USAID’s Maternal and Child Survival Program (MCSP) Uganda Quarterly Report October 1, 2016 to December 31, 2016 Assistant District Health Officer for MCH facilitating a group discussion during a Quarterly Review Meeting in Ntungamo District USAID/Uganda Quarterly Progress Report (Program Year 3) Project Name: USAID’s Maternal and Child Survival Program (MCSP) Routine Immunization (RI) Program Reporting Period: October 1, to December 31, 2016 Obligation Funding Amount: $891,939 (Field Support) Project Duration: July 2014 - March 2019 Program Year (PY3): October 1, 2016 to September 30, 2017 Person Responsible for this Report: Dr Ssekitto Kalule Gerald – Chief of Party MCSP Project Objectives: 1. Strengthen UNEPI’s institutional/technical capacity to plan, coordinate, manage, and implement immunization activities at national level. 2. Improve district capacity to manage and coordinate the immunization program as guided by UNEPI leadership. 2 Acronym List CAO Chief Administrative Officer CBET Competence-Based Education and Training CH Child Health DHMT District Health Management Team DHO District Health Officer DHT District Health Team DTPC District Technical Planning Committees EPI Expanded Program on Immunization EPCMD Ending Preventable Child and Maternal Deaths GAVI Global Alliance for Vaccines and Immunizations Gavi PEF Gavi Partnership Engagement Framework HC Health Centre HF Health Facility HSD Health Sub-District ICHC Institutionalization of Community Health Practices Conference IIP Immunization in Practice ICHC Institutionalization of Community Health Practices Conference IPV Inactivated polio vaccines IRB Institutional Review Board JSI John Snow Inc. LC Local Council MACIS Malaria and Childhood Illnesses NGO Network Secretariat MCH Maternal and Child Health MCHIP Maternal and Child Health Integrated Program MCSP Maternal and Child Survival Program MNCH Maternal, Newborn, Child Health MOH Ministry of Health NCC National Coordination Committee OPL Operational Level PDSA Plan-Do-Study-Act cycles PHC Primary Health Care PY Project Year QI Quality Improvement QRM Quarterly Review Meetings QWITs Quality Work Improvement Teams REC-QI Reaching Every Community using Quality Improvement techniques RED Reach Every District RI Routine Immunization SAS Senior Assistant Secretary SS Supportive Supervision SS4RI Stronger Systems for Routine Immunization STPC Sub-county Technical Planning Committee TOT Training of Trainers TWG Technical Working Group UNEPI Uganda National Expanded Programme on Immunization UNICEF United Nations Children’s Fund USAID United States Agency for International Development 3 USG United States Government VHT Village Health Team WHO World Health Organization 4 Introduction The Maternal and Child Survival Program (MCSP) is a global U.S. Agency for International Development (USAID) cooperative agreement to introduce and support high-impact health interventions in 24 priority countries with the ultimate goal of ending preventable child and maternal deaths (EPCMD) within a generation. MCSP engages governments, policymakers, private sector leaders, health care providers, civil society, faith-based organizations and communities in adopting and accelerating proven approaches to address the major causes of maternal, newborn and child mortality and improve the quality of health services from household to hospital. MCSP also tackles these issues through cross- cutting approaches that focus on health systems strengthening, household and community mobilization, equity, gender, eHealth, and others. MCSP carries forward the momentum and lessons learned from USAID’s Maternal and Child Health Integrated Program (MCHIP), which made significant progress in improving the health of women and children in over 50 developing countries throughout Africa, Asia, Latin America and the Caribbean from 2008-2014. This quarter marked the beginning of a new Program Year (PY3). During this period, MCSP continued its efforts to strengthen the capacity of the Uganda National Expanded Programme on Immunisation (UNEPI) and to strengthen Routine Immunisation (RI) systems for better coverage and utilisation of quality RI services in the two districts of Kanungu and Butaleja. These are referred to as PY1 districts because support to them was initiated in PY1 (October 2014 to September 2015). MCSP also continued to provide support to the four additional districts of Ntungamo, Mitooma, Bulambuli and Kibuku. These are referred to as PY2 districts in the report also based on the year when support was initiated i.e. October 2015 to September 2016. During PY3, quarter 1, MCSP continued to focus on promoting REC-QI practices in the districts, health districts and health facilities. These REC-QI practices include: building capacity for data analysis and use, quarterly review meetings involving political, civic and opinion leaders (eg, non-traditional stakeholders), integrated supportive supervision visits, mapping of health facility catchment areas, micro-planning, community engagement, Quality Work Improvement Teams, and testing changes in Plan-Do-Study-Act (PDSA) cycles. Summary of PY3 Quarter 1 Achievements Immunization achievements for MCSP Uganda RI during PY3, Quarter 1 are summarized as follows: National Level Achievements Jointly, SS4RI and MCSP supported UNEPI in finalizing its official Immunization in Practice (IIP) Manual making it ready for printing. This manual will be used by health workers throughout the country and provides the essential content for UNEPI’s training materials. This long awaited activity paved the way for developing the Operational Level (OPL) training. Using the revised IIP Manual, MCSP and SS4RI supported Ministry of Health (MOH) /UNEPI in conducting a Training of Trainers (TOT) of 35 national trainers. MCSP participated in the only Technical Working Group (TWG) held in this quarter and in a meeting of the National Coordination Committee (NCC) to prepare for the Meningitis A campaigns to be held in high-risk districts. MCSP continued to facilitate organization of the Institutionalization of Community Health Practices Conference (ICHC), originally scheduled to take place in Uganda. MCSP is a key member in the 5 Uganda country delegation to take part in that conference in March 2017. However, the venue for the conference has since been moved to South Africa, and MCSP’s involvement in the planning has ended. District Level Achievements PY1 Districts (Kanungu and Butaleja) REC-QI is comprised of three main steps or phases, namely “Orient,” “Establish and Strengthen,” and “Sustain.” MCSP completed all scheduled activities in all of the two PY1 districts (Kanungu and Butaleja) except the sustainability forum meetings, which are planned for next quarter. MCSP provided the last round of support to quarterly review meetings (QRMs) in the two PY1 districts at the district and health sub-district (HSD) levels. This provided a platform for the District Health Management Teams (DHMTs) together with district and sub-county political, religious and civil leaders to jointly reflect on performance in RI and other Maternal and Child Health (MCH) service areas, and develop strategies for improvement. A number of resolutions were made, namely: increasing involvement of leadership in supporting RI activities, strengthening vaccine forecasting and acquisition by health facility, and strengthening follow up to ensure primary health care (PHC) funds adequately facilitate staff and village health teams (VHTs) involved in RI activities. MCSP provided technical assistance to a team of 28 district supervisors: 18 from Kanungu and 10 from Butaleja District. The aim was to consolidate their knowledge and skills in conducting Supportive Supervision (SS). During this activity, up to 72 health facilities (48 in Kanungu and 24 in Butaleja) that provide RI services were visited by the district supervision teams backstopped by the MCSP technical teams. Emphasis was directed towards addressing RI and REC-QI issues. However, support was integrated to include issues related to other service delivery areas e.g. Maternal and Child Health in general, and Malaria among others. As shown in Figure 1 below based on results from an assessment conducted in October 2016, 67% of health facilities assessed in the PY1 districts had reviewed and completed new health facility micro-plans. Although this was slightly lower than the proportion observed in April 2016 (69%) it was still over ten times higher than the baseline level of 6% observed in July 2015. This showed that following MCSP technical assistance, health facilities had now developed REC micro-plans independently, an early indication of sustainability and a strengthened RI system process (i.e. micro-planning). Up to 37% of health facilities assessed were found to be implementing REC-QI practices (e.g. had a micro-map, micro-plan, and a functional Quality Work Improvement Team that met at least once in the past 3 months) and were found working on at least one PDSA cycle. This was more than ten times higher than the 3% identified at baseline in June 2015. 6 Figure 1: Proportion of PY1 health facilities with completed REC micro-plans (October 2016). PY2 Districts (Ntungamo, Mitooma, Kibuku and Bulambuli) In the PY2 districts (Ntungamo, Mitooma, Kibuku and Bulambuli), MCSP supported district health teams (DHTs) with QRMs. During this quarter, 58 supervisors were trained in SS including; 10 supervisors from Bulambuli, 10 from Kibuku, 12 from Mitooma, and 26 from Ntungamo. PY1 and PY2 Districts During this quarter,