high turnover rate of local health and education personnel, as well as local authorities changing in both countries, hindered the timely fulfillment of work plans. In Ecuador, the work plans signed nation-wide with the Ministries of Health, Education, and Economic and Social Inclusion, allowed intervention stability in the country.

In Peru, high local staff turnover stalled the establishment of collaboration agreements between institutions, both at the central and regional levels. For the project, involving the new personnel took time and delayed the development of joint actions.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xxviii Institutionalizing vector-borne disease prevention work by engaging community monitors, is a challenge in Ecuador. In an analysis workshop with experts and with local authorities of the Ministry of Health, the Project identified the need to link the community monitors with the local health committees for the development of three key activities at home: i) “Ten minutes against Zika” campaign (counseling), ii) water tank inspection to keep homes free of breeding-sites, and iii) identifying fertile and pregnant women to guide them to the nearest health facility.

LEARNING • In the third year of execution, and based on the results of the KAP II study, the Project reoriented its communication campaigns to influence prioritized behavioral changes, and to achieve adherence to prevention and control practices. Through messages and educational-communicational campaigns, the Project worked for the following objectives:

o Strengthen prevention on Zika virus sexual transmission.

o Engaging men in care-giving tasks and in the elimination of breeding-sites, by questioning the gender roles that hold women responsible for these activities.

o In addition, the Project promoted actions to achieve greater engagement from men, such as, training tricimoto3 drivers in some areas of Peru and Ecuador, and asking their help to place posters with Zika prevention messages on their vehicles and in tricimoto stops. We worked with adolescent men and women in schools. In Ecuador, we attended soccer matches to carry on sensitization activities using materials.

o Including messages on the connection between Zika and the Guillain Barre syndrome (especially in Peru, where an epidemic of Guillain Barre syndrome occurred).

o Strengthen knowledge on the importance of brushing, washing and properly capping water tanks, and the importance of the eliminating Aedes aegypti’s breeding-sites; which according to PAHO / WHO, are the most effective actions to prevent mosquito proliferation. These messages were conveyed through games, such as decks of cards, matching pairs games, puzzles and roulettes.

• The educational tools developed by the Project with a gender and cultural adaptation approach, contributed to improving knowledge on the disease both in the intervened locations and in the control group. (EBA good practices Ecuador).

• Community plans are a practical tool to: 1) apply knowledge on prevention, 2) coordinate local efforts and resources for the implementation of best-proven practices, 3) for the coordination of local actors,

3 Motorized tricycle used as public transport in some towns in Ecuador.

xxix | USAID ZIKA ANNUAL REPORT USAID.GOV especially to involve people and community leaders, 4) are important inputs to build local capacities for sustainability.

• The CBSS was based on the training and participation of community monitors for the surveillance of the vector, who gradually become community leaders. The internships, and the national and binational meetings among community monitors managed to encourage better performance quality in their interventions. In spite of progress made, the sustainability of this experience is challenging, because in Peru permanent budget allocation in item PPr017 is required for the maintenance of economic incentives; while in Ecuador, volunteer work and few spaces from the Ministry of Health for participation in prevention actions, hinder the potential of these experiences.

• In Peru, the use of ovi-traps in the CBSS was an effective tool for the surveillance of Aedes aegypti in community setting, and for the activation of the community early warning system (CEWS), because it allows early vector detection, allowing prevention and control actions in a timely manner. Likewise, the Project recommends the periodic use of traditional indicators, since those complement the information offered by the ovi-traps.

• In Peru and Ecuador, the Project observed that the alliances with national Ministries allow a significant increase in interventions to other territories where the Project does not act, even reaching national- wide scale, as happened in Ecuador with the Ministry of Economic and Social Inclusion.

• In Peru, the project adapted the home visit and breeding-site elimination methodology developed by the Fio-Cruz Institute of Brazil, called “Ten Minutes against Zika”. The material developed in Peru was adapted to the cultural and legal context of Ecuador, and used as a key tool for community education. In year 3, the Peruvian Ministry of Health (MoH) incorporated said methodology in its institutional work, delivering the implementation to eight regions of the country, which also resulted in reaching eight other regions.

• The bi-national meeting of mayors from Peru and Ecuador evidenced the importance of carrying out field visits with the authorities. Authorities from Peru learned the on-site actions carried out within the framework of the Community-Based Surveillance System, which allowed a greater understanding of the role of community participation in the prevention and control of Zika, and a greater involvement of mayors from other territories.

• In Peru, the Project identified the need to strengthen political influence for budget allocation in item PPR017, and resource transfer for the prevention and control of vector-borne diseases.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xxx COMMUNICATIONS AND DISSEMINATION

KEY COMMUNICATION ACTIVITIES - PROJECT PROMOTIONAL, PUBLIC OR MEDIA EVENTS/ENGAGEMENTS FOR THE PAST YEAR

Public events to disseminate the project activities or key messages for the prevention and control of Zika:

In both countries, events of: dissemination and promotion of activities have been developed at the local, regional and binational level; including information about the Zika virus, as well as training in Edu communicative tools. The activities are also disseminated through digital media, especially Facebook. In the different public events and press releases on social networks, the USAID brand was positioned through graphic elements of visibility and the reference in the spokespersons to the project representatives, thus complying with the specific regulations in this area.

Below are the links where the information of the activities carried out in Ecuador and in Peru can be found:

Workshop with technicians of the Ministry of Economic and Social Inclusion, regarding prevention of sexual transmission of the virus and gender violence. https://www.facebook.com/MIES.Zona4/posts/1948273122141102

Workshop to design the communication campaigns for the prevention of Zika in Sucre Canton. https://www.facebook.com/municipiobahia/videos/2122928314687896/

Training workshop for the provincial municipality of Zorritos to promote the Community Based Surveillance System https://www.facebook.com/1033374690174440/videos/345688546144067/UzpfSTgwNzcxNjM2OTM3Nj k4NDoxMjg4NTE3MDg0NjMwMjQx/

Workshops on the risks of Zika virus in pregnant women. Manta, San Vicente and Sucre municipalities. https://www.facebook.com/CareEcuadorOrg/videos/567899283633355/

San Francisco de Quito University students’ field trip to the communities of Manta, to learn how community-based surveillance actions on Aedes aegypti breeding sites are carried out. May 2019 https://www.facebook.com/CareEcuadorOrg/photos/pcb.1170211963152574/1170189563154814/?type= 3&theater

News article on the workshop “Participation, mobilization and community empowerment on health” held on March 14 in Quito. January 2019 https://www.facebook.com/CareEcuadorOrg/posts/1126291327544638

Sucre and Pedernales communities’ involvement in Aedes breeding site elimination activities. April 2019 https://www.facebook.com/CareEcuadorOrg/photos/a.894005407439899/1144238499083254/?type=3&t heater

xxxi | USAID ZIKA ANNUAL REPORT USAID.GOV

Educational games for children and adolescents on Zika virus’ risks, and how to eliminate its breeding- sites. June 2019 https://www.facebook.com/CareEcuadorOrg/photos/a.894005407439899/1179270562246714/?type=3&t heater

Informative posts of workshops, diffusion activities and home visits carried out in Jama, Sucre and San Vicente municipalities (Manabí province). In Sucre, the municipality disseminated the information through its radio station and Facebook profile. https://www.facebook.com/CareEcuadorOrg/posts/1051435815030190?__tn__=-R https://www.facebook.com/CareEcuadorOrg/photos/a.893986950775078/1047199188787186/?type=3&t heater https://www.facebook.com/CareEcuadorOrg/posts/1047062975467474?__tn__=-R

Project Steering Committee meeting

The last meeting of the Committee was held delegates from Ecuador and Peru. During the meeting the recommendations for future interventions were analyzed, in the areas of: community participation, community based surveillance, and other areas. https://www.facebook.com/CareEcuadorOrg/posts/1042992465874525

The Dissemination of the Award for Good Practices in prevention and control of the Zika virus had good support from the media (Peru):

Below are the links where the press releases: https://andina.pe/agencia/noticia-premian-iniciativas-sobre-prevencion-y-control-del-virus-del-zika- 754708.aspx https://www.expreso.com.pe/actualidad/premian-practicas-en-prevencion-del-zika/ https://clustersalud.americaeconomia.com/sector-publico/peru-premiaran-buenas-practicas-contra-el-zika http://www.ciencias.pe/ciencia-innova/premiar%C3%A1n-buenas-pr%C3%A1cticas-que-reduzcan-la- infecci%C3%B3n-del-virus-del-zika-en-el-per%C3%BA

Dissemination of key messages through media and social networks:

In Ecuador, weekly messages on how to prevent the appearance of the mosquito, especially how to eliminate its breeding sites, were posted. Messages on Zika have 13,489 followers.

Some of these messages can be accessed through the following links: https://www.facebook.com/CareEcuadorOrg/photos/a.893986950775078/1081328388707599/?type=3&t heater https://www.facebook.com/CareEcuadorOrg/photos/a.893986950775078/1099447383562366/?type=3&t heater https://www.facebook.com/CareEcuadorOrg/videos/1628397263930142/?v=1628397263930142

USAID.GOV USAID ANNUAL PROGRESS REPORT | xxxii https://www.facebook.com/CareEcuadorOrg/photos/a.893986950775078/1166892920151145/?type=3&t heater

Messages posted on the elimination of Aedes aegypti mosquito breeding sites, and preventive measures against sexual transmission of the virus; messages on the prevention of Zika and sexual violence. March 2019 https://www.facebook.com/CareEcuadorOrg/photos/a.894005407439899/1119396404900797/?type=3&t heater https://www.facebook.com/CareEcuadorOrg/photos/a.893986950775078/1131184030388701/?type=3&t heater

Publication of Zika prevention messages in alternative mass media

Billboards on public roads: In coordination with the Zonal Communication Coordination of Zone 4 of the Ministry of Public Health, 6 billboards of 3 x 6 meters were placed along public roads on the Portoviejo - Manta and Portoviejo – Guayaquil highways; and one billboard of 4x8 meters in the Ministry´s building in the city of Portoviejo.

Tricimotos4: The Project capacitated tricimoto drivers on preventive measures against Zika. Posters with key messages were then placed on the vehicles, and we give stickers to the drivers so they can hand them out to their passengers after giving them the message on prevention.

Garbage collection trucks: Under the Agreement with the Municipal Decentralized Autonomous Government (MDAG) of Sucre, the Project installed posters with Zika prevention messages and its sexual transmission in three garbage trucks.

Radio Commercials: Approximately 600,000 people in Manabí province received prevention messages on Zika virus through local radio broadcasts; radio broadcasts reached 15 cantons of the Province with information on microcephaly and the sexual transmission of the virus. Between January and April 2019, approximately 280,000 people were reached in the six cantons of the Manabí province where the Project intervened

The messages broadcasted by the radios mostly reach women and the population over 40.

Additionally, the Municipalities of Sucre and San Vicente transmitted preventive messages through their local radio stations, with their own resources; and reached approximately 10,0

Promotion of the international workshop “Community Mobilization in response to health emergencies and epidemics: learning from the fight against Zika”

4 Motorized tricycle used as public transport in some towns in Ecuador.

xxxiii | USAID ZIKA ANNUAL REPORT USAID.GOV https://www.facebook.com/CareEcuadorOrg/videos/vb.893876814119425/311073036474455/?type=2&t heater https://www.facebook.com/RadiodifusoraCCE/videos/vb.1520073948210056/2385806001466582/?type= 2&theater

Training workshops and activities for adolescents on the Zika prevention:

The principal message was to eliminate mosquito-breeding sites by brushing, cleaning, covering, and sealing water tanks and barrels. The sexual transmission of Zika virus was also discussed.

Peru

A summer without the Zikario:

These activities emphasized on adolescents' use of spare-time during school vacation. At the end of the workshops, closing events were held in which they presented the plays, radio mini-broadcast programs and murals. The play produced in Piura was disseminated in regional and national media. https://www.facebook.com/watch/?v=329371507703373 http://radiofantastico.pe/estudiantes-que-participaron-en-locucion-radial-reciben-reconocimiento-en-la- drep/ http://www.care.org.pe/noticia/la-obra-don-zikario-no-es-de-este-barrio-se-presenta-en-lima/

Ecuador

Workshop with the students of the Miguel de Centeno School, in San Miguel de Briceño community, Pedernales canton https://www.facebook.com/CareEcuadorOrg/photos/pcb.1175926422581128/1175917932581977/?type= 3&theater

Mural with Zika prevention messages with paintings of teenagers and young people from Manta and Portoviejo communities. July 2019 https://www.facebook.com/CareEcuadorOrg/photos/a.894005407439899/1206832786157158/?type=3&t heater

Delivery of equipment and supplies to preserve the cold chain in the transfer of blood samples for Zika tests. https://www.facebook.com/CareEcuadorOrg/photos/pcb.1190846737755763/1190846621089108/?type= 3&theater

USAID.GOV USAID ANNUAL PROGRESS REPORT | xxxiv Binational Meeting of Mayors of Peru and Ecuador: Sharing experiences in territorial articulation against metaxenic diseases with emphasis on Zika from the perspective of local governments. https://www.facebook.com/437141573683967/posts/437599610304830/?app=fbl http://www.care.org.pe/noticia/prevenir-el-virus-del-zika/ https://www.facebook.com/ZikaZikario/photos/a.1338189316329684/1338189779662971/?type=3&theat er

Binational Meeting of Community Monitors, of the community-based surveillance system, in Manta Ecuador. https://www.facebook.com/ZikaZikario/photos/a.1338189316329684/1338189779662971/?type=3&theat er

During the certification process to become a Health Promoter Municipality, San Vicente Municipal Decentralized Autonomous Government presented a baseline on the health situation of the canton. The Project Together against Zika counseled this process. https://www.facebook.com/CareEcuadorOrg/photos/pcb.1214123498761420/1214123435428093/?type= 3&theater

Discussion Table on Gender, Intercultural and Diversity Approaches in the Prevention of Diseases Caused by Arboviruses. The project held this meeting with 22 participants including the Project technicians, delegates of the ministries of health and education, women's rights advocate social organizations, and LGBTI leaders, among others https://www.facebook.com/CareEcuadorOrg/photos/a.1262753670565069/1262754010565035/?type=3& av=893876814119425&eav=AfaXitemALxpu0JSZMPVMW0syaIOWPUioloqeQ5ueADBGn5XOjSYm8s5 kSie8ZgitJ4&theater

Project Closing Events at Local Level

The project developed accountability events, actions for sustainability and project closure at the local level in all the cantons and regions of intervention. In these events, the project presented a report of the results achieved, and materials of edu-communication were delivered to representatives of the Municipalities and of the Ministries of Health, Education and Economic and Social Inclusion (Ecuador), local governments and community monitors ande leaders. In Ecuador, in addition, the agreements defined in the sustainability plans, previously prepared, were presented to the public. https://www.facebook.com/CareEcuadorOrg/photos/pcb.1223216464518790/1223216324518804/?type= 3&theater https://www.facebook.com/CareEcuadorOrg/photos/pcb.1226635530843550/1226635487510221/?type= 3&theater https://www.facebook.com/CareEcuadorOrg/photos/pcb.1214123498761420/1214123435428093/?type= 3&theater https://www.facebook.com/CareEcuadorOrg/photos/a.894005407439899/1232101103630326/?type=3&t heater

Project closing event in Quito and Lima with national and local authorities

xxxv | USAID ZIKA ANNUAL REPORT USAID.GOV Learnings of inter-institutional cooperation to promote community participation in the prevention of Zika were highlighted in the closing event of the project Together against Zika, executed by CARE and financed by USAID. In addition, educational communication material on the subject was officially delivered to delegates from the Ministries of Health, Education and Social Inclusion. https://www.facebook.com/CareEcuadorOrg/photos/pcb.1246254262215010/1246251222215314/?type= 3&theater

Press releases on the Project’s Website www.todoscontraelzika.com

Please visit: http://www.todoscontraelzika.com/noticias/

Note of the Project closing event at national level in Lima, September 2019. https://www.care.org.pe/noticia/cierre-proyecto-zika/

SUSTAINABILITY AND EXIT STRATEGY

1. Actions developed that contribute to sustainability

In year 3, the Project conducted conversations with specialists from various institutions and cooperation agencies, and issued recommendations on lessons learned from the prevention intervention against Zika regarding entomological surveillance, vector control and communication campaigns for social and behavioral change.

For the continuity of the Community-Based Surveillance System in Peru, training was carried out for the officials of the Municipalities and for the healthcare personnel. The Project also impacted for the programming of the Results-based Budget (PPR) in the 017 item “Vector-borne and Zoonotic Diseases” of Local Governments. This will allow continuity of actions contemplated in its multi-sectoral District Health plans for the prevention and control of vector-borne and zoonotic diseases, especially Zika.

Multi-sectoral (Peru) and inter-sectoral (Ecuador) health committees were strengthened to prioritize Zika prevention, and technical assistance was provided for the elaboration of their multi-sectoral work plans to prevent and control vector-borne diseases, especially Zika.

In Peru, the Project made agreements and issued authorizations for the use of the software developed to record the information of the CBSS, which is shared to the key local actors to allow for expedite decision- making and response. CARE granted the corresponding permission for use.

In Peru, the project adapted the home visit and breeding-site elimination methodology developed by the Fio-Cruz Institute of Brazil, called “Ten Minutes against Zika”. In year 3, the Peruvian Ministry of Health (MoH) incorporated said methodology in its institutional work, delivering the implementation to eight regions of the country, which also resulted in reaching eight other regions.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xxxvi In Ecuador to guarantee the continuity of actions in the municipalities, the Project joined the Healthy Municipalities program, to incorporate actions and indicators linked to Zika prevention.

Advocacy and dialogue with national and local authorities, was key to involve institutions and to reach agreements for the development of actions and for the implementation of the CBSS. The project carried out these actions with all the actors involved in the healthcare and education sectors, the regional and municipal government authorities, and community leaders.

RECOMMENDATIONS

To public entities

• 80% of Aedes mosquitoes reproduce in low water tanks, therefore, the most effective measure against vector-borne and acute diarrheal diseases is access to network drinking water (due to the disappearance of water tanks). This must be prioritized in public policy, through resource allocation. Although it is a long-term goal, it is important to direct efforts towards that objective in the interventions.

• The Project recommends incorporating the gender approach in healthcare actions and services, to engage men and foster their responsibility regarding prevention measures and care-giving of pregnant women and children.

• Increase attendance of male users to health services, since health professionals are some of the main sources of promotion and prevention information. Due to the schedules and roles that adult men have, we recommend extending the opening hours and intensifying extramural actions.

• In Peru the Project recommended regional and district governments to allocate resources from their Results-based Budget (PPR 017) to replicate the experience of the CBSS as a strategy that allows community’s and key institutional actors’ mobilization, in the promotion of preventive measures against Zika and other vector-borne diseases.

• The Health, Education, and Economic and Social Inclusion Ministries of Ecuador, the regional and district governments of Peru, the municipalities in Ecuador and Peru, should institutionalize the use of the tools developed in official programs. Some of them are already at that level, such as the Guide and modules for schools, the “10 minutes against Zika” campaign in Peru, the learning guides for children and adolescents, and the modules developed alongside MIES in Ecuador. However, compliance monitoring is necessary.

To the implementing entities

• Involve the community in the design of solutions and projects prior to their implementation, to raise the level of commitment and ensure sustainability.

xxxvii | USAID ZIKA ANNUAL REPORT USAID.GOV • Extend strategies at the community level, besides from individual and family level strategies, to promote the social and organizational fabric, since families indicated that there is no communication and lack of neighborhood and community involvement.

• Maintain and develop inter-sectoral articulation through inter-sectoral meetings and joint work plans to optimize existing actions and human resources.

• In Ecuador it is necessary to strengthen inter-sectoral work to involve other key players, such as the local governments, so that they become visible to the community. This way, the population could expand interlocutors beyond the MoH, which can only contribute in some dimensions of the vector control efforts. The Healthy Municipalities program is the only link between the Municipalities and the Ministry of Health, and should be strengthened.

To the donor

• Due to the international health emergency, the program supported Zika response, therefore, it is necessary to strengthen actions regarding elimination of Aedes aegypti and other vectors, since the diseases have epidemiological changes but the origin is the same. It is necessary to clearly identify what to do in a health emergency, and adapt preventive interventions against vectors and not only against diseases; this will allow to adequately respond to the evolution of the epidemic, and that the Project’s implementation continues in another epidemiological scenario.

• Consider that generating behavioral changes in the population requires more time than that defined for a project, and we recommend being more specific on indicators that can be achieved with the interventions.

To the communities

• To maintain risk perception on health problems, the Project recommends to carry out participatory diagnoses and community-based epidemiological surveillance actions. This work should not only be done with local health committees, but with other community groups.

• Identify their primary needs, such as permanent access to potable water, to promote the development of public policies that satisfy them.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xxxviii ANNEXES

xxxix | USAID ZIKA ANNUAL REPORT USAID.GOV ANNEX IA. PERFORMANCE INDICATOR REPORTING SHEET • ECUADOR

Reporter: (Please provide contact information) Cecilia Tamayo /Alex Portilla/Adriana Echeverria / Adriana Muela Submission Date: 24/9/2019 Definition of Community in Country: ECUADOR Approximate # of Persons in Community: Ecuador 128.944 Type of Index for Indicator 1 e (e.g. house index, container index, Breteau index, or Stegomyia index), oviposition indices, or via pupal demographic surveys:

FY 2017 FY 2018 FY 2019 Cumulative Life of Life of Project Results to Project Comments Results Partner Country Indicator Number INDICATOR Year End Q1 Q2 Q3 Q4 S1 S2 Q1 Q2 Q3 Q4 S1 S2 Date Target

Numerator - number of communities This data is not cumulative (column R is not reached with any physical vector correct) . The number of communities CARE Ecuador 1a control activities within the targeted 14 36 24 9 10 29 26 39 17 204 39 reached was 39. geographic area Information from the Ministry of Health was incorporated Denominator - number of communities in the targeted CARE Ecuador 43 43 43 43 43 43 43 43 43 387 43 This data is not cumulative (column R) 1a geographic area, per 100.

Percent (%) of communities where CARE Ecuador 1a physical vector control activities are 32,56% 83,72% 55,81% 20,93% 23,26% 67,44% 60,47% 90,70% 39,53% 80,00% 90,70% The goal of the Project was achieved. being implemented Numerator -number of communities This data is not cumulative (column R is not conducting vector surveillance and/or correct). CARE Ecuador 10 6 24 28 7 29 23 32 17 176 32 1b monitoring activities within the Information from the Ministry of Health targeted geographic area was incorporated Denominator - number of communities in the targeted CARE Ecuador 43 43 43 43 43 43 43 43 43 387 43 This data is not cumulative 1b geographic area

Percent (%) of communities in which vector monitoring activities are being CARE Ecuador 23,26% 13,95% 55,81% 65,12% 16,28% 67,44% 53,49% 74,42% 39,53% 80,00% 74,42% The goal reached was 93% 1b implemented

The goal of the Project was achieved Number of people trained in vector The project trained the vector control and CARE Ecuador 1c control 343 250 332 599 750 218 190 500 0 3182 2000 159% community health personnel of all the health districts in which it intervened and the community monitors Baseline total number of eggs CARE Ecuador 1d NA NA NA NA NA NA NA NA NA NA NA NA Current total number of eggs CARE Ecuador 1d NA NA NA NA NA NA NA NA NA NA NA NA Percent (%) change in mosquito egg density, from baseline, in targeted CARE Ecuador 1d geographic areas (Baseline- NA NA NA NA NA NA NA NA NA NA NA NA Current/Baseline)%

CARE Ecuador 1e Baseline Index Value 0 5,4 5,40 5,40 5,40 5,40 5,40 5,40 5,40 5,4 5,4 5,4

In the Q2, the current index value increases due to the rainy season. In the Q3, Q4, the current index value CARE Ecuador 1e Current Index Value 0 4,7 5,21 5,34 4,63 4,26 7,12 5,72 5,55 5,55 4,86 5,55 increases due to the reduction of number of the vector control teams in the MoH. Data of the MoH corresponding to all project intervention areas. In the Q2, the current index value increases % change in mosquito frequency, due to the rainy season. from baseline, in targeted geographic In the Q3, Q4, the current index value CARE Ecuador 1e areas #¡DIV/0! -13,0% -3,5% -1,1% -14,3% -21,1% 31,9% 5,9% 2,8% 2,8% -10,0% 2,8% increases due to the reduction of number of the vector control teams in the MoH. Data of the MoH corresponding to all project intervention areas.

USAID.GOV USAID ANNUAL PROGRESS REPORT | xl Number of health providers trained to provide Zika prevention counseling The goal of the Project was exceeded. Total to Women of Reproductive Age (WRA) reached in the 3 years was 1424. This data CARE Ecuador 2a 480 49 112 189 169 84 272 69 714,00 500 143% was due to the fact that the health personnel who attend the health services type A and B of the first level of care are changed every year Numerator: Number of women of reproductive age surveyed within the No This data is not cumulative (column R is not CARE Ecuador targeted project areas who can 370 317 correspond 293 980 293 2b correct). identify the potential risks of ZIKA e infection during pregnancy.

Denominator: Total number of No women of reproductive age surveyed This data is not cumulative (column R is not CARE Ecuador 531 541 correspond 365 1437 365 2b within the targeted project areas. correct). e

% of WRA in project areas who can The goal of the Project was achieved. CARE Ecuador identify the potential risks of ZIKA 70% 59% 80% 80% 80% 2b This data is not cumulative. infection during pregnancy Numerator: Number of women of reproductive age surveyed within the No CARE Peru 2c targeted project areas who can 107 199 correspond 167 identify at least one sexual e transmission prevention method

Denominator: Total number of No CARE Peru 2c women of reproductive age surveyed 531 541 correspond 365 within the targeted project areas. e

% of women of reproductive age in project areas who can identify at least CARE Ecuador 20,2% 36,8% 45,8% #¡DIV/0! 80% 57% 2c one sexual transmission prevention method # communities with members actively participating in Zika monitoring, CARE Ecuador 3 17 11 5 4 15 20 26 17 43 35 122,86% The goal of the Project was achieved. 5a prevention, and/or support activities

# communities with community plans CARE Ecuador 13 3 3 4 7 1 17 3 3 43 40 107,50% The goal of the Project was achieved. 5b for the prevention and control of Zika

# Zika events that involve families, schools, municipality governments, or CARE Ecuador 25 12 10 4 8 87 33 34 56 150 100 150,00% 5c community organizations The goal of the Project was exceeded.

The data in not cumulative in the Y3 Total # of individuals of reproductive Greater diffusion of mensages was carried CARE Ecuador age in project areas who have received 5000 1172 873 1598 98371 2045 99969 260269 413107 148903 206263 673376 355166 1135556 1135556 6a out by the rainy season and the publicity Zika messages billboards in Portoviejo city. # of FEMALE individuals of Greater diffusion of mensages was carried reproductive age in project areas who CARE Ecuador 3200 40960 0 40960 129790 192749 66018 99.479 322539 165497 432717 432717 out by publicity billboards in Portoviejo 6a have received MASS MEDIA Zika city. messages

# of MALE individuals of reproductive CARE Ecuador 6a age in project areas who have received 1800 23040 0 23040 114063 186306 73140 102.169 300369 175309 398349 398349 MASS MEDIA Zika messages

# of FEMALE individuals of reproductive age in project areas who CARE Ecuador 0 0 22442 0 22442 7621 13253 1976 1028 20874 3004 45292 45292 6a have received DIGITAL MEDIA Zika messages

# of MALE individuals of reproductive CARE Ecuador 6a age in project areas who have received 0 0 8534 0 8534 2727 6828 2476 1071 9555 3547 20565 20565 DIGITAL MEDIA Zika messages

# of FEMALE individuals of reproductive age in project areas who CARE Ecuador 3200 837 670 1081 2092 1507 3173 3853 7135 3216 1522 10988 4738 22084 22084 6a have received INTERPERSONAL COMMUNICATION Zika messages # of MALE individuals of reproductive age in project areas who have received CARE Ecuador 1800 335 203 517 1303 538 1820 2215 6836 2077 994 9051 3071 15286 15286 6a INTERPERSONAL COMMUNICATION Zika messages xli | USAID ZIKA ANNUAL REPORT USAID.GOV # of FEMALE individuals of reproductive age in project areas who This data is not cumulative (column R is not CARE Ecuador 386 307 363 1.056 363 6c can name one vector transmission correct). prevention method Total # FEMALES of reproductive age This data is not cumulative (column R is not CARE Ecuador 531 541 375 1.447 375 6c surveyed correct). % of FEMALE individuals of reproductive age in project areas who CARE Ecuador 72,69% 56,75% 96,80% 96,80% 6c can name one vector transmission prevention method # of MALE individuals of reproductive age in project areas who can name This data is not cumulative (column R is not CARE Ecuador 114 112 111 337 6c one vector transmission prevention correct). method Total # MALES of reproductive age This data is not cumulative (column R is not CARE Ecuador 129 126 121 376 6c surveyed correct). % of MALE individuals of reproductive age in project areas who can name CARE Ecuador 88,37% 88,89% 91,74% The goal of the Project was achieved. 6c one vector transmission prevention method % of individuals of reproductive age in project areas who can name one CARE Ecuador 6c vector transmission prevention 75,76% 62,82% 95,56% 70% 137% The goal of the Project was achieved. method.

# Has this country developed a Strategic Zika Social Behavior Change CARE Ecuador 6b framework as part of their Zika No No No No No No No No No No No No No No No No response? Enter Yes or No

New CARE Ecuador # of referrals to clinical services 48 0 38 23 1 0 0 0 110 100 110% The goal of the Project was achieved. 4a indicador New CARE Ecuador # of referrals to non-clinical services 0 0 0 0 0 0 0 0 0 4a indicador # (total) of referrals of affected New CARE Ecuador individuals to care and support 48 0 38 23 1 0 0 0 110 100 110% The goal of the Project was achieved. 4a indicador services # of Female individuals of reproductive age in project areas who CARE Ecuador 6e have taken at least one action within 394 363 233 990 the lasta mont to prevent Zika infection or its consequences Total # females of reproductive age CARE Ecuador 531 365 375 1271 6e surveyed % of Female individuals of reproductive age in project areas who This data is not cumulative (column R is not CARE Ecuador have taken at least one action within 74,20% 99,45% 62,13% 77,9% 6e correct). the lasta mont to prevent Zika infection or its consequences # of Male individuals of reproductive age in project areas who have taken at This data is not cumulative (column R is not CARE Ecuador least one action within the lasta mont 96 93 59 248 6e correct). to prevent Zika infection or its consequences Total # Males of reproductive age This data is not cumulative (column R is not CARE Ecuador 129 126 121 376 6e surveyed correct). % of MALE individuals of reproductive age in project areas who have taken at least one action within CARE Ecuador 74,42% 73,81% 48,76% 66,0% 6e the last month to prevent Zika infection or its consequences.

% of individuals of reproductive age in In Ecuador since year 2 no cases of Zika project areas who have taken at least were reported. This affects a lower Ecuador 6e one action within the lasta mont to 74,24% 92,87% 58,87% 70% 84% perception of risk and the need to prevent prevent Zika infection or its CARE consequences

Number of volunteers working to support New The goal was exceeded by the participation CARE Ecuador 9a 519 70 262 500 159 1.019 500 204% community-level Zika response indicador of university and high school students who participated as community monitors

Number of schools with tools and New CARE Ecuiador 76 35 37 11 5 88 164 120 137% The goal of the Project was achieved. 9b methods to address arboviruses indicador

Number of carigivers that have received This indicator does not correspond to this CARE Ecuador information/orientation to conduct early NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 9c project stimulation with infants USAID.GOV USAID ANNUAL PROGRESS REPORT | xlii • PERU

Reporter: (Please provide contact information) Maria Espinoza / Rosa Galvan. Rev: Cecilia Tamayo Submission Date: 27/9/2019 Definition of Community in Country: PERU Approximate # of Persons in Community: 263.009 Type of Index for Indicator 1 e (e.g. house index, container index, Breteau index, or Stegomyia index), oviposition indices, or via pupal demographic surveys: FY 2017 FY 2018 FY 2019 Life of Project Life of Project Target Comments Results Partner Country Indicator Number INDICATOR Year End 2017 Q1/2018 Q2/2018 Q3/2018 Q4/2018 S1 S2 Q1/2019 Q2/2019 Q3/2019 Q4/2019 S1 S2 Cumulative Results to Date

Numerator - number of communities reached with any physical This data is not cumulative. CARE Peru vector control activities within the targeted geographic area 126 113 28 99 58 101 62 53 42 682 125 1a The number of communities reached was 125

Denominator - number of communities in the targeted CARE Peru 1a geographic area, per 100. 965 145 145 145 145 145 145 145 145 2125 145 This data is not cumulative.

Percent (%) of communities where physical vector control CARE Peru 13,1% 77,9% 19,3% 68,3% 40,0% 70% 42,8% 36,6% 29,0% 86,20% 70% 86,21% 1a activities are being implemented The goal of the Project was achieved

Numerator -number of communities conducting vector These data are not cumulative. The number of communities reached was 62. CARE Peru 1b surveillance and/or monitoring activities within the targeted 295 35 43 48 56 50 58 60 57 702 62 This data includes 45 communities where the development of the SVBC was geographic area complete and others with partial progress. In Jaén and Chiclayo the progress was lower due to the rotation of the project staff.

Denominator - number of communities in the targeted This data is not cumulative. In the first year we had 965 communities and in the CARE Peru geographic area 965 145 145 145 145 145 145 145 145 2125 145 1b second and third year 145 communities

Percent (%) of communities in which vector monitoring activities This data is not cumulative. CARE Peru are being implemented 30,6% 24,1% 29,7% 33,1% 38,6% 34% 40,0% 41,4% 39,3% 42,80% 70% 43% 1b . The goal was not reached.

The goal of the Project was achieved. In addition to what was reported, another Number of people trained in vector control 174 people were trained, this is the result of scaling interventions In addition to CARE Peru 680 238 179 571 0 417 571 27 44 494 0 71 494 2233 2000 112% 1c what was reported, another 174 people were trained, this is the result of scaling interventions

Baseline total number of eggs CARE Peru 1d 42,12 42,06 42,61 43,64 31,82 53,17 24,49 24,44 24,44 40,03

Current total number of eggs CARE Peru 1d 33,84 53,17 24,49 24,44 16,42 30,38 28,14 2488 14,46 23,27

The general tendency of the average of eggs per ovitraps was of descent all along the project; nevertheless, the average rate of the baseline was of 23.27 Percent (%) change in mosquito egg density, from baseline, in versus the global average of the last year which was of 25.73. These data CARE Peru targeted geographic areas (Baseline-Current/Baseline)% 20% -26% 43% 44% 48,4% -50% -14,9% -10080,0% 40,8% -10,55% 10% -10,55% 1d contains official information from the MoH corresponding to all project intervention areas.

CARE Peru 1e Baseline Index Value 1,09 1,48 4,33 3,95 2,16 3,18 4,02% 2,92% 2,92% 2,98

CARE Peru 1e Current Index Value 4 3,18 4,02 2,92 2,33 1,82 3,09% 6,14% 5,04% 3,53

The general tendency of the average of eggs per ovitraps was of descent all % change in mosquito frequency, from baseline, in targeted along the project; nevertheless, the average rate of the baseline was of 3.53 geographic areas CARE Peru 1e -267% -116% 7% 26% -8% 43% 23,1% -110,3% -72,6% -18,46% 10% -18,46% versus the global average of the last year which was of 4.19. These data contains official information from the MoH corresponding to all project intervention areas.

xliii | USAID ZIKA ANNUAL REPORT USAID.GOV CARE Peru 2a Number of health providers trained to provide Zika prevention 0 0 20 196 74 12 30 76 67 475 500 95% counseling to Women of Reproductive Age (WRA) In the third year, the ASSIST Zika project began operating in two regions of the JAZ project, so the counseling activities were carried out by that project.

Numerator: Number of women of reproductive age surveyed CARE Peru 2b within the targeted project areas who can identify the potential 261 604 1179 1179 risks of ZIKA infection during pregnancy.

Denominator: Total number of women of reproductive age CARE Peru 2b surveyed within the targeted project areas. 291 740 1373 1373

% of WRA in project areas who can identify the potential risks of CARE Peru 90% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 82% #¡DIV/0! #¡DIV/0! 86% 86% 80% 86% There is an increase of 4% from year 2 to year 3. (KAP Study) 2b ZIKA infection during pregnancy

Numerator: Number of women of reproductive age surveyed CARE Peru 2c within the targeted project areas who can identify at least one 164 503 966 966 sexual transmission prevention method

Denominator: Total number of women of reproductive age CARE Peru 291 740 1373 1373 2c surveyed within the targeted project areas.

% of women of reproductive age in project areas who can CARE Peru 56% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 68% #¡DIV/0! #¡DIV/0! 70% 70% There is an increase of 2% from year 2 to year 3.( KAP Study) 2c identify at least one sexual transmission prevention method

This data is not cumulative. # communities with members actively participating in Zika The number of communities reached was 65, the % reached relates to this CARE Peru monitoring, prevention, and/or support activities 51 4 24 25 35 28 60 37 18 32 45 55 77 271 50 130% 5a number. .

This data is not cumulative. 5b: # communities with community plans for the prevention and CARE Peru 5 0 4 0 4 4 4 8 19 31 38 27 69 109 50 100% The number of communities reached was 51, the % reached relates to this 5b control of Zika number

5c # Zika events that involve families, schools, municipality The goal was exceeded due to the participation of local governments and CARE Peru governments, or community organizations 154 41 34 97 52 75 149 27 39 504 0 66 504 948 100 150% 5c communities. Total reached in the 3 years was 1258 events.

Total # of individuals of reproductive age in project areas who Massive and dissemination activities have allowed the beneficiaries of the CARE Peru 162440 47160 19325 16890 3007 34507 322314 19897 356821 605643 3250 6a have received Zika messages project to reach.

# of FEMALE individuals of reproductive age in project areas CARE Peru 71851 0 0 0 0 142266 0 142266 71851 6a who have received MASS MEDIA Zika messages

# of MALE individuals of reproductive age in project areas who CARE Peru 81500 0 0 0 0 123733 0 123733 81500 6a have received MASS MEDIA Zika messages

# of FEMALE individuals of reproductive age in project areas CARE Peru 5036 461 1572 1315 1723 5071 0 0 8106 0 8106 10107 6a who have received DIGITAL MEDIA Zika messages

# of MALE individuals of reproductive age in project areas who CARE Peru 4053 461 1572 1315 1723 5071 0 0 6633 0 6633 9124 6a have received DIGITAL MEDIA Zika messages

# of FEMALE individuals of reproductive age in project areas CARE Peru 6a who have received INTERPERSONAL COMMUNICATION Zika 0 1152 1754 2343 16982 22231 19325 8982 2169 18246 21966 11151 21966 41556 messages

# of MALE individuals of reproductive age in project areas who CARE Peru 0 213 213 520 13841 14787 7908 838 16261 19610 8746 19610 14787 6a have received INTERPERSONAL COMMUNICATION Zika messages

USAID.GOV USAID ANNUAL PROGRESS REPORT | xliv # of FEMALE individuals of reproductive age in project areas CARE Peru 236 667 1073 1073 6c who can name one vector transmission prevention method

CARE Peru 6c Total # FEMALES of reproductive age surveyed 291 740 1167 1167

% of FEMALE individuals of reproductive age in project areas CARE Peru 81% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 90,14% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 92% 92% There is an increase of 2% from year 2 to year 3.( KAP Study) 6c who can name one vector transmission prevention method

# of MALE individuals of reproductive age in project areas who CARE Peru 100 227 396 396 6c can name one vector transmission prevention method

CARE Peru 6c Total # MALES of reproductive age surveyed 125 270 433 433

% of MALE individuals of reproductive age in project areas who CARE Peru 80% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 84,07% #¡DIV/0! #¡DIV/0! #¡DIV/0! 91% There is an increase of 7% from year 2 to year 3.( KAP Study) 6c can name one vector transmission prevention method

% of individuals of reproductive age in project areas who can CARE Peru 6c name one vector transmission prevention method. 81% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 88,51% #¡DIV/0! #¡DIV/0! #¡DIV/0! 92% 92% 70% 131% IThere is an increase of 3,5% from year 2 to year 3.( KAP Study)

# Has this country developed a Strategic Zika Social Behavior Change framework as part of their Zika response? Enter Yes or CARE Peru no yes yes 6b No

CARE Peru 4a # of referrals to clinical services 0 5 60 2 0 65 2 2 5 29 99 7 128 202 CARE Peru 4a # of referrals to non-clinical services 0 0 0 0 0 0 0 0 0 0 0 0 0 0 # (total) of referrals of affected individuals to care and support CARE Peru 0 5 60 2 0 65 2 2 5 29 99 7 128 202 100 202% The goal of each year was met. 186 additional references have been registered. 4a services # of FEMALE individuals of reproductive age in project areas who have taken at least one action within the last month to CARE Peru 276 563 1010 1010 6e prevent Zika infection or its consequences.

CARE Peru 6e Total # FEMALES of reproductive age surveyed 302 740 1167 1167 % of FEMALE individuals of reproductive age in project areas who have taken at least one action within the last month to CARE Peru 91% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 76,08% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 87% 87% There is an increase of 21% from year 2 to year 3.( KAP Study) 6e prevent Zika infection or its consequences.

# of MALE individuals of reproductive age in project areas who have taken at least one action within the last month to prevent CARE Peru 82 184 369 635 6e Zika infection or its consequences.

CARE Peru 6e Total # MALES of reproductive age surveyed 94 270 433 797 % of MALE individuals of reproductive age in project areas who have taken at least one action within the last month to CARE Peru 87% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 68,15% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 85% 80% There is an increase of 17% from year 2 to year 3.( KAP Study) 6e prevent Zika infection or its consequences.

% of individuals of reproductive age in project areas who have taken at least one action within the last month to prevent Zika CARE Peru 90,40% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 73,96% #¡DIV/0! #¡DIV/0! #¡DIV/0! #¡DIV/0! 86% 86% 70% 123% There is an increase of 12% from year 2 to year 3.( KAP Study) 6e infection or its consequences.

This data is not cumulative. Number of volunteers trained and working to support community- New indicator 177 177 65 186 250 159 436 300 130% The number of volunteers, include MC was 389 , the % reached relates to this CARE Peru 9a level Zika response 94 772 number. This data is not cumulative. CARE Peru 9b Number of schools with tools and methods to address arboviruses New indicator 92 92 12 0 35 64 12 99 203 120 93% The number of IIEE reached was 111 , the % reached relates to this number.

CARE Peru 9c Number of carigivers that have received information/orientation to NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA This indicator does not correspond to this project. conduct early stimulation with infants

xlv | USAID ZIKA ANNUAL REPORT USAID.GOV ANNEX IB. OTHER ZIKA ACTIVITY INDICATORS

• ECUADOR AND PERU

Progress of Indicators Result 1.- Best practices in community participation and mobilization on prevention, promotion and practices regarding Zika identified.

% of % of Cumulative Indicator Y1 Progress Y2 Progress Planned Y3 Y3 Progress Completion Indicators PAIS Goal Completion progress Comments Number Achieved Achieved Target Achieved of total of Y3 Target achieved project goal Number of EBA reports on best practices on PERU 3 1 1 1 1 100% 3 100,00% The KAP study was replaced by the I.1 vector control. good practice contest ECUADOR 3 1 1 1 1 100% 3 100,00% Goal Achieved Number of KAP studies implemented and shared at PERU 3 1 1 1 1 100% 3 100,00% Goal Achieved I.2 local and national levels ECUADOR 3 1 1 1 1 100% 3 100,00% Goal Achieved Number of EBA reports on community surveillance PERU 3 1 1 1 1 100% 3 100,00% Goal Achieved I.3 practices ECUADOR 3 1 1 1 1 100% 3 100,00% Goal Achieved

USAID.GOV USAID ANNUAL PROGRESS REPORT | xlvi Result 2.- Best practices and lessons learned against Zika found through the EBA and KAP implemented immediately in priority risk areas

% of % of Cumulative Indicator Y1 Progress Y2 Progress Planned Y3 Y3 Progress completion of Indicators PAIS Goal completion of progress Comments Number Achieved Achieved Target Achieved total project Y3 Target achieved goal I.4 Number of local health and local government Goal achieved and scaling indicator (municipal) personnel, and community monitors In addition to what was reported, 174 from selected areas trained in protocols or PERU 2000 680 1448 228 228 100% 2356 117,80% more people were trained in vector guidelines based on EBA and KAP findings on control, the cascading strategy vector control contributed to this result

ECUADOR 2000 343 1663 175 697 >100% 2703 135% Goal achieved and scaling indicator. I.5 Number of local health and local government PERU 500 50 255 195 293 150% 598 119,60% (municipal) personnel, and community monitors Goal achieved and scaling indicator. from selected areas implementing protocols or guidelines based on EBA and KAP findings on Goal achievedscaling indicator. In vector control ECUADOR 500 0 411 175 200 114% 611 122% addition to what was reported, 300 more monitors implemented guidelines on the vector control activities. I.6 Number of communication messages developed, Goal achieved and scaling indicator. validated or updated 9 additional messages were elaborated PERU 10 15 4 10 0 0% 19 190,00% for murals and for spots spread on community radios. Goal achieved and scaling indicator. 6 additional messages were elaborated ECUADOR 10 5 10 1 1 100% 16 160% for prevention in adolescents and men.

I.7 Improve the efficiency of ovitraps in at least 10% for vector control and community surveillance Goal achieved. (Peru - Pilot study) PERU 3 0 1 2 2 100% 3 100,00% A decrease in the # of eggs and larval index indicators was demonstrated in the study communities, improving the results of the 2018 in Campo Amor. In Ecuador ovitrap were not used by ECUADOR NA NA NA NA NA NA NA NA the Ministry of Health for vector control. I.8 Number of vector control and community Goal achieved and scaling indicator. surveillance events implemented involving families, Additionally 3, 100 additional events. PERU 100 154 195 100 0 0% 349 >100% communities, municipalities, health systems, were made in year 3. Completely exceeding the established goal community water management organizations Goal achieved and scaling indicator. In addition to what was reported, ECUADOR 100 42 40 18 50 278% 132 132% another 63 events were held. I.9 Number of local governments (municipalities) in Goal achieved PERU 20 3 12 20 20 100% 20 100,00% selected areas that implemented action of zika prevention and control as planned The Municipalities of Huaquillas ( El Oro Province) and Jama (Manabí ECUADOR 10 8 6 6 6 100% 8 80% Province) had less participation in prevention and control. xlvii | USAID ZIKA ANNUAL REPORT USAID.GOV Result 3.- System (Community Based Surveillance System) for local governments and community use to enable a continuous gathering and analysis of best practices at community level in use.

% of % of Cumulative Indicator Y1 Progress Y2 Progress Planned Y3 Y3 Progress completion of Indicators PAIS Goal completion of progress Comments Number Achieved Achieved Target Achieved total project Y3 Target achieved goal Community Based Surveillance System (CBSS) PERU 1 0 1 1 1 100% 1 100,00% Goal achieved. I.10 developed, validated (Pilot study) ECUADOR 1 0 1 1 1 100% 1 100,00% Goal achieved. Goal achieved and scaling indicator. PERU 10 0 12 10 13 130% 13 130,00% In addition 3 more locations were Number of local governments (municipalities) reached. I.11 using the CBSS in the planning of actions against The Municipalities of Huaquillas ( El Oro Province) and Jama (Manabí Zika and make decisions ECUADOR 10 0 4 6 6 100% 8 80% Province) had less participation in prevention and control.

PERU 500 0 195 305 207 68% 402 80,40%

Goal achieved and scaling indicator.The Number of community monitors dully providing number of CM that generated I.12 periodic surveillance reports to local health surveillance reports was higher due to services. ECUADOR 500 0 411 175 500 >150% 911 >150% the alliance with 2 universities, in Manabí and El Oro, this allowed the participation of students as CM.

% of community monitors who collect information PERU 80% 0 85% 80% 100% 125% 100% 125,00% Goal achieved and scaling indicator. I.13 and generate valid reports of community 125% 80,77% 101% surveillance through the CBSS ECUADOR 80% 0 61,54% 80,00% 100,00% Goal achieved

% of people (Health Workers, Local Authorities) PERU 80% 0 9% 80% 63% 79% 63,06% 78,82% I.14 who have (provided) used information valid from CBSS ECUADOR 80% 0 75% 80% 81% 101% 78,00% 98%

% of Health Services that issue and receive PERU 70% 0 44,74% 70,00% 97,14% 139% 97,14% 135,00% Goal achieved and scaling indicator. I.15 information to-from other stakeholders for its use in the planning of actions against Zika (Peru) ECUADOR NA NA NA NA NA NA NA NA NA % of community members who have received 50% of the beneficiaries of CBSS information from other stakeholders (Community PERU 60% 0 40% 60% 50% 83% 47,13% 78,54% received information of the application. I.16 Health Agents, Community Monitors, Health Personnel, local authorities) for its use in the 143% 76,50% 128% ECUADOR 60% 0 67% 60% 86% Goal achieved and scaling indicator. planning of actions against Zika Proportion of local authorities/ Community Health PERU 100% 0 100,00% 100,00% 100% 100% 100,00% 100,00% Goal achieved I.17 Agents/community monitors/ who have received feedback through the CBSS ECUADOR 100% 0 97,42% 100% 81% 81% 89,21% 89% Goal achieved and scaling indicator Number of health personnel trained in CBSS. PERU 500 0 163 300 405 135% 568 113,60% In addition to what was reported, 112 I.18 (Peru) more people were training. ECUADOR NA NA NA NA NA NA NA NA NA Goal achieved and scaling indicator PERU 250 0 85 250 336 134% 421 135,00% Goal achieved and scaling indicator In addition to what was reported, 150 Number of local governments and community I.19 more monitors were training, because monitors trained in CBSS. ECUADOR 250 125 223 100 100 100% 448 179% new CBSS experience was developed during year 3, so more monitors were formed USAID.GOV USAID ANNUAL PROGRESS REPORT | xlviii Result 4.- Communication strategy for behavior change among women of reproductive age, pregnant women and adolescents implemented using formal and informal means

% of Cumulative % of Indicator Y1 Progress Y2 Progress Planned Y3 Y3 Progress Indicators PAIS Goal completion of progress completion of Comments Number Achieved Achieved Target Achieved Y3 Target achieved total project Communication strategy developed, validated or PERU 1 1 1 1 1 100% 1 100% Goal achieved I.20 updated ECUADOR 1 0 1 1 1 100% 1 100% Goal achieved Goal achieved and scaling indicator. In addition to what was reported, 23 PERU 20 0 4 20 20 100% 24 120,00% more plans were prepared in year 3, Number of Local Communications Plan I.21 completing 47 in total. implemented by key stakeholders The Municipalities of Huaquillas ( El ECUADOR 10 0 3 7 5 71% 8 80% Oro Province) and Jama (Manabí Province) had less participation in Goal achieved % of communities (localities) that recognize the role PERU 60% 0 89,83% 60,00% 90,00% 150% 90,00% 135,00% I.22 of key stakeholders (community organizations, local governments and health services) ECUADOR 60% 29,24% 17% 60% 79% 132% 41,87% 70%

Goal achieved and scaling indicator. PERU 300 0 98 300 390 130% 488 135,00% 5 additional kits were delivered Number of communication kit to promote Goal achieved.The goal was exceeded I.23 prevention and control of Zika delivered to by the participation of university community health workers ECUADOR 260 0 260 500 500 153,85 students as Community Monitors. In total 760 kits were delivered

Goal achieved % of women of reproductive age and pregnant PERU 80% 50% 94,33% 80,00% 95,78% 119,73% 95,78% 119,73% I.24 women informed on prevention and control of Zika. ECUADOR 80% New 81% 80% 76% 95% 78,50% 98% Goal achieved Goal achieved +L54KAP 2019, evidenced an increase PERU 60% 54% 86,11% 70,00% 93,08% 132,97% 93,08% 135,00% of this indicator by 8% compared to year 2 of the project. Total increase % of women of reproductive age and pregnant 39% I.25 women who increased awareness/knowledge on KAP 2019, evidenced an increase of prevention and control against Zika infection. this indicator by 7% in Y3 compared to ECUADOR 70% 64% 82% 10% 89% 70% 70,00% 56% year 2. Total increase25%, This data represents 56% in relation to the baseline and the target

Goal achieved % of women of reproductive age and pregnant PERU 60% 54% 17,89% 60,00% 73,05% 121,75% 73,05% 121,75% I.26 women, who apply better practices in prevention The absence of cases affected a lower and care-giving against Zika ECUADOR 60% New 48% 60% 58,40% 97,33% 58,40% 97,33% perception of risk and practices

% of adolescents who increased their PERU 70% New 76,35% 70,00% 18,94% 27% 18,94% 27,06% I.27 awareness/knowledge on prevention and control Goal achieved against zika infection. ECUADOR 70% New 28% 70% 70% 100% 70,00% 101%

Goal achieved % of adolescents who knows prevention practices PERU 80% 60% 82,50% 80,00% 98,13% 123% 98,13% 122,66% I.28 against Zika infection. ECUADOR 80% New 45% 80% 56% 70% 51% 63% Goal achieved KAP 2019, evidence increase in year 3 % of adolescents who apply better practices in PERU 60% 40,49% 76,88% 60,00% 95,00% 158% 95,00% 135,00% I.29 in relation to year 2 of the project, prevention and care-giving against Zika xlix | USAID ZIKA ANNUAL REPORT 24% USAID.GOV ECUADOR 60% New 28% 60% 46% 77% 37% 62% Result .5.- Extend the strategies and protocols developed and applied locally to other areas of the country.

% of % of Cumulative Indicator Y1 Progress Y2 Progress Planned Y3 Y3 Progress completion of Indicators PAIS Goal completion of progress Comments Number Achieved Achieved Target Achieved total project Y3 Target achieved goal Goal achieved and scaling indicator Number of local governments (municipalities) in PERU 20 15 6 20 19 95% 19 95,00% selected areas trained in annual budgeting I.30 The lack of competencies in health of processes to allow for planning and budgeting ECUADOR 10 5 4 6 6 100% 7 70% the Municipalities makes it difficult to against Zika (Peru) plan prevention actions

% of local governments (municipalities) in selected Goal achieved and scaling indicator PERU 80% 80% 16,67% 80% 79% 99% 79 98,75% I.31 areas that include planning for Zika prevention . actions and control as part of annual budget. (Peru) ECUADOR NA NA NA NA NA NA NA NA % of local governments in selected areas implementing joint inter-sector coordination and PERU 90% 62% 56% 90% 54% 60% 54% 60,00% I.33 planning of Zika prevention and control, involving other stakeholders and communities ECUADOR 90% 40% 30% 90% 70% 78% 70% 78% Goal achieved and scaling indicator Number of activities implemented to achieve PERU 6 1 4 6 6 100% 11 135,00% I.34 mutual learning, experience exchanges, results and Goal achieved and scaling indicator recommendations discussion, etc. ECUADOR 6 2 4 4 4 100% 10 167%

Goal achieved PERU 3 1 2 1 1 100% 4 133,33% The Project Closing event was held.

Goal achieved and scaling indicator In addition to what was reported, 9 ECUADOR 3 1 2 2 2 100% 5 167% local workshops were held for sustainability at the local level Goal achieved PERU 3 1 1 1 1 100% 3 100,00% Binational Meeting of Mayors of Peru and Ecuador Number of exchange and learning meeting held at Goal achieved and scaling indicator I.35 ECUADOR 3 1 2 1 1 100% 4 133% local, national, bin/national and international levels National Meeting of Community PERU 1 1 1 1 1 100% 1 100,00% Monitors Goal achieved and scaling indicator International workshop “Community Mobilization in response to health ECUADOR 1 Y3 Y3 1 1 100% 1 100% emergencies and epidemics: learning from the fight against Zika” Binational Meeting of Community Monitors

Goal achieved PERU 1 Y3 Y3 1 1 100% 1 100,00% Number of recommendations for the Document with 12 recommendations formulation of policies for the control and proposed by various specialists. I.36 prevention of Zika and related topics, for: Document of good practices, lessons local government, regional government learned and recommendations ECUADOR 1 Y3 Y3 1 1 100% 1 100% and national government elaborated from the experiences of the projects supported by USAID. USAID.GOV USAID ANNUAL PROGRESS REPORT | l ANNEX II SUCCESS STORIES

PERU COMMUNITY-BASED SURVEILLANCE PILOT PROJECT IN CAMPO AMOR - ZARUMILLA – TUMBES

Campo Amor is one of the largest human settlements in the Zarumilla District, that due to its geographical location and the trading and social interaction that there occur is considered a gateway entrance of various diseases, including Zika. Coupled with the deficiencies regarding water supply, sanitation and the inadequate self- care practices of the population, Campo Amor became an important location to intervene to reduce the propagation of Zika and other vector-borne diseases.

The pilot project "Campo Amor" is a community-based surveillance system that aims at involving the community in the prevention and control of vector-borne diseases, particularly Zika, through the coordinated work and active communication of its leaders, authorities and other organizations that converge in the locality. The implementation process involved capacity building, organization (mapping, sectoring and population census), planning, action execution, conversations with the participants, and experience evaluation.

Under the leadership of a health committee run by the municipality and the community monitors, people in the locality played an important role in the development of the project. The community monitors volunteered to work hand in hand with their leaders and authorities in the development of prevention and control actions. Such actions included home visits, mosquito breeding sites elimination, informative fairs, and radio broadcasts and other mass media that were not available in the locality before, thus allowing people to access real and updated information on the actions taken, and permitting an articulated response in the area.

People in Campo Amor are now aware of preventive measures, so they can plan actions, monitor the presence of the mosquito, and respond together against the vector. This sets a precedent for the region and for the rest of the country, since community- based surveillance system proved effective, and no Zika cases were reported, and new cases of dengue and chikungunya were reduced. Subsequently, the experience was reproduced in ten other locations in Tumbes, and in the Piura, Lambayeque and Cajamarca (Jaen district) regions.

li | USAID ZIKA ANNUAL REPORT USAID.GOV A SUMMER WITHOUT ZIKARIO5

Catacaos-Piura is rightfully also known as the Heroic Village, because of its long history of struggles at different points in time; in fact, in 2017 its inhabitants faced challenge when the Piura River flooded, but once again demonstrated their strength. Nevertheless, such harsh environment has also created opportunities of improvement for its inhabitants, such as the project Together against Zika, which helped to strengthen local capabilities to cope with the Zika outbreak in the Piura Region. Especially in Catacaos, the project contributed to improving social change for the prevention of Zika.

At the beginning of 2019, and after a year of working intensely with teachers to incorporate Zika prevention in the school curriculum, the project promoted the vacation course called “A summer without Zikario”, aimed at middle and high school students from the prioritized towns. Catherine Muñoz A., who is part of the project as facilitator of performing arts and responsible for Health Promotion of the Catacaos Health Center, says that inviting students to take part in the course was not easy, because the vacations had already begun. She contacted Jose Jacobo Cruz Villegas High School’s principal, who invited fifth-year high school students, however, there was no good response either; so he opted for second year high school students, who were the most interested.

Rafael Sime, professional actor and author of the play "Don Zikario is not from this Neighborhood", led the vacation course. Jireh Dayana Adanaque Chero, one of the actors, said that the tools used by Rafael to break the ice and lose stage fright impressed her.

“Don Zikario is not from this Neighborhood,” tells the story of an Aedes aegypti mosquito and its two henchmen, who settle in a neighborhood where families do not cap their water containers properly. The play follows some funny scenes, until a pregnant woman contracts Zika and people protest, Don Zikario and his friends then go to trial and are convicted. The play has been presented successfully on nine occasions, in schools, in a higher learning institute, in a public park, and in the city of Lima, during the award ceremony of the III Edition of the Zika Prevention and Control Good Practices Prize. For these students from low-income families, taking a plane for the first time, from the city of Piura to Lima, was an important event.

Jireh Dayana, who plays “Chana”, a well-informed teenager on Zika prevention, says that the most important thing that she learned from the play has been “being able to reach people with a more entertaining message, raise awareness through a very funny story, … we conveyed the message through jokes, and funny situations, and because of that, people listened to us and took the recommendations that we give them throughout the play, such as properly capping the tanks, using mosquito nets and repellents, among others. ” Catherine Muñoz A. says that, unlike with other type of campaigns, the public did not lose attention during the play.

Other teenagers now want to follow in the footsteps of the community monitor and their eight classmates that appeared in the play; In this regard, Jireh says she feels admired by her peers. Meanwhile, Catherine Muñoz hopes

5 Sicario in Spanish means Hitman in English; thus, Zicario is a play on words that alludes to the Zika virus. USAID.GOV USAID ANNUAL PROGRESS REPORT | lii to continue using theater as a means to promote healthy practices and generate behavioral change in the population of Catacaos.

liii | USAID ZIKA ANNUAL REPORT USAID.GOV ECUADOR

CARLOS VEGA I feel like a leader of my community, who teaches people how to protect themselves from Zika

Carlos Vega lives in the Santa Martha neighborhood of San Vicente Canton, in the province of Manabi. He is 33 year old and drives a tricimoto6. He participated in several recreational activities that the project Together against Zika carried out in the city's central park to spread information. “When I went through the park and saw the Zika campaigns, I would stay to learn more and have something to talk about with the passengers who got on my tricimoto. Since I liked the topic, I asked them to invite me to the workshops”.

Thus, he participated in training workshops regarding control and prevention of Zika, and in informative campaigns. The project carried out 212 training events and 213 sensitization events, including home visits and vector control mingas7, one of the community-based epidemiological surveillance activities.

Carlos also participated in the planning workshop for the Community Prevention Plan against Zika, and in the cantonal communication plan for the control and prevention of Zika. “At the beginning I was very embarrassed and afraid, and hardly even spoke. Then I got more confident and began to talk, I was encouraged to organize campaigns in my neighborhood, and to accompany CARE and Ministry’s personnel to the home visits”.

The San Vicente canton, in which Carlos lives and works, is one of the 10 cantons in which the project Together against Zika takes action, and one of the most affected by the April 2016 earthquake.

Carlos is involved in a campaign called “10 minutes against Zika”, where he makes home visits once a week, to explain families about the project. The work is not easy, he says, “Some people do not open their doors. Some others don’t want to be bothered; other people are afraid or suspicious, because of robbers. It is not easy, but little by little, we must convince people that we want to give them information that will be very useful for their lives, and that can help us all”.

6 Motorized tricycle used as public transport in some towns in Ecuador. 7 Unpaid collaborative work. USAID.GOV USAID ANNUAL PROGRESS REPORT | liv Additionally, Carlos placed banners on Zika prevention in his tricimoto, and this motivated 20 other tricimoto drivers to do the same, and to hand their passengers out stickers and magnets with messages concerning the sexual transmission of the virus, and actions to eliminate hatcheries. With these and other communication campaigns, foreseen in the communication plan for social and behavioral change regarding Zika prevention, the project delivered its message to 1.028.542 people of reproductive age, the majority of whom are women. The project placed messages in the radio, in garbage trucks, in tricimotos, and in 5 billboards.

“Before I was part of the project, people in my community laughed at how I spoke. The children treated me badly. Now everyone greets me, everyone knows me, and I feel like a leader. I want to continue informing families on Zika prevention; someday I want that we all shout Together against Zika”.

lv | USAID ZIKA ANNUAL REPORT USAID.GOV

MIRTA SABANDO We must educate families on Zika, to prevent children from being born with microcephaly

In Ecuador, the project “Together against Zika”, promoted educational and communicative campaigns, promoted educational and communicative campaigns on the control and prevention of Zika. Such campaigns were designed and assessed based on studies on knowledge, attitudes and practices (KAP); best practices in the control of Aedes aegypti (EBA); and community-based surveillance actions. We carried out three studies on each subject.

The first KAP study revealed that 7 out of 10 people thought that fumigation was the best way to prevent Zika, and that such was the responsibility of the Ministry of Health. To revert such beliefs, the project promoted communication campaigns that conveyed three messages: the relation between Zika and microcephaly syndrome, the importance of properly brushing, washing and capping water tanks; and the sexual transmission of the virus. The project also sponsored community-based surveillance actions, which encouraged participants to dedicate “10 minutes” every week to eliminate mosquito-breeding sites, both at home and in the community.

The project also increased the informative and educational activities that targeted adolescents and their families, through an agreement signed with the Ministry of Economic and Social Inclusion (MIES in Spanish), whose actions include the education of families to allow them to build spaces for the prevention and protection against any situation that may violate the exercise of their rights.

The MIES implements its programs through cooperation agreements with other institutions, such as Simón Palacios Foundation, that executes a Child Development project in Pedernales. Mirta Sabando, Director, says that the Foundation got involved with the project Together against Zika “because we believe it is necessary to inform and educate people to prevent the birth of children with microcephaly. Prevention is the most important thing; a lot of money is needed when a child is born with health problems, and it affects the whole family. Mothers suffer the most; we have even had cases where the father refuses to take responsibility and leaves home. They blame the woman for not Mirta Sabando, Director of Simon Palacios Foundation, taking caring of herself, and for the child being in the informative campaign held in neighborhood born with the disability”. Ciudad Jardin, in Pedernales canton. Personnel from the Simon Palacios Foundation participated in training activities, and are currently part of the 875 community monitors of the project, who make weekly home visits to teach families how to avoid the sexual transmission of the virus, and how to prevent and eliminate mosquito breeding.

Mirta Sabando commented, “Our personnel have learned a lot from the workshops that CARE and the Ministry of Health’s staff has given us. The meeting in Manta made the biggest impact, since they could meet and share experiences with people from Peru and Ecuador. Our personnel arrived very motivated and knowing that it is our job to reach the families and the community, to teach them how to take care of their health, the environment and to prevent them from getting sick”.

USAID.GOV USAID ANNUAL PROGRESS REPORT | lvi In Ecuador, the project developed four national training workshops, and four bi-national knowledge exchange meetings, aimed at agents and volunteers who carried out vector surveillance actions in their communities.

Informative campaign on Zika prevention preceded by CARE and the Simon Palacios Foundation. Ciudad Jardin neighborhood. Pedernales Canton.

The strategies and actions developed by the project throughout three years, either directly or through partnerships with public and private institutions, and social organizations, made possible that 51% of communities take part in vector control activities, and that approximately 94 thousand people personally receive messages on the control and prevention of Zika.

For Mirta, the partnership with CARE has also allowed the Foundation to strengthen inter-institutional coordination, to work with families and the community in a more comprehensive way. Moreover, she commented, "we have reinforced our knowledge on how to promote and strengthen community work." This is one of the biggest challenges for those who work in the Pedernales canton, where people are not motivated to work for the community, “everyone is worried about their own survival. Very few care about the neighbor, even considering that after the earthquake we met each other and joined a little”, commented Mirta with a sense of longing.

lvii | USAID ZIKA ANNUAL REPORT USAID.GOV ANNEX III TRAINING REPORT Annex III Training Report ECUADOR # of Total Training Curriculum (Full Name) days Training Dates F M Individuals (Abbreviated name) Trained Zika prevention Talks on how to prevent Zika 1 October 4, 2018 81 52 133 Vector control Training to strengthen capacities in detection and destruction of 4 November 15, 2018 18 17 35 hatcheries, aimed at health personnel linked to vector control. Zika prevention Development of Module 4: Health Education 1 November 16, 2018 13 12 25 Zika prevention and control Galileo Galiley School Students Training 1 November 22, 2018 294 369 663 Community-Based Surveillance Training of ULEAM students, for work with adolescents of basic and high 2 November 23, 2018 17 17 34 System (CBSS) school education on Zika prevention, health and personal care. Zika prevention and control MIES events in Family Schools - Protect a lifetime without violence, and 1 November 23, 2018 298 7 305 awareness talks on Zika prevention and control. Sexuality and prevention of Zika Gender, sexual and reproductive rights and prevention of sexual 1 November 28, 2018 63 1 64 risks violence. Zika prevention in adolescents Workshop addressed to adolescent men and women on Zika prevention. 1 November 30, 2018 93 100 193

Zika prevention Wokrshopadressed to children on Zika prevention. 1 November 30, 2018 21 24 45 Zika prevention in adolescents Workshop addressed to adolescent men and women on Zika prevention. 1 November 30, 2018 69 69 138

Zika prevention Workshop adressed to children on Zika prevention. 1 November 30, 2018 65 67 132 Zika prevention in adolescents Workshop addressed to adolescent men and women on Zika prevention. 1 November 30, 2018 185 199 384

Zika prevention planning Identification of major threats and vulnerabilities aiming to develop 1 December 2, 2018 17 3 20 community Zika prevention plans. Zika prevention in adolescents Conference on prevention of Zika sexual transmission and elimination of 1 December 3, 2018 27 31 58 vector hatcheries, aimed at adolescents Zika prevention and control Workshop addressed to adolescent men and women on Zika prevention. 1 December 4, 2018 29 43 72

Zika prevention and control Workshop addressed to adolescent men and women on Zika prevention. 1 December 4, 2018 183 235 418

Zika prevention Health and Zika prevention. 1 December 4, 2018 227 154 381 Zika prevention and control Workshop addressed to adolescent men and women on Zika prevention. 1 December 5, 2018 55 38 93

Zika prevention in adolescents Educational Day on Zika sexual transmission and hatcheries elimination 1 December 5, 2018 15 9 24 aimed at adolescents and teachers of the Antoine School, Pedernales. Community-Based Surveillance Training for community surveillance volunteers. 1 December 6, 2018 16 9 25 System (CBSS) Zika prevention planning Development of community plans for Zika prevention and control, with a 1 December 9, 2018 24 5 29 disaster risk reduction approach. Community-Based Surveillance Training of the Muisne community epidemiological surveillance project's 1 December 12, 2018 21 7 28 System (CBSS) volunteers. Zika prevention Zika prevention educational and recreational day. 1 December 13, 2018 77 81 158 Sexuality and prevention of Zika Zika virus prevention and responsible sexuality. 1 December 15, 2018 40 17 57 risks Safe water and Zika prevention Strengthening of Jama-Pedernales Drinking Water Boards and the 1 December 18, 2018 25 46 71 promotion of actions aimed at Zika prevention, control and surveillance.

Zika prevention and control Training on health, personal care, and Zika prevention, addressed to 1 January 1, 2019 25 32 57 students of Eloy Alfaro District's schools. Zika prevention Workshop on health, personal care and Zika prevention. 1 January 3, 2019 9 7 16 Zika prevention Workshopon health, personal care and Zika prevention. 6 January 4, 2019 216 246 462 Sexuality and prevention of Zika Training on health, personal care, and Zika prevention, addressed to 1 January 6, 2019 51 45 96 risks students of Eloy Alfaro District's schools. Zika prevention and control Training on health, personal care, and Zika prevention, addressed to 1 January 6, 2019 26 31 57 students of Eloy Alfaro District's schools. Zika prevention and control Replication of awareness talk on preventing Zika virus, in Picoaza School. 1 January 7, 2019 41 47 88

USAID.GOV USAID ANNUAL PROGRESS REPORT | lviii # of Total Training Curriculum (Full Name) days Training Dates F M Individuals (Abbreviated name) Trained Zika prevention and control Replication of awareness talk on preventing Zika virus, in Picoaza School. 1 January 7, 2019 27 35 62

Community-Based Surveillance Training of community surveillance volunteers on data collection at home 1 January 8, 2019 19 5 24 System (CBSS) visits. Zika prevention and control Training on Zika, aimed at students of the Paquisha School of the Eloy 1 January 8, 2019 61 72 133 Alfaro District. Zika prevention and control Training on health, personal care, and Zika prevention, addressed to 1 January 8, 2019 32 18 50 students of Eloy Alfaro District's schools. Zika prevention and control Training on health, personal care, and Zika prevention, addressed to 1 January 8, 2019 44 47 91 students of Eloy Alfaro District's schools. Zika prevention and control Training on health, personal care, and Zika prevention, addressed to 1 January 9, 2019 125 124 249 students of Emilio Bowen School of Eloy Alfaro District. Zika prevention and control Training on health, personal care, and Zika prevention, addressed to 1 January 9, 2019 29 28 57 students of El Progreso School of Eloy Alfaro District. Zika prevention and control Training on health, personal care, and Zika prevention, addressed to 1 January 9, 2019 42 42 84 students of Jacobo Vera School of Eloy Alfaro District. Zika prevention and control Training on health, personal care, and Zika prevention, addressed to 1 January 9, 2019 38 52 90 students of Medardo Mora Sierra School of Eloy Alfaro District. Sexuality and prevention of Zika Zika virus and gender violence prevention. 1 January 14, 2019 19 6 25 risks Zika prevention Workshop on heath, personal care and Zika prevention. 1 January 15, 2019 19 12 31 Risk counseling for pregnant Zika: prevention, transmission, clinical manifestations, treatments, and 1 January 15, 2019 41 26 67 women Zika and pregnancy Sexuality and prevention of Zika Capacity building workshop for the Simon Palacios Foundation 1 January 15, 2019 9 2 11 risks technicians' team, for work with families in gender violence prevention and Zika prevention. Zika prevention Workshop on heath, personal care and Zika prevention. 1 January 15, 2019 47 37 84 Community-Based Surveillance Training on Community Surveillance System 1 January 16, 2019 46 27 73 System (CBSS) Sexuality and prevention of Zika Training for students of the Camilo Gallegos school in Zika prevention, 1 January 16, 2019 11 11 22 risks sexual contagion and congenital syndrome. Sexuality and prevention of Zika Training in Zika prevention, sexual contagion and congenital syndrome. 1 January 17, 2019 16 24 40 Zika prevention Capacity building workshop for MIES' Zika prevention technical team. 1 January 17, 2019 41 6 47 Community-Based Surveillance Training on community surveillance system, workshop with volunteers of 1 January 17, 2019 29 5 34 System (CBSS) GAD Portoviejo. Zika prevention planning Zika Prevention's Community Plan Development. 1 January 17, 2019 8 10 18 Community-Based Surveillance Training on community surveillance system, workshop with volunteers of 1 January 18, 2019 63 8 71 System (CBSS) GAD Portoviejo. Zika prevention and control Workshop with members of health committees on Zika virus control and 1 January 18, 2019 15 11 26 prevention. Zika prevention and control Training on health, personal care, and Zika prevention, addressed to 1 January 18, 2019 85 59 144 students of Eloy Alfaro District's schools. Community-Based Surveillance Training on Community Surveillance System 1 January 19, 2019 15 13 28 System (CBSS) Zika prevention planning Zika prevention community plan development. 1 January 19, 2019 16 4 20 Zika prevention Capacity building of MIES technical team, to work with families of MIES 1 January 22, 2019 54 9 63 services, Part # 1. Zika prevention Capacity building of MIES technical team, to work with families of MIES 1 January 22, 2019 51 12 63 services, Part # 2. Zika prevention Capacity building workshop for MIES' Zika prevention technical team. 1 January 22, 2019 66 0 66 Zika prevention Talk on heath, personal care, and Zika prevention. 1 January 23, 2019 86 69 155 Healthy municipalities and Zika Evaluation of indicators of GAD Las Lajas, for Health Promotion 1 January 23, 2019 9 12 21 prevention Certification. Zika prevention Workshop on heath, personal care, and Zika prevention. 1 January 24, 2019 32 36 68 Zika prevention Workshop on heath, personal care, and Zika prevention. 1 January 25, 2019 323 230 553 Zika prevention Workshop on heath, personal care, and Zika prevention. 1 January 25, 2019 70 70 140 Zika prevention Workshop on heath, personal care, and Zika prevention. 1 January 25, 2019 20 18 38 Zika prevention Workshop on heath, personal care, and Zika prevention. 1 January 25, 2019 226 163 389 Social Communicators' Role Preparation, with key actors, of the local communication plan. 1 January 29, 2019 20 14 34 lix | USAID ZIKA ANNUAL REPORT USAID.GOV # of Total Training Curriculum (Full Name) days Training Dates F M Individuals (Abbreviated name) Trained Community-Based Surveillance Training for students of the University of Machala in epidemiological 1 January 29, 2019 87 34 121 System (CBSS) surveillance, Huaquillas. Zika prevention planning Development of strategies to implement community plans for Zika 1 January 29, 2019 6 8 14 prevention. Sexuality and prevention of Zika Awareness and prevention workshop on Zika virus risks and women 1 January 30, 2019 38 0 38 risks sexual transmission. Zika prevention planning Zika prevention community plan development. 1 January 30, 2019 18 2 20 Zika prevention planning Development of community plans for Zika prevention and control, with a 1 January 30, 2019 11 13 24 disaster risk reduction approach. Zika prevention planning Awareness and prevention workshop on Zika virus risks and women 1 February 1, 2019 16 10 26 sexual transmission. Bigua Community. Sexuality and prevention of Zika Workshop on prevention of Zika virus sexual transmission and pregnant 1 February 1, 2019 34 0 34 risks women self-care. Sexuality and prevention of Zika Workshop on prevention of Zika virus sexual transmission and pregnant 1 February 1, 2019 25 0 25 risks women self-care. Zika prevention planning Vector control community plan development. 1 February 4, 2019 22 7 29 Zika prevention planning Development of community plans for Zika prevention and control, with a 1 February 8, 2019 13 7 20 disaster risk reduction approach. Las Tecas (Coaque) community. Masculinities and Zika New Masculinities, sexual violence, and Zika risks. 1 February 8, 2019 27 9 36 Prevention Sexuality and prevention of Zika Eradication and prevention of sexual violence. Workshopon Zika 1 February 11, 2019 42 29 71 risks prevention. Zika prevention Capacity building, development and implementation of workshops for 1 February 11, 2019 16 2 18 Zika prevention. Zika prevention planning Workshop on developing community plans for Zika prevention. 1 February 15, 2019 8 0 8 Zika prevention and control Training day on Zika prevention and elimination of mosquito breeding 1 February 15, 2019 10 0 10 sites. Sexuality and prevention of Zika Prevention of risks of Zika infection and sexual transmission. 1 February 16, 2019 29 4 33 risks Sexuality and prevention of Zika Zika sexual transmission prevention. 1 February 19, 2019 19 0 19 risks Masculinities and Zika New Masculinities, sexual violence, and Zika risks. 1 February 19, 2019 47 27 74 Prevention Masculinities and Zika New Masculinities, sexual violence, and Zika risks. 1 February 20, 2019 19 1 20 Prevention Healthy municipalities and Zika Process for certification as a Health Promotion Municipality, GAD Sucre 1 February 22, 2019 13 13 26 prevention and San Vicente. Sexuality and prevention of Zika Workshops on risks, transmission vector and prevention of Zika sexual 1 February 22, 2019 18 1 19 risks transmission. Addressed to ESIKA Entrepreneurs. Sexuality and prevention of Zika Zika prevention and prevention of sexual transmission of the virus. 1 February 23, 2019 18 1 19 risks Sexuality and prevention of Zika Risk prevention of the Zika transmitter and sexual transmission vector. 1 February 23, 2019 15 7 22 risks Social Communicators' Role Workshop to prepare the Communication Plan. Portoviejo. 1 February 23, 2019 19 15 34 Social Communicators' Role Workshop to prepare the Communication Plan. Manta. 1 February 25, 2019 7 4 11 Zika prevention Meeting to socialize Zika prevention actions and strategies, Muisne 1 February 25, 2019 27 28 55 Canton, in coordination with MoH. Zika prevention planning Workshop on the development of community plans for Zika prevention 1 February 28, 2019 8 1 9 and control. Zika prevention planning Workshop to build the community plan in the Crucita community. 1 March 6, 2019 48 26 74 Sexuality and prevention of Zika Exhibition: Women's Rights Violence and Resilience for Gender Violence. 1 March 8, 2019 18 4 22 risks Zika prevention and control Participation, Mobilization and Community Empowerment in Health. 1 March 14, 2019 36 18 54 BPLAED CARE- ZIKA. Community-Based Surveillance Training on community work for Zika prevention, aimed at health 2 March 14, 2019 33 19 52 System (CBSS) promoters of the Muisne canton. Sexuality and prevention of Zika Workshop on Zika Prevention, sexual health care, proper use of the 1 March 18, 2019 67 61 128 risks condom as a method of prevention of sexual transmission of the Zika virus, Sucre Canton. USAID.GOV USAID ANNUAL PROGRESS REPORT | lx # of Total Training Curriculum (Full Name) days Training Dates F M Individuals (Abbreviated name) Trained Zika prevention and control Information day on the Zika virus, aimed at families of the summer school 1 March 18, 2019 47 41 88 program. El Florón sector. Sexuality and prevention of Zika Prevention of Zika, and use of the condom as a barrier method to 1 March 19, 2019 18 1 19 risks prevent the Zika virus through sexual transmission, aimed at women of childbearing-age. Sucre canton.B134 Sexuality and prevention of Zika Intersectorial Working Group Meeting, to Prevent Gender-Based 1 March 19, 2019 15 13 28 risks Violence, Huaquillas. Zika prevention planning Workshop to build the community plan in the El Guayabo community. 1 March 19, 2019 12 0 12 Zika prevention and control Zika workshop with children's sports activities, in the Muisne canton. 1 March 20, 2019 6 58 64 Safe water and Zika prevention Sexual transmission of the Zika virus and awareness of the conservation 1 March 21, 2019 16 29 45 of water sources, in San Isidro of the Sucre canton. Safe water and Zika prevention Sexual transmission of the Zika virus and awareness of the conservation 1 March 21, 2019 20 26 46 of water sources, aimed at several communities in the Sucre canton.

Safe water and Zika prevention Sexual transmission of the Zika virus and awareness of the conservation 1 March 22, 2019 45 30 75 of water sources, carried out in the community of San Agustín of the Zika prevention planning Plan Comunitario para la prevención del Zika, Hualtaco- Huaquillas 1 March 26, 2019 4 6 10 Zika prevention planning Preparation of the Community Plan for the Prevention of Zika, San 1 March 26, 2019 40 13 53 Vicente-Arenillas. Zika prevention planning Preparation of the Community Plan for the Prevention of Zika, Las Lajas. 1 March 27, 2019 14 4 18

Zika prevention planning Workshop to build the community plan in the community of Colon. 1 March 28, 2019 14 4 18 Zika prevention planning Community planning. 1 March 29, 2019 8 3 11 Zika risks and complications in Training Day in personal care health, Zika virus prevention and hatchery 1 March 29, 2019 20 10 30 pregnant women elimination, aimed at women of reproductive age and pregnant women in the Cuba Libre health operating unit. Community-Based Surveillance Training for students of the University of Machala in the management of 1 March 29, 2019 2 8 10 System (CBSS) Kobo and Iformbuilder applications to enter data in community surveillance formats. Sexuality and prevention of Zika Workshop on prevention of sexual transmission and the risks of Zika 1 March 30, 2019 23 5 28 risks infection, Canton Sucre. Zika prevention planning Development of community plans for control and prevention of Zika, 1 April 4, 2019 14 9 23 Safe water and Zika prevention WorkshopSucre canton. on conservation of water sources, prevention of mosquito 1 April 5, 2019 28 47 75 breeding sites, and proper use of female and male condoms to prevent sexual transmission of Zika. Canton Sucre. Zika prevention and control Training and prevention of Zika and vector diseases. 1 April 5, 2019 38 34 72 Zika prevention planning Development of the Community Plan for Zika prevention and control 1 April 6, 2019 20 6 26 with a disaster risk reduction approach, Pedernales Canton. Safe water and Zika prevention Prevention of sexual transmission and the risks of Zika infection, and 1 April 9, 2019 103 192 295 awareness of the conservation of water sources, community of Laguna- Cantón Sucre. Zika prevention and control Management Training as a Health Technician 1 April 10, 2019 11 15 26 Sexuality and prevention of Zika Workshop for pregnant women, San Vicente health center, on the risks 1 April 12, 2019 18 0 18 risks of the vector transmitter and prevention of sexual transmission of Zika, canton San Vicente Sexuality and prevention of Zika Workshop on sexual and reproductive health and prevention of Zika, to 1 April 12, 2019 55 19 74 risks young people in Colon. Zika prevention and control Training in Union Lojana 1 April 16, 2019 53 2 55 Sexuality and prevention of Zika Prevention of Zika and gender violence, from the management of local 1 April 17, 2019 28 29 57 risks GADs, district boards and municipal boards. Zika prevention and control Information day on the Zika virus, aimed at families of the summer school 5 April 18, 2019 29 29 58 program. El Florón sector. Community-Based Surveillance Monitoring and capacity building meeting of the community monitors of 1 April 22, 2019 20 9 29 System (CBSS) Muisne canton. Sexuality and prevention of Zika Workshops and counseling on the risks of Zika infection during 1 April 23, 2019 42 6 48 risks pregnancy and prevention of sexual transmission, aimed at pregnant women. Sucre canton.

lxi | USAID ZIKA ANNUAL REPORT USAID.GOV # of Total Training Curriculum (Full Name) days Training Dates F M Individuals (Abbreviated name) Trained Safe water and Zika prevention Training on prevention of Zika sexual transmission, risks of Zika 1 April 23, 2019 15 40 55 infection, and awareness of the conservation of water sources. Sucre canton. Healthy municipalities and Zika Methodological transfer for the proper management of promotion and 1 April 24, 2019 20 11 31 prevention health flipcharts, for the municipality in the certification process. Bahia, Sucre canton. Social Communicators' Role Workshop on communication plan for the prevention of Zika and care 1 April 26, 2019 8 9 17 actions in pregnant and childbearing-age women, addressed to the technicians of the GAD and Jama-Pedernales Health District personnel. Sexuality and prevention of Zika Workshop on prevention of sexual transmission and the risks of Zika 1 May 10, 2019 9 12 21 risks virus infection, aimed at women and men of reproductive age. Sexuality and prevention of Zika Prevention of sexual transmission and the risks of Zika infection. Sucre 1 May 10, 2019 28 3 31 risks canton. Sexuality and prevention of Zika Training session for pregnant women on risks, the transmitting vector 1 May 10, 2019 29 4 33 risks and the prevention of sexual transmission of Zika. Sexuality and prevention of Zika Training session for pregnant women, on risks, transmitting vector and 1 May 10, 2019 26 4 30 risks prevention of Zika sexual transmission. Sexuality and prevention of Zika Training Day for pregnant women on the risks of the vector transmitter 1 May 10, 2019 27 4 31 risks and prevention of Zika sexual transmission. Zika prevention and control Zika risks prevention training for Citizen Committee of Health Ecuador- 1 May 14, 2019 24 16 40 Peru. Sexuality and prevention of Zika Workshop on Zika prevention and Sexual and Reproductive Health, 1 May 14, 2019 27 14 41 risks using methodology, and flipchart of Municipal GAD Portoviejo. San Zika prevention and control Counseling on Zika, addressed to Mothers of Family of the CDI, 1 May 14, 2019 21 8 29 Ciudadela November 18 - Huaquillas. Zika prevention planning Zika prevention community plan development. 1 May 15, 2019 5 18 23

Zika prevention planning Zika prevention community plan development. 1 May 15, 2019 7 16 23

Zika clinical and epidemiological Comprehensive assessment of RN, adequate microcephaly screening, 1 May 17, 2019 31 23 54 management initial actionsm, and case management for care and follow-up. Counseling for pregnant women. Sexuality and prevention of Zika Information and training session on the risks of Zika infection during 1 May 17, 2019 87 0 87 risks pregnancy, the transmission vector and prevention of sexual transmission, aimed at women of reproductive age and pregnant women. Safe water and Zika prevention Day of sensitization to water boards on the risks of the vector and 1 May 22, 2019 9 28 37 sexual transmission of Zika, and elimination of hatcheries. Pedernales

Risk counseling for pregnant Informationcanton. and training session on the risks of Zika infection during 1 May 22, 2019 7 0 7 women pregnancy. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 2 May 28, 2019 34 20 54 risks violence, and prevention of Zika, for men and women of reproductive Risk counseling for pregnant Information and training session on risks of Zika infection during 1 May 29, 2019 12 0 12 women pregnancy, the vector transmitter and prevention of sexual transmission, aimed at women of reproductive age and pregnant women. Risk counseling for pregnant Workshop on sexual health, reproductive health, violence prevention 1 June 1, 2019 39 2 41 women and prevention of Zika, to pregnant women. Risk counseling for pregnant Information and training session on the risks of Zika infection during 3 June 3, 2019 7 0 7 women pregnancy, the vector and prevention of sexual transmission. Zika prevention and control Community mobilization in response to health emergencies and 1 June 4, 2019 55 31 86 epidemics, learning from the fight against Zika. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, violence prevention, 1 June 4, 2019 11 4 15 risks and prevention of Zika, pregnant and reproductive age women, Andrés Sexuality and prevention of Zika Workshop on sexual health, reproductive health, violence prevention, 1 June 5, 2019 10 5 15 risks and prevention of Zika, pregnant and reproductive age women, Picoazá Sexuality and prevention of Zika Workshop on sexual health, reproductive health, violence prevention, 1 June 6, 2019 5 7 12 risks and prevention of Zika, pregnant and reproductive age women, El Florón Sexuality and prevention of Zika Workshop on sexual health, reproductive health, violence prevention, 1 June 7, 2019 14 6 20 risks and prevention of Zika, pregnant and reproductive age women, Andrés Zika prevention and control Strengthening knowledge and training in Zika prevention, using the 10 3 June 9, 2019 46 31 77 minutes against Zika tool, as part of the neighborhood's medical program.

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxii # of Total Training Curriculum (Full Name) days Training Dates F M Individuals (Abbreviated name) Trained Sexuality and prevention of Zika Workshop on sexual health, reproductive health, violence prevention, 1 June 10, 2019 19 1 20 risks and prevention of Zika, pregnant and reproductive age women. Sexuality and prevention of Zika Workshop on sexual and reproductive health. 1 June 11, 2019 8 18 26 Sexualityrisks and prevention of Zika Workshop on sexual health, reproductive health, violence prevention 1 June 11, 2019 4 15 19 risks and prevention of Zika in pregnant women. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, violence prevention 1 June 12, 2019 33 13 46 risks and prevention of Zika in pregnant women. Sexuality and prevention of Zika JInformation and training session on the risks of Zika infection during 1 June 12, 2019 14 1 15 risks pregnancy, the transmission vector, and prevention of sexual transmission, aimed at women of reproductive age and pregnant women.

Sexuality and prevention of Zika Workshop on sexual health, reproductive health, violence prevention 1 June 13, 2019 15 5 20 risks and prevention of Zika in pregnant women. Sexuality and prevention of Zika Information and training session on the risks of Zika infection during 1 June 14, 2019 15 1 16 risks pregnancy, the transmission vector, and prevention of sexual transmission, aimed at women of reproductive age and pregnant women.

Sexuality and prevention of Zika Workshop on sexual health, reproductive health, violence prevention 1 June 17, 2019 102 0 102 risks and prevention of Zika in pregnant women. Zika prevention planning Socialization of the results of the project "Together against Zika" to the 1 June 18, 2019 25 12 37 authorities of the cantonal and parochial GAD, in order to promote sustainability. Sexuality and prevention of Zika Workshop on the risks of Zika infection during pregnancy and 1 June 19, 2019 65 49 114 risks prevention of sexual transmission, in Sucre canton. Zika prevention and control Day of strengthening on the handling of educommunicative material and 1 June 20, 2019 11 13 24 flipcharts for the Zika prevention and control, aimed at technicians of the Municipal GAD of Pedernales. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 June 21, 2019 19 0 19 risks violence, and Zika prevention, for men and women of reproductive age. Risk counseling for pregnant Information and training session on the risks of Zika infection, during 1 June 21, 2019 16 7 23 women pregnancy, the transmitter vector and prevention of sexual transmission of Zika. Sexuality and prevention of Zika Information and training session on the risks of Zika infection during 1 June 21, 2019 13 0 13 risks pregnancy, transmission vector, and prevention of sexual transmission, aimed at women of reproductive age and pregnant women. Zika prevention Training for Zika prevention, aimed at members of the Arenillas recyclers 1 June 21, 2019 21 12 33 association. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 June 26, 2019 58 48 106 risks violence, and Zika prevention, for men and women of reproductive age. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 June 28, 2019 3 11 14 risks violence, and Zika prevention, for men and women of reproductive age. Sexuality and prevention of Zika Information and training session on the risks of Zika infection during 1 June 28, 2019 14 11 25 risks pregnancy, vector transmission, and prevention of sexual transmission, aimed at pregnant and childbearing-age women. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 June 29, 2019 7 3 10 risks violence, and Zika prevention, for men and women of reproductive age. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 1, 2019 15 16 31 risks violence, and Zika prevention, for men and women of reproductive age. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 1, 2019 19 10 29 risks violence, and Zika prevention, for men and women of reproductive age. Risk counseling for pregnant Information and training session on the risks of Zika infection during 1 July 2, 2019 24 9 33 women pregnancy, vector transmission, and prevention of sexual transmission, aimed at pregnant and childbearing-age women. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 2, 2019 16 16 32 risks violence, and Zika prevention, for men and women of reproductive age. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 3, 2019 18 26 44 risks violence, and Zika prevention, for men and women of reproductive age.

lxiii | USAID ZIKA ANNUAL REPORT USAID.GOV # of Total Training Curriculum (Full Name) days Training Dates F M Individuals (Abbreviated name) Trained Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 5, 2019 32 50 82 risks violence, and Zika prevention, for men and women of reproductive age. Sexuality and prevention of Zika Workshop on sexual health. 1 July 9, 2019 58 72 130 risks Zika prevention planning Sustainability workshop aimed at health officials, Municipal GAD, 1 July 9, 2019 21 7 28 academia and representatives of neighborhood organizations to promote commitments and intersectoral actions that contribute to the prevention of Zika. Jama canton. Zika prevention planning Sustainability workshop aimed at health officials, Municipal GAD, 1 July 10, 2019 12 8 20 academia and representatives of neighborhood organizations to promote commitments and intersectoral actions that contribute to the prevention of Zika. Pedernales canton. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 10, 2019 20 0 20 risks violence, and Zika prevention, for men and women of reproductive age. Portoviejo Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 11, 2019 39 38 77 risks violence, and Zika prevention, for men and women of reproductive age. Manta. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 12, 2019 15 1 16 risks violence, and Zika prevention, for men and women of reproductive age. Manta. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 15, 2019 20 39 59 risks violence, and Zika prevention, for men and women of reproductive age. Manta. Zika prevention and control Zika prevention training, aimed at students of the Arenillas Technical 2 July 16, 2019 41 29 70 College. Zika prevention planning Strategies to define actions that allow sustainability in the prevention of 1 July 17, 2019 28 6 34 Zika with local actions. Healthy municipalities and Zika Socialize the work carried out in the Sucre Canton to prevent Zika and 1 July 17, 2019 19 12 31 prevention to define sustainability strategies. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 17, 2019 26 16 42 risks violence, and Zika prevention, for men and women of reproductive age. Zika prevention and control Zika prevention training, aimed at students of the Huaquillas school. 1 July 17, 2019 61 48 109 Zika prevention planning Strategies and proposals that allow the sustainability of Zika prevention 1 July 18, 2019 9 6 15 actions with local actors. Healthy municipalities and Zika Define sustainability strategies and socialize the work carried out in the 1 July 18, 2019 17 13 30 prevention San Vicente canton to prevent Zika. Healthy municipalities and Zika Socialization of situation room GADM San Vicente. 1 July 19, 2019 6 13 19 prevention Sexuality and prevention of Zika Workshop on sexual health, reproductive health, prevention of gender 1 July 23, 2019 36 38 74 risks violence, and Zika prevention, for men and women of reproductive age. Sexuality and prevention of Zika Workshop on sexual health, reproductive health, and prevention of 1 July 25, 2019 90 0 90 risks gender violence. Healthy municipalities and Zika Strengthening of actions and health certification. Arenillas. 1 July 26, 2019 3 12 15 prevention Risk counseling for pregnant Jornada de información y capacitación sobre los riesgos de la infección del 1 July 28, 2019 32 8 40 women zika durante el embarazo, el vector transmisor y prevención de la transmisión sexual del Zika. TOTAL ECUADOR 7524 5365 12889

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxiv Annex III Training Report PERU Training (Short # of Total Curricula (Long name) Training Dates F M Name) Days Trained Training workshop Communication strategy for the Zika approach 1 07/11/2018 9 7 16 Training workshop Communication strategy for the Zika approach 1 13/11/2018 7 5 12 Training workshop Communication strategy for the Zika approach 1 14/11/2018 14 12 26 Training workshop Communication strategy for the Zika approach 1 15/11/2018 12 10 22 Training workshop Communication strategy for the Zika approach 1 15/11/2018 13 7 20 Training workshop Communication strategy for the Zika approach 1 15/11/2018 20 15 35 Training workshop Communication strategy for the Zika approach 1 16/11/2018 16 2 18 Training workshop Communication strategy for the Zika approach 1 22/11/2018 11 9 20 Training workshop Communication strategy for the Zika approach 1 23/11/2018 8 8 16 Training workshop Communication strategy for the Zika approach 1 27/11/2018 8 8 16 Training workshop Communication strategy for the Zika approach 1 27/11/2018 12 6 18 Training workshop Communication strategy for the Zika approach 1 29/11/2018 8 10 18 Training workshop Communication strategy for the Zika approach 1 30/11/2018 22 17 39 Training workshop Communication strategy for the Zika approach 1 01/12/2018 30 12 42 Training workshop Communication strategy for the Zika approach 1 03/12/2018 7 5 12 Training workshop Communication strategy for the Zika approach 1 17/01/2019 19 8 27 Training workshop Communication strategy for the Zika approach 1 18/01/2019 20 16 36 Training workshop Communication strategy for the Zika approach 1 19/01/2019 10 8 18 Training workshop Communication strategy for the Zika approach 1 21/01/2019 10 10 20 Training workshop Communication strategy for the Zika approach 1 20/02/2019 5 4 9 Training workshop Communication strategy for the Zika approach 1 30/03/2019 16 16 Training workshop Communication strategy for the Zika approach 1 15/04/2019 25 11 36 Training workshop Communication strategy for the Zika approach 1 22/04/2019 12 10 22 Training workshop Communication strategy for the Zika approach 1 26/04/2019 15 1 16 Training workshop Communication strategy for the Zika approach 1 26/04/2019 15 5 20 Training workshop Communication strategy for the Zika approach 1 26/04/2019 21 21 Training workshop Communication strategy for the Zika approach 1 29/04/2019 1 7 8 Training workshop Communication strategy for the Zika approach 1 29/04/2019 28 39 67 Training workshop Communication strategy for the Zika approach 1 30/04/2019 21 23 44 Training workshop Communication strategy for the Zika approach 1 03/05/2019 7 29 36 Training workshop Communication strategy for the Zika approach 1 03/05/2019 4 7 11 06/05/2019 al 21- Training workshop Communication strategy for the Zika approach 1 6 6 12 05-2018 Training workshop Communication strategy for the Zika approach 1 07/05/2019 25 1 26 Training workshop Communication strategy for the Zika approach 1 07/05/2019 15 16 31 Training workshop Communication strategy for the Zika approach 1 08/05/2019 5 3 8 Training workshop Communication strategy for the Zika approach 1 09/05/2019 10 8 18 Training workshop Communication strategy for the Zika approach 1 09/05/2019 19 7 26 Training workshop Communication strategy for the Zika approach 1 15/05/2019 5 6 11 Training workshop Communication strategy for the Zika approach 1 15/05/2019 12 11 23 Training workshop Communication strategy for the Zika approach 1 15/05/2019 14 10 24 Training workshop Communication strategy for the Zika approach 1 16/05/2019 9 1 10 Training workshop Communication strategy for the Zika approach 1 17/05/2019 16 13 29 Training workshop Communication strategy for the Zika approach 1 20/05/2019 19 9 28 Training workshop Communication strategy for the Zika approach 1 21/05/2019 14 13 27 Training workshop Communication strategy for the Zika approach 1 21/05/2019 1 36 37 Training workshop Communication strategy for the Zika approach 1 21/05/2019 15 4 19 Training workshop Communication strategy for the Zika approach 1 21/05/2019 4 6 10 Training workshop Communication strategy for the Zika approach 1 22/05/2019 9 5 14 Training workshop Communication strategy for the Zika approach 1 23/05/2019 51 76 127 Training workshop Communication strategy for the Zika approach 1 25/05/2019 13 1 14 Training workshop Communication strategy for the Zika approach 1 28/05/2019 9 9 18 Training workshop Communication strategy for the Zika approach 1 30/05/2019 4 9 13 Training workshop Communication strategy for the Zika approach 1 03/06/2019 12 8 20 Training workshop Communication strategy for the Zika approach 1 03/06/2019 7 5 12 Training workshop Communication strategy for the Zika approach 1 04/06/2019 6 3 9 Training workshop Communication strategy for the Zika approach 1 05/06/2019 38 38 lxv | USAID ZIKA ANNUAL REPORT USAID.GOV Annex III Training Report PERU Training (Short # of Total Curricula (Long name) Training Dates F M Name) Days Trained Training workshop Communication strategy for the Zika approach 1 07/06/2019 38 7 45 Training workshop Communication strategy for the Zika approach 1 07/06/2019 16 16 32 Training workshop Communication strategy for the Zika approach 1 11/06/2019 18 18 Training workshop Communication strategy for the Zika approach 1 11/06/2019 11 5 16 Training workshop Communication strategy for the Zika approach 1 12/06/2019 94 26 120 Training workshop Communication strategy for the Zika approach 1 12/06/2019 18 15 33 Training workshop Communication strategy for the Zika approach 1 13/06/2019 6 5 11 Training workshop Communication strategy for the Zika approach 1 13/06/2019 5 8 13 Training workshop Communication strategy for the Zika approach 1 13/06/2019 12 14 26 Training workshop Communication strategy for the Zika approach 1 13/06/2019 10 8 18 Training workshop Communication strategy for the Zika approach 1 13/06/2019 11 11 22 Training workshop Communication strategy for the Zika approach 1 14/06/2019 22 1 23 Training workshop Communication strategy for the Zika approach 1 14/06/2019 9 21 30 Training workshop Communication strategy for the Zika approach 1 14/06/2019 12 7 19 Training workshop Communication strategy for the Zika approach 1 14/06/2019 15 9 24 Training workshop Communication strategy for the Zika approach 1 16/06/2019 14 13 27 Training workshop Communication strategy for the Zika approach 1 18/06/2019 5 10 15 Training workshop Communication strategy for the Zika approach 1 18/06/2019 20 5 25 Training workshop Communication strategy for the Zika approach 1 19/06/2019 28 18 46 Training workshop Communication strategy for the Zika approach 1 20/06/2019 6 1 7 Training workshop Communication strategy for the Zika approach 1 20/06/2019 15 2 17 Training workshop Communication strategy for the Zika approach 1 21/06/2019 4 4 8 Training workshop Communication strategy for the Zika approach 1 21/06/2019 11 16 27 Training workshop Communication strategy for the Zika approach 1 24/06/2019 9 13 22 Training workshop Communication strategy for the Zika approach 1 25/06/2019 14 12 26 Training workshop Communication strategy for the Zika approach 1 26/06/2019 12 7 19 Training workshop Communication strategy for the Zika approach 1 26/06/2019 13 13 Training workshop Communication strategy for the Zika approach 1 26/06/2019 26 17 43 Training workshop Communication strategy for the Zika approach 1 26/06/2019 12 1 13 Training workshop Communication strategy for the Zika approach 1 27/06/2019 6 9 15 Training workshop Communication strategy for the Zika approach 1 28/06/2019 12 8 20 Training workshop Communication strategy for the Zika approach 1 28/06/2019 14 1 15 Training workshop Communication strategy for the Zika approach 1 28/06/2019 13 13 26 Training workshop Communication strategy for the Zika approach 1 01/07/2019 18 7 25 Training workshop Communication strategy for the Zika approach 1 01/07/2019 10 1 11 Training workshop Communication strategy for the Zika approach 1 01/07/2019 30 30 Training workshop Communication strategy for the Zika approach 1 01/07/2019 15 5 20 Training workshop Communication strategy for the Zika approach 1 01/07/2019 25 27 52 Training workshop Communication strategy for the Zika approach 1 01/07/2019 29 29 02/07/2019 al 12- Training workshop Communication strategy for the Zika approach 1 7 8 15 07-2019 Training workshop Communication strategy for the Zika approach 1 02/07/2019 3 4 7 Training workshop Communication strategy for the Zika approach 1 03/07/2019 10 15 25 Training workshop Communication strategy for the Zika approach 1 04/07/2019 42 19 61 Training workshop Communication strategy for the Zika approach 1 04/07/2019 12 4 16 Training workshop Communication strategy for the Zika approach 1 06/07/2019 10 6 16 Training workshop Communication strategy for the Zika approach 1 09/07/2019 15 15 Training workshop Communication strategy for the Zika approach 1 09/07/2019 7 12 19 Training workshop Communication strategy for the Zika approach 1 11/07/2019 13 23 36 Training workshop Communication strategy for the Zika approach 1 11/07/2019 14 14 Training workshop Communication strategy for the Zika approach 1 11/07/2019 17 1 18 Training workshop Communication strategy for the Zika approach 1 12/07/2019 2 6 8 Training workshop Communication strategy for the Zika approach 1 12/07/2019 8 4 12 Training workshop Communication strategy for the Zika approach 1 13/07/2019 22 7 29 Training workshop Communication strategy for the Zika approach 1 15/07/2019 14 24 38 Training workshop Communication strategy for the Zika approach 1 17/07/2019 8 3 11 Training workshop Communication strategy for the Zika approach 1 17/07/2019 7 8 15

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxvi Annex III Training Report PERU Training (Short # of Total Curricula (Long name) Training Dates F M Name) Days Trained Training workshop Communication strategy for the Zika approach 1 18/07/2019 9 9 18 Training workshop Communication strategy for the Zika approach 1 24/07/2019 7 2 9 Other prevention activities, general aspects, Training workshop 1 10/04/2019 22 26 48 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 11/04/2019 22 18 40 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 16/04/2019 13 2 15 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 17/04/2019 3 5 8 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 17/04/2019 20 3 23 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 17/04/2019 9 16 25 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 17/04/2019 9 4 13 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 30/04/2019 16 9 25 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 02/05/2019 11 2 13 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 03/05/2019 9 5 14 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 03/05/2019 10 8 18 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 08/05/2019 13 4 17 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 08/05/2019 5 3 8 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 27/05/2019 12 2 14 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 28/05/2019 34 3 37 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 28/05/2019 11 1 12 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 28/05/2019 24 4 28 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 29/05/2019 7 4 11 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 29/05/2019 9 7 16 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 06/06/2019 22 7 29 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 13/06/2019 8 7 15 control and surveillance of Zika Other prevention activities, general aspects, Training workshop 1 14/06/2019 24 5 29 control and surveillance of Zika Training workshop Results Budget (PPR) 1 12/02/2019 10 4 14 Training workshop Results Budget (PPR) 1 22/02/2019 14 21 35 Training workshop SVBC Community Based Surveillance System 1 04/10/2018 11 11 Training workshop SVBC Community Based Surveillance System 1 11/10/2018 11 11 Training workshop SVBC Community Based Surveillance System 1 11/10/2018 11 11 Training workshop SVBC Community Based Surveillance System 1 11/10/2018 11 11 Training workshop SVBC Community Based Surveillance System 1 11/10/2018 11 11 Training workshop SVBC Community Based Surveillance System 1 11/10/2018 6 6 Training workshop SVBC Community Based Surveillance System 1 11/10/2018 11 11 Training workshop SVBC Community Based Surveillance System 1 16/10/2018 6 6 Training workshop SVBC Community Based Surveillance System 1 18/10/2018 10 10 Training workshop SVBC Community Based Surveillance System 1 18/10/2018 10 10 Training workshop SVBC Community Based Surveillance System 1 18/10/2018 10 10 lxvii | USAID ZIKA ANNUAL REPORT USAID.GOV Annex III Training Report PERU Training (Short # of Total Curricula (Long name) Training Dates F M Name) Days Trained Training workshop SVBC Community Based Surveillance System 1 19/10/2018 11 11 25/11/2018 - 26- Training workshop SVBC Community Based Surveillance System 1 7 3 10 11-2108 Training workshop SVBC Community Based Surveillance System 1 26/11/2018 5 5 10 Training workshop SVBC Community Based Surveillance System 1 05/12/2018 26 1 27 Training workshop SVBC Community Based Surveillance System 1 06/12/2018 26 1 27 Training workshop SVBC Community Based Surveillance System 1 21/01/2019 31 3 34 Training workshop SVBC Community Based Surveillance System 1 22/01/2019 31 2 33 Training workshop SVBC Community Based Surveillance System 1 25/01/2019 12 12 25/02/2019 al 13- Training workshop SVBC Community Based Surveillance System 1 5 5 03-2019 Training workshop SVBC Community Based Surveillance System 1 26/02/2019 6 6 Training workshop SVBC Community Based Surveillance System 1 04/03/2019 4 13 17 Training workshop SVBC Community Based Surveillance System 1 26/03/2019 20 5 25 Training workshop SVBC Community Based Surveillance System 1 27/03/2019 15 4 19 Training workshop SVBC Community Based Surveillance System 1 28/03/2019 21 5 26 Training workshop SVBC Community Based Surveillance System 1 23/04/2019 7 4 11 Training workshop SVBC Community Based Surveillance System 1 25/04/2019 5 4 9 Training workshop SVBC Community Based Surveillance System 1 27/04/2019 30 1 31 Training workshop SVBC Community Based Surveillance System 1 06/05/2019 25 1 26 Training workshop SVBC Community Based Surveillance System 1 22/05/2019 20 1 21 Training workshop SVBC Community Based Surveillance System 1 22/05/2019 8 1 9 Training workshop SVBC Community Based Surveillance System 1 24/05/2019 24 24 Training workshop SVBC Community Based Surveillance System 1 21/06/2019 7 1 8 Training workshop SVBC Community Based Surveillance System 1 24/06/2019 6 8 14 Training workshop SVBC Community Based Surveillance System 1 26/06/2019 9 12 21 Training workshop SVBC Community Based Surveillance System 1 02/07/2019 12 4 16 Training workshop SVBC Community Based Surveillance System 1 02/07/2019 3 1 4 Training workshop SVBC Community Based Surveillance System 1 03/07/2019 6 2 8 Training workshop SVBC Community Based Surveillance System 1 03/07/2019 7 2 9 Training workshop SVBC Community Based Surveillance System 1 19/07/2019 16 1 17 Training workshop SVBC Community Based Surveillance System 1 23/07/2019 6 5 11 Training workshop SVBC Community Based Surveillance System 1 23/07/2019 27 1 28 Training workshop SVBC Community Based Surveillance System 1 31/07/2019 23 9 32 Training workshop SVBC Community Based Surveillance System 1 31/07/2019 31 8 39 Training workshop SVBC Community Based Surveillance System 1 31/07/2019 11 8 19 Training workshop SVBC Community Based Surveillance System 1 31/07/2019 5 2 7 Training workshop SVBC Community Based Surveillance System 1 01/08/2019 10 3 13 Training workshop Vector control protocols 1 09/01/2019 16 3 19 Training workshop Vector control protocols 1 10/01/2019 28 5 33 Training workshop Vector control protocols 1 06/03/2019 12 12 Training workshop Vector control protocols 1 07/03/2019 7 1 8 Training workshop Vector control protocols 1 12/03/2019 8 10 18 Training workshop Vector control protocols 1 15/03/2019 7 6 13 Training workshop Vector control protocols 1 02/04/2019 31 55 86 Training workshop Vector control protocols 1 02/04/2019 31 55 86 Training workshop Vector control protocols 1 04/04/2019 33 33 Training workshop Vector control protocols 1 04/04/2019 33 33 Training workshop Vector control protocols 1 06/04/2019 37 7 44 Training workshop Vector control protocols 1 12/04/2019 13 4 17 Training workshop Vector control protocols 1 12/04/2019 14 4 18 Training workshop Vector control protocols 1 17/04/2019 49 49 Training workshop Vector control protocols 1 23/04/2019 46 1 47 Training workshop Vector control protocols 1 13/05/2019 80 17 97 Training workshop Vector control protocols 1 15/05/2019 20 3 23 Training workshop Vector control protocols 1 16/05/2019 22 3 25 Training workshop Vector control protocols 1 16/05/2019 21 3 24

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxviii Annex III Training Report PERU Training (Short # of Total Curricula (Long name) Training Dates F M Name) Days Trained Training workshop Vector control protocols 1 20/05/2019 47 6 53 Training workshop Vector control protocols 1 21/05/2019 79 19 98 Training workshop Vector control protocols 1 22/05/2019 47 7 54 Training workshop Vector control protocols 1 05/07/2019 4 14 18 Training workshop Vector control protocols 1 05/07/2019 6 19 25 Training workshop Vector control protocols 1 24/07/2019 7 7 Training workshop Zika counseling 1 01/12/2018 4 4 Training workshop Zika counseling 1 07/12/2018 7 1 8 Training workshop Zika counseling 1 22/02/2019 20 3 23 Training workshop Zika counseling 1 22/02/2019 20 3 23 Training workshop Zika counseling 1 29/03/2019 8 8 Training workshop Zika counseling 1 03/05/2019 25 5 30 Training workshop Zika counseling 1 07/05/2019 18 6 24 Training workshop Zika counseling 1 11/06/2019 23 3 26 Training workshop Zika counseling 1 05/07/2019 21 1 22 Training workshop Zika counseling 1 19/07/2019 16 1 17 Training workshop Zika counseling 1 23/07/2019 27 1 28 Total 3347 1784 5131

lxix | USAID ZIKA ANNUAL REPORT USAID.GOV ANNEX IV PICTURES (EVENTS, TRAININGS ETC.)

Peru

• Zika Virus Prevention Best Practices Award 2019. A special ceremony was held to reward winning practices in this year's edition. https://www.flickr.com/photos/155502826@N05/albums/72157710950115291

• Workshop on vector control protocols for the military barracks "Coloma BIM 5" in Tumbes Region. https://www.flickr.com/photos/155502826@N05/albums/72157708681292474

• Workshop on soft skills for female community monitors. https://www.flickr.com/photos/155502826@N05/albums/72157691529027993

• Anti-ZIKArio Fair and baby shower: https://www.flickr.com/photos/155502826@N05/albums/72157710951113502

• Activation with motorcycle-taxis to involve men in promoting a culture of Zika virus prevention. https://www.flickr.com/photos/155502826@N05/albums/72157710951267257

• National Meeting of Male and Female Community Monitors of the Project Zika Response in Peru. The exchange of experiences among all monitors implementing the community-based surveillance system was promoted. https://www.flickr.com/photos/155502826@N05/albums/72157710950403041

• Bi-national Meeting of Mayors: Local government authorities at the border of Northern Peru and Southern Ecuador met to exchange experiences in the prevention and control of Zika virus, as well as the establishment of agreements on the prevention of metaxenic diseases. https://www.facebook.com/pg/ZikaZikario/photos/?tab=album&album_id=1338189316329684

• Delivery of play kits to educational institutions to continue promoting a culture of prevention in the educational community https://www.flickr.com/photos/155502826@N05/albums/72157710675856746

• Closing Ceremony of the Project Zika Response in Peru with representatives from the health and education sector, as well as regional and local government authorities, to strengthen the project transfer process. https://www.flickr.com/photos/155502826@N05/albums/72157710951107946

ECUADOR

• Adolescents are trained on Zika prevention and best practices for the elimination of mosquito breeding sites in Aedes aegypti, canton Sucre, February 2019. https://www.flickr.com/photos/137449521@N03/48087341683/in/album-72157709145827086/

• Community of Mangle 2000, Sucre Canton, builds Community Zika Prevention Plan, Canton Sucre, February 2019. https://www.flickr.com/photos/137449521@N03/46509476544/in/album-72157676859116257/

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxx • Mass event to report on the risks of Zika in pregnant women, Canton Sucre, March 2019. https://www.flickr.com/photos/137449521@N03/47806667381/in/album-72157708570854784/

• Workshops on prevention of the infection of the virus Zika on pregnant women, St. Vincent Health Center, May 2019. https://www.flickr.com/photos/137449521@N03/47806672991/in/album-72157708535785665/

• Workshops with children and adolescents on Zika control and prevention, in the community of El Matal, Canton Jama, June 2019. https://www.flickr.com/photos/137449521@N03/48260321626/in/album-72157709726429756/

• As a sustainability strategy, a communicative education kit for Zika prevention was donated to the Don Juan Community Library, Canton Jama, June 2019. https://www.flickr.com/photos/137449521@N03/48087341513/in/album-72157709145806533/

• Prevention of sexual transmission of the Zika virus and maternal death with communities. This activity was carried out in coordination with the MIES. Published June, 2019 https://www.flickr.com/photos/137449521@N03/48087345128/in/album-72157709147064908/

• Vector control activities with the community participation and students of the Technical University of Manta, July 2019. https://www.flickr.com/photos/137449521@N03/48260320361/in/album-72157709726127332/

• Delivery of teams and inputs for the conservation of the chain of cold of the blood samples for the Zika examinations. This donation was done to the Districts of Health of Portoviejo, Pedernales and Huaquillas, July 2019. https://www.flickr.com/photos/137449521@N03/48260318291/in/album-72157709725668182/

• International Workshop on "Learning from the fight against the Zika: community mobilization in response to health emergencies and epidemics", Quito, 4, 5 and 6 of June 2019. https://www.flickr.com/photos/137449521@N03/48417054937/in/album-72157709993753442/ https://www.flickr.com/photos/137449521@N03/48415926102/in/album-72157709992282041/

• Zika prevention messages with music from Afro Ecuadorian culture at the International Workshop, a group of the May 6 School of the Chamanga, Muisne community. Quito, June 4, 5 and 6, 2019. https://www.flickr.com/photos/137449521@N03/48415730821/in/album-72157709993183367/

• Mural painting with messages of prevention of Zika. In the year 3 This activity is developed in the cantons of Pedernales, Portoviejo and Huaquillas. https://www.flickr.com/photos/137449521@N03/48260387337/in/album-72157709726104796/ https://www.flickr.com/photos/137449521@N03/48779522473/in/album-72157711026007493/ • Delivery of kit for the destruction of the Aedes aegypti mosquito breeding sites in the communities of San Vicente, July - August, 2019. https://www.flickr.com/photos/137449521@N03/48779880381/in/album-72157711026055473/

• The Second meeting of the Steering Committee for the project Zika Response in Ecuador and Peru, was attended by delegates from UNICEF, CARE ECUADOR AND CARE Peru, delegate of USAID, Ministry of Health of Ecuador and delegates of the communities of Ecuador and Peru, Quito, 22 August 2019. https://www.flickr.com/photos/137449521@N03/48780066057/ https://www.flickr.com/photos/137449521@N03/48779887541/ lxxi | USAID ZIKA ANNUAL REPORT USAID.GOV

• Participants in the panel discussion on gender approach and disability in the prevention of Zika, developed in Quito, 22 August 2019. https://www.flickr.com/photos/137449521@N03/48799452002/in/photostream/

• Closing event of the binational Project Zika Response in Ecuador. Jaime Chang, Zika Regional Coordinator for South America USAID, participates in the closing event of the binational Project Zika Response in Ecuador and Peru, Quito, August 23, 2019. https://www.flickr.com/photos/137449521@N03/48799139838/

Andrea Collaguazo, Director of Participation of the Ministry of Economic and Social Inclusion, reports on the activities carried out under the CARE-MIES agreement, through the binational project Junto’s ante el Zika in Ecuador and Peru, Quito, August 23, 2019. https://www.flickr.com/photos/137449521@N03/48799492466/

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxxii ANNEX V SUB-GRANTS UNDER THE ACTIVITY

Awardee Name: CARE Country: Ecuador & Peru

Cooperative for Assistance & Relief Everywhere

Award Name: “Zika Response in Ecuador Award Number: AID-OAA-A-16-00078 and Peru”

Start Date: 30/ 09/ 2016 End Date: 29/ 09/ 2019

Submission Date 15 / 12 / 2016

Total Amount $ 7,000,000.00

Reporting Period: October 1, 2017 - September 30, 2018

Awardee HQ Contact Name and Title: Alexandra Moncada

Country Director, Ecuador

Awardee HQ Contact Address: El Nacional N39-111 y El Telégrafo, Quito, Ecuador

Awardee HQ Contact Telephone +593 9 8 8388766 Number: +593 2 2433069

Awardee HQ Contact Email Address: [email protected]

Zika Response in Ecuador and Peru Two objectives to achieve in two phases over three years: 3. To 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 (animadores), in Zika priority areas (prevention, and vector control).

4. To 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.

lxxiii | USAID ZIKA ANNUAL REPORT USAID.GOV Geographic Focus

Ecuador: 10 cantons belonging to 3 provinces in the coastal region of the country: Esmeraldas (01), Manabi (06); El Oro (03).

Peru: 20 districts in the northern section of the country: Tumbes (04); Piura (11); Lambayeque (03) and Cajamarca (02).

Results and activities

Result 1.- Best practices in community participation and mobilization on prevention, promotion and practices regarding Zika identified.

Activity 1.- Evidence-Based Analysis of community based systems on roles and performance of vector control at household and community levels.

Activity 2.- KAP studies in selected areas on individual and collective behavior change regarding prevention, care giving to childbearing age women and pregnant women.

Activity 3.- Evidence-Based Analysis on inter-sector and community participation, roles and performance of community-based surveillance systems.

Result 2.- Best practices and lessons learned against Zika found through the EBA and KAP implemented immediately in priority risk areas.

Activity 1.- Training of local health and municipal personnel, and community health agents on new protocols based on EBA and KAP findings on vector control best practices and lessons learned.

Activity 2.- Based on EBA and KAP findings, develop and validate communication messages to improve knowledge and understanding on key risks of Zika, especially on microcephaly in babies of infected women, and key prevention and care giving practices.

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxxiv Activity 3.- Applying best practices for integrated vector control involving families, communities, municipalities, health systems, community water management organizations.

Result 3.- System (Community Based Surveillance System) for local governments and community use to enable a continuous gathering and analysis of best practices at community level in use.

Activity 1.- Friendly information system (CBSS) linking health, local government and community services for registration, monitoring, analysis, planning and action, developed and validated (Pilot study).

Activity 2.- Friendly information system (CBSS) scaled-up in the intervention areas.

Activity 3.- Training of local health services personnel, local governments and community health workers on community-based follow-up and monitoring systems.

Result 4.- Communication strategy for behavior change among women of reproductive age, pregnant women and adolescents implemented using formal and informal means.

Activity 1.- Develop and validate a communication strategy (based on EBA and KAP findings) for improving knowledge and understanding on key risks of Zika, especially on microcephaly in babies of infected women, and key prevention and care giving practices.

Activity 2.- Within the framework of the communication strategy, identify the roles of stakeholders (community, local government and health services) and tools to be used for influencing knowledge building and behavior change.

Activity 3.- Implement a communications strategy aimed to women of reproductive age and pregnant women, addressing Zika prevention, health and personal care, vector control practices and surveillance practices.

Activity 4.- Implement a communications strategy aimed to primary and secondary school students addressing Zika prevention, health and personal care, vector control practices and surveillance practices.

Result .5.- Extend the strategies and protocols developed and applied locally to other areas of the country.

Activity 1.- In selected areas, train local government staff in managing the budgeting system to include activities against metaxenic diseases in their regular planning processes (including stipend for community monitors).

Activity 2.- Technical support to local governments to promote and enhance local inter- sector and community coordination platforms for joint planning of community health plans.

Activity 3.- Support bi-national mutual learning and exchange of experiences, results and recommendations of the EBA and KAP studies through joint field visits, discussion events and documentation to adjust national and local plans of action to the proven best lxxv | USAID ZIKA ANNUAL REPORT USAID.GOV practices and protocols.

Activity 4.- Organize at least one international event, with other countries to share the results of the Evidence Based Analysis and KAP study, as well as successful experiences of adjusted implementation strategies and their results impact on the virus outbreak in community health care systems.

Initial Target Beneficiaries:

The total number of direct target beneficiaries of the project is 391,953 people

Ecuador 128,944

Peru 263,009

Total beneficiaries: 391,953

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxxvi ANNEX VI INTEGRATION OF CROSS-CUTTING ISSUES

(A) GENDER EQUALITY AND FEMALE EMPOWERMENT

In Ecuador and Peru, gender inequality persists, affecting mainly women. In Ecuador, 65% of women survive GBV (gender-based violence) and in Peru 30%.

Another critical situation to consider is teen pregnancy. In Peru, 13% of all pregnancies correspond to adolescents between the ages of 15-19 and it is estimated that every day, 4 adolescents under 15 years of age become pregnant. In Ecuador, in 2015, 26% of deliveries corresponded to adolescents from 10 to 19 years old. Of these, 7% are girls under the age of 14. Every day, 7 girls under 14 become mothers. Pregnancies in children under 14 in Ecuador are classified as sexual violence.

In Ecuador and Peru, cultural and gender conceptions and patterns persist, assigning women the responsibility of avoiding pregnancy; to prevent Zika and its complications in pregnancy, and to care for and protect children. There is little participation of men in prevention actions. In addition, in Ecuador it is assumed that women are the only ones responsible for unplanned / unwanted pregnancies.

The inclusion of a gender approach in the third year was reinforced in training and awareness events. Communication pieces included messages with a gender approach, which addressed the roles that men should assume on the sexual transmission of the Zika virus (condom use in pregnancy or to prevent it), and in the elimination of the mosquito breeding sites (washing, brushing and tank capping).

In Ecuador, the results of KAP III study, showed that the sexual division of care tasks still persists, it is a difficult topic to modify due to the historically and culturally roles assigned to women and men. The project confirmed that with permanent and continuous messages it is possible to influence the intention of the change (EBA II).

Additionally, through the counseling for Zika prevention; the importance of self-care and female empowerment to make active decisions in sexual and reproductive life was emphasized, decisions such as the use of condoms, as there is little adherence to the use of condoms to prevent Zika.

(B) ENVIRONMENTAL COMPLIANCE

In Peru, on December 18, 2018, the Congress approved Law No. 30884, which regulates disposable plastic and disposable containers. Likewise, on August 22, 2019, the Executive promulgated the Decree No. 006-2019- MINAM, which approves the Regulations of the aforementioned Law. The importance of both standards is that the use of disposable containers creates breeding grounds for Aedes aegypti mosquitoes, therefore these regulations will help reduce the use of disposable containers, and thus mosquito breeding sites. The legal norms are in the next links:

Law Nº 30884: https://busquedas.elperuano.pe/normaslegales/ley-que-regula-el-plastico-de-un-solo-uso-y-los- recipientes-ley-n-30884-1724734-1/

Law Reglamentation: https://busquedas.elperuano.pe/normaslegales/aprueban-el-reglamento-de-la-ley-n-30884- ley-que-regula-el-decreto-supremo-n-006-2019-minam-1800497-4/

lxxvii | USAID ZIKA ANNUAL REPORT USAID.GOV Considering the EMMR and USAID environmental regulations, in Annex X. Environmental Compliance, the detailed report of the Environmental Mitigation and Monitoring Plan (EMMP) for the third year is presented.

In the actions developed by the project, the physical control of the vector, Aedes aegypti, is promoted, prioritizing the messages for change of behavior with respect to the maintenance of water containers, final disposal of unusable containers that can be potential breeding sites, campaigns of collection, elimination of unusable containers and elimination of breeding sites. Using the tools developed, especially the flipchart "Ten minutes against Zika". The aim is to minimize environmental impact by avoiding or reducing the use of disposable plastic containers that pollute the environment. Paper containers are used and in large events we try to provide water through stations installed for the effect instead of bottles. In regards food service, reusable dishes are requested. In the project digital formats were preferred and only a limited number of guides are printed at the training events. Before field visits, facilitators, researchers and project staff are advised of measures to prevent mosquito bites.

The Project in Ecuador and Peru strengthened the intersectoral and interinstitutional coordination of the competent institutions at the national and local levels to work on the response to Zika. Coordination was fostered among the social sector: health, education, regional and local governments, municipalities and community social organizations. Through meetings or platforms for coordinating intersectoral plans and joint actions, the project influenced these coordination and articulation processes.

Neighborhood women's, youth and adolescent organizations have been strengthened through a learning-by- doing process that begins with information on the Zika virus and is then complemented by reflections on self-esteem, leadership and the prevention of gender-based violence. This is a strategy to promote community participation in community epidemiological monitoring actions.

To ensure and maintain the sustainability of the project's actions in the communities, work was carried out with local actors and with the residents of communities. This work ensured that the key activities related to the prevention of Zika virus transmission and risks are incorporated into community prevention plans, as well as in the planning of institutional activities.

In Peru, the Regional Education Directorates of Tumbes, Piura and Lambayeque, issued regional Directives (norms). Those norms institutionalized the use of the ‘Educational Guide for the Promotion of a Culture of Prevention and Control of Zika’ in Educational Institutions. This allows teachers to have tools for mainstreaming Zika content with an epidemic risk and disaster prevention.

The Ministry of Health assumed the strategy of ‘Ten-minutes against Zika’, for changing family behavior by scaling it to 8 more regions.

In Ecuador, as part of the agreements with the Ministry of Health, several supplies and equipment were delivered to the project intervention districts, in order to strengthen the mechanism of transport for Zika samples. In addition, the Ministries of Economic and Social Inclusion as well as of Education incorporated the modules and guides developed with the project into their regular programs.

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxxviii The Municipalities of Arenillas and Las Lajas, with the support of the project, were certified as Health Promotion Municipalities. Actions were developed aimed at maintaining spaces free of contamination, which are safe and healthy, where productivity, risk management and citizen participation are promoted.

(D) YOUTH (IF APPLICABLE)

In Ecuador and Peru, the project incorporates the work of young people in different activities, as the population of reproductive age is a prioritized population. Therefore, young people, men and women, are direct beneficiaries of the actions.

The activities with adolescents and young people were carried out based on the “training of trainers” methodology, which allows a group to be formed and they are in charge of training their peers. In pairs, the adolescents trained other groups of young people in prevention and control of the virus, with a follow-up of the field technicians of the project.

Teachers in basic, secondary and high school education units, as well as health professionals, were trained in methodologies for working with adolescents, especially in contents on: prevention and control of the Zika virus, human rights and sexual and reproductive health. This activity allowed to expand the coverage of the project, and also contributed for the message to reach the families and communities of adolescents.

Considering the high rates of adolescent pregnancy, gender-based violence, and a lack of knowledge about the risks of sexual transmission of the Zika virus, adolescents were taught and instructed in sexual and reproductive health.

(E) DISABILITY (IF APPLICABLE)

In Ecuador, the project achieved the inclusion of children with visual and hearing disabilities in prevention and control activities of the Zika virus. This achievement was a result of training teachers with educommunicative tools, which facilitated the adaptation of Zika prevention messages, learning and inclusion in the classroom of children with disabilities.

In addition, the prevention of disabilities was discussed upon the reflection on the risk for children exposed to the Zika virus during the pregnancy. This topic was specially worked with pregnant women, women and men of reproductive age and with child development technicians.

(F) SCIENCE, TECHNOLOGY, AND INNOVATION (IF APPLICABLE)

In Peru, the project developed a software for the CBSS, which has 2 versions: the Web version (www.epidemiasperu.com) designed to be used on a desktop computer or laptop with internet capabilities, and the mobile version on Android platform to be used by the community monitors in the collection of primary information. That software contains the entomological information and other related to the social mobilization activities of the project, carried out by the monitors was collected using this technology.

This software is a support system for managing the community prevention of Zika and other metaxenic diseases. The Regional Government of Tumbes, requested the transfer of the software to give continuity to lxxix | USAID ZIKA ANNUAL REPORT USAID.GOV the CBSS, this also repeated with other local governments. Care-Peru will maintain the hosting to give continuity to the system.

In Ecuador, for the collection of information from the surveys of the CAP study, the free software application Kobo Toolbox was used, this allowed the field work to be much more agile (with the Kobo collect application on cell phones), with the only limitation of not having been able to register GPS markers in some locations where there was no internet service.

In the community based surveillance system activities, the Epi-Info Vector Surveillance application was used. The main objective was to georeferenced the households visited by the community monitors, however, it was not possible to continue using this system because not all community monitors had cell pones, which allowed them to download and use of the platform. Also, the inhabitants of the intervened communities removed the QR codes placed on their households for security reasons.

(G) POLICY AND REGULATORY REFORM (IF APPLICABLE)

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxxx

ANNEX VII RESEARCH AND PUBLICATION TRACKER

RESEARCH AND PUBLICATION TRACKER ECUADOR

RESEARCH

• Study on knowledge, attitudes and practices (KAP), on the control and prevention of the Zika virus. CARE Ecuador, August 2019.

• Comparative analysis on the results of years one, two, and three KAP studies. CARE Ecuador, August 2019.

• Study on good practices regarding the prevention and control of Zika virus. CARE Ecuador, August 2019.

PUBLICATIONS

Modules

• Methodological Module, Let’s Protect Collection, A Lifetime without Violence. CARE - MIES, November 2018. Link: http://www.todoscontraelzika.com/wp-content/uploads/2019/06/5.pdf

• Families and Communities prepared to prevent Zika Module, Let’s Protect Collection, A Lifetime without Violence. CARE - MIES, November 2018. Link: http://www.todoscontraelzika.com/wp- content/uploads/2019/06/web-baja-MODULO-AZUL-PROTEJAMOS-ZIKA-FINAL-OK-24-abril.pdf

• Sexuality Module - sexual rights and reproductive rights, Let’s Protect Collection, A Lifetime without Violence. CARE - MIES, November 2018. Link: http://www.todoscontraelzika.com/wp- content/uploads/2019/06/2.pdf

• Sexual Violence Prevention Module - a responsibility of us all, Let’s Protect Collection, A Lifetime without Violence. CARE - MIES, November 2018. Link: http://www.todoscontraelzika.com/wp- content/uploads/2019/06/1.pdf

• Systematization of the International Workshop “Community Mobilization in response to health emergencies and epidemics: learning from the fight against Zika”. CARE, September 2019

Guides

• Sustainability plans developing guide, CARE - Ecuador, July 2019.

Manuals

• Educational manual on communicative tools for the prevention and control of Zika, aimed at health promoters. CARE- Ecuador, March 2019. • Certification Manual for guardian municipalities against Zika, Dengue and Chikungunya. September 2019.

lxxxi | USAID ZIKA ANNUAL REPORT USAID.GOV • Implementation Manual of a Community-based epidemiological surveillance system for the control of Zika, Dengue and Chikungunya. CARE-Ecuador, September 2019.

Communication campaigns

Audiovisual

• Animation regarding the control and prevention of breeding sites of Aedes. CARE, Ecuador, March 2019. link: https://www.youtube.com/watch?v=qeT4Up7_KS4&list=LL4lh9iJpSBfPCsUT6xLqTKw • Matching pairs game for the prevention of Zika. CARE, Ecuador, May 2018. Link: https://www.care.org.ec/ZIKAJUEGO/zika/pares.html

Posters

• Prevention of sexual transmission of Zika virus for adults. CARE, Ecuador, March 2019. Link: http://www.todoscontraelzika.com/estrategia-de-comunicacion/piezas-educomunicativas/ • Prevention of sexual transmission of Zika virus for adolescents. CARE, Ecuador, March 2019. Link: http://www.todoscontraelzika.com/estrategia-de-comunicacion/piezas-educomunicativas/ • Brushing, washing and capping the water tank. CARE, Ecuador, March 2019. Link: http://www.todoscontraelzika.com/estrategia-de-comunicacion/piezas-educomunicativas/#!

Games on Zika prevention:

• Card game (54 cards) with Zika prevention messages. CARE, Ecuador, January 2019. Link: http://www.todoscontraelzika.com/wp-content/uploads/2019/09/naipes-ok-1.pdf • Matching pairs game (24 cards) with Zika prevention messages. CARE, Ecuador, January 2019. Link: https://www.care.org.ec/ZIKAJUEGO/zika/pares.html • Puzzles for adults with messages on the prevention of sexual transmission of Zika virus. CARE, Ecuador, January 2019. Link: http://www.todoscontraelzika.com/wp-content/uploads/2019/09/ROMPECABEZAS- 2019-hombres-edad-reproductiva-transmision-sexual.pdf • Puzzles for children and adolescents with messages on the prevention of sexual transmission of Zika virus. CARE, Ecuador, January 2019. Link: http://www.todoscontraelzika.com/wp- content/uploads/2019/09/ROMPECABEZAS-2019-ni%C3%B1as-ni%C3%B1os-y-adolescentes.pdf • Roulette with Zika prevention messages. CARE, Ecuador, January 2019. Link: http://www.todoscontraelzika.com/wp-content/uploads/2019/09/RULETA.pdf • Diptych with Zika prevention messages during pregnancy. Adaptation of pictures to the project’s imagery. CARE, Ecuador, January 2019

Billboards

• Five billboards with messages on the elimination of hatcheries, and the prevention of sexual transmission of the virus. Portoviejo Canton. CARE-Ecuador, June 2019. Link: http://www.todoscontraelzika.com/estrategia-de-comunicacion/piezas-educomunicativas/

RESEARCH AND PUBLICATION TRACKER PERU

RESEARCH

• Knowledge, Attitudes and Practices study on Zika virus. Year III

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxxxii • Ovitraps Efficiency Study: Campo Amor Community (Tumbes) • Ovitraps Efficiency Study: AAHH 28 de Julio (Tumbes) • Zika Virus Prevention and Control Best Practices Award: 2019 Edition

SYSTEMATIZATION

• Systematization of the Best Practice for Prevention and Control of Zika Virus Award • Systematization of Campo Amor Pilot • Systematization of intervention at schools

PUBLICATIONS

• Friendly Systematization of Campo Amor Pilot • Modular Guide to a Community Surveillance System for Local Governments in Zika Prevention and Control

Courses • Course for the development of community plans • Course on accountability • Course on the new SVBC application • Course on referrals and counter-referrals for SVBC • Course on SVBC home visits

Videos

• Experience of the Community-Based Surveillance System pilot model https://www.youtube.com/watch?v=GqgzE5-GJuM&t=145s

• Statements of neighbors who were benefited through the Community Based Surveillance System https://www.youtube.com/watch?v=QZSDv2CraDo&t=8s

• Statements of community leaders who responded to Zika virus in their communities https://www.youtube.com/watch?v=iEQuhvwWMG0

• Statements of municipal authorities involved in the response to Zika virus https://www.youtube.com/watch?v=ZqDIKS-ckHU

• Statements of public and private officials involved in the Zika response https://www.youtube.com/watch?v=35-ZFaCg1Tc&t=

lxxxiii | USAID ZIKA ANNUAL REPORT USAID.GOV

ANNEX VIII MANAGEMENT AND ADMINISTRATIVE ISSUES

B. MODIFICATIONS AND AMENDMENTS

Modification Description of Modification Date Number

3 1. Incorporate the name and contact information 12/21/2018 of the Agreement Officer's Representative (AOR), Jaime Chang; and 2. Update Attachment D - Standard Provisions for U.S. Nongovernmental Organizations

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxxxiv ANNEX IX ENVIRONMENTAL MITIGATION AND MONITORING Y3 & FINAL REPORT (EMMR)

List each Mitigation Measure List any outstanding issues from column 3 in the EMMP Status of Mitigation Measures relating to required Remarks (EMMT Part 2 of 3) conditions 1. Education, Technical Assistance, Training

• The methodological guides, education and training tools will The actions for the management of solid and liquid make explicit mention of the proper waste generated were implemented in all activities. management of solid and liquid Also, these actions were diffused by the technical

wastes generated in these events. team through work with the stakeholders and During all the events, the good providers to guarantee compliance. The main practices for Environmental recommendations were related to reducing, In the municipalities, differentiated Mitigation will be followed, included recycling and reusing. Specifically, we insisted on waste management was not in trainings, and reflected in a avoiding or reducing the use of disposable and brochure or triptych. polluting materials and on the differentiated implemented, so the separation in collection of waste, to facilitate recycling. the source has little impact on environmental protection. In Peru, the guides for facilitators of the The project emphasized the importance Community-Based Surveillance System Course of raising awareness and positioning incorporated environmental mitigation and good waste management practices for

monitoring measures in education, technical Environmental Mitigation with partners assistance and training activities. and local actors. In Ecuador, the educommunication guides incorporated recommendations for the management of waste generated at events. In faraway places, providers may An important number of activities are developed in be people of the community. coordination with the municipalities. Waste Usually they not have tableware management is a municipal competence, so one of available or resources to purchase the issues approached in the planning of activities it. In these cases, we insisted on was the cleaning and removal of waste during and the use of less polluting after the events. disposables.

We required food service providers not to use plastic containers and to replace them with paper

lxxxv | USAID ZIKA ANNUAL REPORT USAID.GOV cups or sleeves. This material is biodegradable, less polluting for the environment. • The reuse of educational and At fairs, open houses or other events held in public outreach materials will be actively spaces and institutions, games or sets of didactic promoted, along with a limited use materials were reused. The use of stationery such Exceptions were the materials such as of disposable materials. as flyers was avoided. Only a diptych related to pens, entry and exit test forms and information about the Zika`s risks in pregnancy event evaluation forms, which were was distributed. delivered at each event. Priority was given to the use of invitations to events or activities, through digital media. The Paper reuse was promoted in the offices diffusion of relevant public events was done of the Zika Response Project in through loudspeakers, radios, press conferences, Ecuador-Peru. social networks or other means available at the community level. CARE workers and strategic allies will To reduce the use of paper, it was prioritized to be constantly reminded about the deliver the electronic files of the contents analyzed importance of rationalizing the use of to the participants of the training. These were paper in the reporting processes. For delivered through email or similar mechanisms. this purpose, it is mainly recommended

In addition, the reports were worked on, to scan documents, and then send them consolidated and delivered in digital formats to through different electronic means, such reduce the use of paper. as mail and wetransfer.

In our offices, the use of recycled paper for unofficial documents was implemented. • The facilitators will be monitored to The project provided the didactic materials for ensure proper application of these the development of events or training activities. guidelines. These were reused whenever possible. Additionally, the use of recycled materials in the elaboration of products during the training days was promoted.

During the training events promoted and/or financed by the project, there was always a staff member from Care-Peru verifying compliance with the guidelines related to environmental care.

• The content of vector control In the management of the project, the physical training for communities and control of the vector and the empowerment of the Educational materials on the importance technical staff must be in line with population were prioritized in order to influence of solid waste management in the

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxxxvi USAID (i.e. Zika PERSUAP), WHO, the practices. This was evidenced in the tools and prevention of metaxenic diseases should and host country environmental methods developed for training officials, groups be prepared. These materials would be regulations. prioritized for intervention and communities. directed to environmental managers or responsible for the municipal service of Among the Zika preventive measures were: the solid waste collection. elimination of breeding sites, the practice of washing, covering and brushing containers where water is stored and collection from breeding sites, as well as the use of wet sand in vases. The main tool used was "Ten minutes against Zika" and educomunication tools with these messages.

Additionally, it was encouraged to reduce the consumption of products packaged in other plastic containers, which on top of affecting the environment are potential breeding sites.

The project provided technical assistance to municipalities, institutions and local organizations in Ecuador and to multisectoral health committees in Peru, for the development of district prevention and control plans for Zika and other metaxenic diseases.

The municipalities carried out a campaign to eliminate hatcheries in the prioritized areas, with participation of the institutions that belong to the multisectoral health committee (including the armed forces and police).

In Ecuador, communal work was carried out with the participation of the population and local institutions, including MoH and municipality, for the detection and elimination of hatcheries, in addition to strengthening prevention actions.

In Peru, the use of the improved tank cover in the locality of Cuchareta Baja, as a measure to control Aedes aegypti, as part of the training in new vector control protocols was promoted as a successful experience.

lxxxvii | USAID ZIKA ANNUAL REPORT USAID.GOV 2. Research and Development NA NA NA

3. Public Health Commodities NA NA NA

4. Small-Scale Construction NA NA NA

5. Small-Scale Water and Sanitation NA NA NA

6. Nutrition NA NA NA

7. Vector Control In the management of the project, the physical control of the vector and the empowerment of the population were prioritized in order to influence the practices. This was evidenced in the tools and methods developed for training officials, groups prioritized for intervention and communities.

• In coordination with UNICEF and In Peru, the Ministry of Health must PAHO, information will be The information on vector control activities determine the indicators to measure requested from the MOH regarding was requested every three months, in the areas the effectiveness of the hormonal the use of chemical and/or biological of project intervention. This information was inhibitor piriproxifen, since the existing pesticides, as well as the relevant recorded in the quarterly indicator reports. ones up to now refer to the use of the regulatory frameworks. Temephos larvicide. In Ecuador, PAHO worked with the Ministry of Health to raise evidence regarding the use of larvicides • Provide information to families on The chemical control and the acquisition of potential harmful effects of pesticides corresponds to the State (Ministry of pesticides carried out by the MOH. Health, in Peru also to the Regional Directorate of Health, Health Sub-regions and Municipalities). The Ministry of Health has technical standards for the use of larvicides, adulticides and hormonal inhibitors, in accordance with the regulations of the Pan American Health Organization.

In Peru, integrated consent protocols were incorporated into the Integrated Vector Control Protocols for families to carry out focal treatment, perifocal treatment and spatial nebulization activities. This issue was addressed

USAID.GOV USAID ANNUAL PROGRESS REPORT | lxxxviii during the training of health personnel and other stakeholders, reinforcing the need to comply with this requirement during the development of the work.

In Ecuador, the vector control brigades, before fumigation activities (if they were to be carried out) went through and informed the population on the precautions that must be taken, mainly to protect water and food for consumption.

The community monitors supported providing information within their communities to reduce the number of unwilling houses.

• Learning meetings will be held with The Ministry of Health has a protocol governmental agencies and academia for housing inspection and vector regarding Evidence-Based Analysis control and best practices in the application of these products. All applications recommended will be consistent with the Zika PERSUAP, international standards (e.g. WHO, PAHO, USAID) and host country regulations and policies. • Guidelines will include national and In Peru, the topic was included in vector control international standards on the protocols. These were implemented by proper handling and disposal of facilitators (trained by the Project), who trained ovitraps. health personnel, teachers, authorities, community leaders and community health agents.

Ecuador NA

• Ensure any reference on the disposal of traps follow the Zika In Peru, the contents related to the provision of PERSUAP requirements, ovitraps complied with the regulations defined by international best practices (e.g., WHO / PAHO and the national standards. WHO, PAHO) and host country requirements. ECUADOR NA 8. Emergency Response NA NA NA

lxxxix | USAID ZIKA ANNUAL REPORT USAID.GOV