July 1– September 30, 2016 Project Year 3, Quarter 4 Report

Mayer Hashi Family Planning Project in Bangladesh (MH-II) QUARTERLY REPORT

Reporting Period: July 1– September 30, 2016

Project Year 3, Quarter 4 Report

Submitted to: Office of Population Health, Nutrition and Education United States Agency for International Development USAID/Dhaka

By MH-II Project

Associate Cooperative Agreement No. AID-388-LA-13-00002 Under Leader Award No. GPO-A-00-08-00007-00

Date of Submission

October 31, 2016

Table of Contents Acronyms and Abbreviations ...... 3 INTRODUCTION ...... 6 MAJOR PROGRAM RESULTS AND ACHIEVEMENTS ...... 7 MONITORING, EVALUATION, AND RESEARCH ...... 13 PROGRAM MANAGEMENT ...... 14 NEXT STEPS ...... 14 Appendix 1: Activity Description and Achievements by IR ...... 16 IR 1: Effective and High Quality FP Services Delivered Nationwide ...... 16 Appendix 1: Indicator Tracking Table ...... 170 Appendix 2: Findings from QA and FP Compliance Monitoring Visit ...... 175

Acronyms and Abbreviations

ANC Antenatal care AUFPO Assistant Upazilla Family Planning Officer APO Assistant Program Officer BRAC Bangladesh Rural Advancement Committee BCC Behavior change communication BCCWG Behavior Change Communication Working Group BEPZ Bangladesh Export Processing Zone BGMEA Bangladesh Garment Manufacturers and Exporters Association BKMI Bangladesh Knowledge Management Initiative BMRC Bangladesh Medical Research Council BSR Business Social Responsibility CAO Chief Accounts officer CAR Contraceptive Acceptance Rate CC Community clinic CCSDP Clinical Contraceptive Services Delivery Program CHCP Community health care provider CHW Community health worker CLP Chars Livelihoods Programme CMES Centre for Mass Education in Science CS Caesarean Section CS Civil Surgeon CSBA Community Skilled Birth Attendants CTU Contraceptive technology update CYM Courtyard meeting CYP Couple-years of protection DC Deputy Commissioner DD Deputy Director DG Director General DFID Department for International Development DGFP Directorate General of Family Planning DGHS Directorate General of Health Services DQA Data quality assessment ECP Emergency contraceptive pill EdM Enfants du Monde EPI Expanded Programme for Immunisation FAQ Frequently asked question FGD Focus group discussion FP Family planning FPCST FP Clinical Supervision Team FSDP Field Services Delivery Program FWA Family Welfare Assistant FWC Family Welfare Center FWV Family Welfare Visitor GOB Government of Bangladesh HEU Health Economics Unit H&FWC Health and Family Welfare Centre HQ Headquarters ICV Informed choice and voluntarism

ICT Information communication technology iDQA Internal Data Quality Assessment IFB Islamic foundation of Bangladesh IPC Interpersonal communication IEC Information, Education, Communication IEM Information, Education, and Monitoring ILO International Labor Organization IR Intermediate result IPC Interpersonal communication IUD Intra-uterine device KM Knowledge management LARC Long-acting reversible contraception LD Line Director L&S Logistics and Supply MAB Municipal Association of Bangladesh MCWC Maternity and Child Welfare Center MEC Medical Eligibility Criteria (of the World Health Organization) ME&R Monitoring, evaluation, and research MFSTC Mohammadpur Fertility Service and Training Center MIH Marketing Innovation for Health MIS Management Information System MH-II Mayer Hashi FP Project in Bangladesh MNHI Maternal and Neonatal Health Initiative managed by UNFPA MO Medical Officer MOHFW Ministry of Health and Family Welfare MOLGRD&C Ministry of Local Government and Rural Development and Cooperatives MOU Memorandum of Understanding MOY Ministry of Youth MR Menstrual regulation MSD Merck Sharp & Dohme MSDCT Mobile Service Delivery Care Team Mukti Nari O Shishu Unnayan Sangstha NGO Nongovernmental organization NHSDP NGO Health Service Delivery Project NSV No-scalpel vasectomy NTC National Technical Committee Ob-Gyn Obstetrics and Gynecology OGSB Obstetrics and Gynecological Society of Bangladesh QAT Quality Assurance Team OJT On-the-job training Q1 Quarter 1 OP Operational plan QIS Quality Improvement Secretariat PAC Postabortion care PM Permanent method (of contraception) PNC Postnatal care POC Person of collaboration POP Progestin-only pills PPFP Postpartum FP PPIUD Postpartum IUD

PPBTL Postpartum bilateral tubal ligation PSTC Population Services and Training Center PY Project year Q Quarter QA Quality assurance QAT Quality Assurance Team RHSPO Reproductive Health Service Promotion Officer RTMI Research, Training, and Management International SACMO Sub-Assistant Community Medical Officer SBCC Social and behavioral change communication. SHOPS Strengthening Health Outcomes through the Private Sector SIAPS Systems for Improved Access to Pharmaceuticals and Services Program SMC Social Marketing Company SOP Standard Operating Procedure SRHR Sexual and reproductive health and rights SSN Senior Staff Nurse TA Technical assistance TOT Training of trainers UHC Upazilla Health Complex UNO Upazilla Nirbahi Officer UP Union Parishad UFPO Upazilla FP Officer UPHCSDP Urban Primary Health Care Service Delivery Project UNFPA United Nations Population Fund USAID United States Agency for International Development VPKA Voluntary Paribar Kallayon Association VSC Voluntary surgical contraception WHO World Health Organization YMC Young married couple YPSA Young People in Social Action

INTRODUCTION

Mayer Hashi II (MH-II) is a follow-on project to Mayer Hashi, a four-year family planning (FP) project in Bangladesh (October 1, 2013—September 30, 2017) Leader with Associate Cooperative Agreement awarded by the United States Agency for International Development (USAID). MH-II aims to advance the use of reproductive health (RH) and FP services with a focus on informed and voluntary use of long-acting reversible contraception (LARC) and permanent methods (PMs). MH-II provides in-country capacity development to strengthen RH service delivery by providing support to Bangladesh’s National FP and Maternal Health

This progress report covers the reporting period of quarter four (Q4) of project year three (PY3) which is for the period July 1– September 30, 2016. During this reporting quarter, the MH-II project achieved the majority of its performance benchmarks. By the end of Q4, MH- II achieved 85% of the quarterly benchmark for indicator one (couple years of protection/ CYP), which is 80% of the annual CYP benchmark and 64% of the overall project benchmark for this indicator. Performance against the project’s remaining 13 indicators can be found in Appendix 1.

Information on all the project indicators including the two USAID standard indicators and the custom indicators can be found in the MH–II Performance Tracking Table (Appendix 1) and the summary of district coverage of key interventions and their follow-up in (Appendix 6).

Baseline Method Mix for Method Mix June'16 for Country Program Country Program Implant Injectable 12% Injectable Implant 3% 6% 20% NSV IUD NSV 39% 18% 21%

IUD 22%

FS FS 28% 31% Implant IUD FS NSV Injectable Implant IUD FS NSV Injectable

MAJOR PROGRAM RESULTS AND ACHIEVEMENTS

Achievements of Service Delivery and Training (IR1) for Quarter 4, Year 3

Following are the highlights of IR Team 1 activities: During Quarter 4 (Q4) of PY3 the Service Delivery and Training Team (IR1) of MH-II continued implementation of activities as per the Workplan including accelerated action plan. During Q4 four (4) meetings were held with the Research, Training, and Management International (RTMI). In July 2016 two meetings were held to initiate additional activities to increase the performance and to strengthen support to the mobile service delivery care teams (MSDCTs) by the RTMI Headquarter (HQ) staff to ensure the effective organization of FP special days. Two meetings were held to finalize the planning of the no-cost extension of the project for 5 months (till March 2017), and to develop a comprehensive plan to increase the LARC and PM performance during the last 6 months (October 2016 – March 2017) of the project.

During this quarter six (6) joint field visits were conducted with RTMI management staff to monitor the quality of the RTMI mobile service delivery care team (MSDCT) field level activities, and to support RTMI management staff to conduct monitoring visits. On 14 August, 2016 an all MSDCT staff meeting was held to develop a six months’ comprehensive plan with focus on client mobilization and to discuss how to overcome the challenges faced during the previous quarter. One challenge faced by the team was getting access to high performing districts for LARC and PM due to the allocation of low performing hard to reach areas by the DGFP. Another challenge comes from the FWAs and UFPOs requesting transportation money for the clients, and remuneration for organizing the special days which is not permitted under USAID rules and regulations.

On August 27 and 28, 2016 RTMI organized orientation sessions for two batches of participants (57) from SHIMANTIK, these were volunteers working in Sylhet Municipal area to involve them in client counseling and referral during the special days. During the reporting quarter the performance of RTMI has improved compared to the previous two quarters. During Q4 (July to September 2016) RTMI performed 23,873 LARC and PM, (Tubectomy 2,446, Vasectomy 2,982, IUD, 1585, Implant 16,860 and 448 injectable using mobile teams and hired surgeons.

During this quarter, Postpartum FP (PPFP) onsite follow-up visits were conducted in 31 facilities from PY1, PY2 and PY3 districts. All the facilities are performing female sterilization with C-section but, very few Intra-uterine device (IUDs) are being inserted after normal delivery. PPFP performance for quarter 4, Postpartum Tubectomy, 4,726 and 1,527 IUDs.

A circular issued in Q2 ensuring PPFP counseling is integrated in all antenatal care (ANC) and postnatal Care (PNC) visits and during immunization services was distributed through different programs. An amendment has been made based on two policy changes on PPFP provision of immediate PP Implant and progestin- only pill (POP) to mothers immediately after delivery) and a letter was sent to the Line Director (LD), clinical contraceptive service delivery program (CCSDP) to include this change in the PPFP Participants Training Handbook.

In this quarter clinical orientations on PPFP were organized for 37 service providers and facility managers working at nine facilities, two maternity and child welfare centers (MCWCs), one District Hospital, and six nongovernmental organizations (NGOs) located in seven districts. One (1) doctor and six (6) paramedics from the NGO health service delivery project (NHSDP), Jessore district received clinical training on PPIUD. The issue regarding the availability of the Imprest fund at the Directorate General of Health Services (DGHS) facilities has yet to be resolved. The Ministry of Finance (MoF) has issued an embargo on using funds from the Directorate General of Family Planning (DGFP) by the Directorate General of Health Services, (DGHS). As a result, the PPFP performances at the DGHS facilities (especially PP IUD insertions) remains low.

During Quarter 4 an orientation on the use of FP in post abortion care (PAC) and after menstrual regulation (MR) services were organized for 15 providers from two (2) MCWCs. The quarter 4 performance reports received from nine (9) MCWCs shows that 460 women came for PAC/post-MR services, and 360 of them, received a family planning method. During quarter 4, MH - II continued to organize special FP service delivery days at private facilities in Dhaka city in collaboration with the DGFP. During this quarter, 47 special FP service days were organized in Dhaka, and 603 clients received FP which include 504 no- scalpel vasectomy (NSV) and 99 Implants. The DGFP service providers working in other facilities were hired to provide FP services on these special days where there are no services.

MH-II has started using text messages to obtain monthly IUD performance from the trained Family Welfare Visitors (FWVs) and the female Sub-Assistant Community Medical Officers (SACMO) During the reporting quarter 66 FWVs and female SACMOs out of 87 reported that they are inserting IUDs, they have inserted a total of 365 IUDs.

During the reporting period MH-II followed-up 235 newly trained injectable providers comprising of Community Skilled Birth Attendants (CSBA) trained Family Welfare Assistants (FWAs) (71) and Community Health Care Providers (CHCPs) (64) from Brahmanbaria, Cox’s Bazar and Dhaka districts. All of the trained providers are providing injectable services after the training. CSBAs are screening the clients using the government consent form. During follow up visits 11 new participants (02 FWAs and 09 CHCPs) were trained on how to give the injectable.

During this quarter, service providers from BRAC, trained on IUD, Implant and injectable during PY1, PY2 & PY3 were followed up. The follow up was done in batches at the Mohammadpur Fertility Services and Training Center (MFSTC), Dhaka by the MH – II clinical staff. Their knowledge and skill assessment were found to be satisfactory. During July-August 2016 trained providers from BRAC provided 3,056 injectable, 238 IUDs, and 140 Implants. During the reporting quarter MH-II collaborated with the Fistula Care + project of EngenderHealth to provide on the job training on infection prevention and waste management for 52 service providers from Bangabandhu Sheikh Mujib Medical University (BSMMU), Hope Foundation Cox’s Bazar, and Kumudini Hospital.

During this reporting quarter, the Obstetrics and Gynecological Society of Bangladesh (OGSB) RH and FP Training Center conducted 3 batches of training for a total of 37 providers on the provision of IUD, and counseling. The trainers conducted on-site follow-up of 21 service providers who received training on IUD and Implant in four (4) districts. All trained providers are performing IUD competently. During the reporting quarter 4 meetings were held with the President, General Secretary, OGSB and Director, OGSB Hospital and other concerned persons to discuss the sustainability plan for the OGSB RH & FP Training center.

MH-II Senior Quality Assurance & Family Planning (Sr. QA & FP) Compliance Officers conducted 69 quality assurance (QA) visits to Maternity and Child Welfare Centers (MCWCs), Upazilla Health Complexes (UHCs), Health and Family Welfare Centers (H&FWCs), and NGO clinics. Of these, 42 were first time visits and 27 were follow-up visits. During this period, the Assistant Program Officers (APOs) (Logistics) with support from the Senior QA & FP Compliance Officers organized 793 special FP service delivery days where trained providers were not available using hired surgeons from the DGFP and DGHS at the district and Upazilla level. Special day performances in this quarter have improved, 15,093 LARC, PM, and injectable services were provided (1,142 female sterilizations, 2,166 NSVs, 10,681 implants, 221 IUDs, and 883 injectable)

Sr. QA & FP) Compliance Officers are working on the readiness of facilities, advocating for the handing over of the operating theaters (OT) to the DGFP at the Upazilla level and ensuring the availability of a separate room for the provision of IUD services. They are also supporting the Quality Improvement Secretariat (QIS) of the Ministry of Health and Family Welfare (MOHFW) on quality improvement issues.

Challenges faced by IR Team 1:

In Q3 MH-II reported that they provided technical and financial support to train 15 DGHS doctors to provide LARC and PM services, especially where trained providers are not available. Due to their non-performance for various reasons MH-II has discontinued their support to training DGHS doctors.

PPFP performances at DGHS facilities did not improve in this quarter due to the non- availability of the Imprest fund and FP commodities. The establishment of cost centers at the DGHS facilities has come to a standstill due to an embargo issued by the Ministry of Finance. This has affected PP IUD services due to the non-availability of commodities. The postpartum performance for this quarter PP IUD 1,527 and Tubectomy 4,726

Achievements of Demand Generation (IR2) for Q4, PY3:

With successful advocacy efforts from MH-II and other USAID partners, the DG, DGFP approved the inclusion of BCC line items to be added to the dashboard of the eLMIS. After approval Systems for Improved Access to Pharmaceuticals and Services (SIAPS) project integrated SBCC line items in the Upazilla inventory management and eLMIS. As a result of the policy change program decision makers can generate the information from the eLMIS to determine the SBCC materials' in stock and take the required actions. In the reporting quarter, MH-II distributed 2,911,779 units of information, education, communication/behavior change communication (IEC/BCC) materials to 5,165 public facilities through the logistic & supply (L&S) unit of the DGFP. From July to September 2016, the private health facility Reproductive Health Services Promotion Officers (RHSPO) referred 4,783 clients and 1,626 from the workplace interventions and they received a modern method of family planning. Volunteers from BRAC, Young People in Social Action (YPSA), Shushilan, Population Services and Training Center (PSTC), Nari O Shishu Unnayan Sangstha (Mukti), and Voluntary Paribar Kallayon Association (VPKA) referred 56,084 clients to the nearest health facilities providing LARC and PM services. As a result, 38,015 clients accepted a modern FP method in this quarter.

Injection Implant IUD Tubectomy NSV Total 30,217 5,724 892 980 202 38,015

In PY-3 A total of 154,607 prospective clients were referred out of which 128,640 received an injectable or a LARC and PM method.

Trend of Injectbale and LARC and PM Uptake in PY3 60,000

50,000 48,425 48,241 40,000 41,907 37,143 37,614 30,000 29,392

20,000 20,798 19,727 10,000

- Q1 Q2 Q3 Q4

Refer Received

To create demand for FP services, especially IUD and NSV, CCSDP with the support of MH- II built the capacity of 30 satisfied IUD clients and 47 NSV clients in two (2) orientation sessions held in Sadar Upazilla in Barguna district and Kuakata Pourashava under Khepupara

Upazilla in Patuakhali district. The satisfied IUD and NSV acceptors worked with the FWAs to increase the demand and dismiss myths and misconceptions about the methods.

Challenges faced by IR Team 2: The unavailability of clinical service providers is a long standing challenge that we are facing in trying to increase the uptake of LARC and PM services. To address the situation, MH-II BCC) partners ensures the availability of serve providers before referring a client to public facilities; organize FP special days with support from hired surgeons and RTMI; refer to other NGO facilities, Smiling Sun, Marie Stopes, and Mamata. To dispel myths and misconceptions about FP, some BCC interventions are carried out, which includes one session workshops with the religious leaders, advocacy workshop/seminars with the services providers, courtyard sessions with community people, male engagement, and distribution of information leaflets etc. These activities are conducted by the BCC partners (BRAC, YPSA and Shushilan) and the volunteers from different NGOs (PSTC, Mukti and VPKA).

Key Achievements of Policy, Advocacy, and Enabling Environment (IR3) for Q3, PY3:

As a part of local level advocacy to show case service provider’s critical roles in LARC ad PM service delivery (including PPFP), 6 (six) district level advocacy workshops were conducted jointly with the DGFP in Cox’s Bazar, Comilla, Thakurgaon, Lalmonirhat and Kurigram districts. Multisector stakeholders—including the Deputy Commissioner, Civil Surgeon (CS), Superintend of Police, Deputy Director of FP, Upazilla Chairmen, Upazilla Nirbahi Officer, Upazilla Health & Family Planning Officer, Upazilla Family Planning Officer, Ob/Gyn. consultant, Medical Officer MCH-FP), DD-Islamic Foundation Bangladesh, President/Secretary of the Imam Association, and journalists attended the workshops. Key outcomes from these workshops included commitments made by the different stakeholders to help strengthen the FP programs, such as the commitment by the CS to allocate an OT to the DGFP to improve the quality of FP services, the commitment by the DGHS providers to increase PPFP services, a commitment by both DGHS and DGFP providers to ensure the implementation of all changed policies including 100% counseling on FP focused on PPFP during ANC, PNC, and immunization services.

In connection with the creation of the cost centers within the DGHS facilities, on 08 September 2016, the office of the Secretary, MOF sent a letter to the Senior Secretary of the Ministry of Health and Family Welfare (MOHFW) enquiring about few pertinent issues. The MOF wrote in the letter, “You are advised to let us know if there is any provision to open Imprest fund or permanent advance fund in favor of Officers/staffs from the money of one budget holder’s office to the different budget holder’s office. One important thing to be mentioned the current Operational Plan (OP) which started in July/2011 is ending in December/2016. The MOF questioned the rationale behind opening an Imprest fund or permanent advance fund at the end of the OP. There is a possibility of having problems in reimbursing the Imprest fund or permanent advance fund or consolidating the fund by December 2016 in the government account”. The MOF won’t allow the MOHFW to open a cost center in the DGHS sites. As an alternative MH-II has initiated a discussion with the DGFP that they place one FWV at each of the Medical Colleges and District Hospitals. The deputed FWV will be responsible the DGFP Imprest money and supplies etc. as well, as reporting sending the performance reports and receive the Imprest money. For ensuring better privacy for IUD service delivery at the Upazilla Health Complexes, MH-II did local level advocacy discussing the issue related to IUD during district level advocacy meetings, 11 one-on-meetings with CS and Upazilla Health & Family Planning Officers, issuance of request letter by the DD-FPs to the CSs, etc. so that the DGHS hands over the OTs to the DGFP. So far, 254 DGHS OTs have been handed over to DGFP at the Upazilla level across the country. Division-wise breakdown of those allocations are: Dhaka- 82, Chittagong- 62, Rajshahi- 41, Barisal- 0, Khulna- 43, Sylhet- 09 and Rangpur- 17.

During this quarter two (2) Bangladesh Garment Manufacturers and Exporters Association (BGMEA) clinics located at Savar/Dhaka and Gazipur city obtained DGFP affiliation and have started receiving DGFP logistics, commodities and the Imprest fund to provide both short acting and long acting FP services. Under compliance culture piloting (it is expected that after the one-year piloting of this intervention, a culture of comprehensive group accountability for contraceptive performance would be developed among all cadres of FP staff who work at the field up to the Upazilla level.

A 6-day training on IUD was conducted from the 17-22 August 2016. A total of nine (9) female SACMOs from five (5) Upazillas (Sadar 2, Dgaanbhuiya 4, Sonagazi 1, Fulgazi 1 and Chagalnaiya 1) in Feni district participated in the training. The female SACMOs will start providing IUD service during the 8 days a month when the FWVs conduct satellite/outreach clinics. Since the start of the pilot, the DDFP attends all the Upazilla staff meetings and follows-up different activities performed by the DGFP staff, Upazilla Family Planning Officers have started doing visits/mobile phone follow ups with the field staff, the frequency of holding satellite clinics and court yard meetings has improved, special PPFP information campaigns for pregnant mothers are being held, to encourage the staff to provide FP related services and information, the DDFP initiated a ‘Staff of the Month’ certificate award for the best performer and the reporting system has been updated and discussions during monthly meetings includes other topics not only the monthly projections for the staff.

A FP Manual Review Committee was formed by the DGFP and a meeting was held on the 26th April 2016, a decision was taken to revise 12 chapters of the FP Manual, these have been revised and rewritten. The changes were shared on 22nd September 2016 with the FP Manual Review Committee, and a decision was made to do a technical review of the whole manual. It is expected that the revision would be completed in the 1st quarter of year 4 of the project.

After receiving training during this quarter, young married couples (YMC) volunteers started to refer client to the service delivery centers. During May-Septembers 2016, YMC volunteers referred 4,628 clients and they accepted different types of LARCs (IUD 277, Implant 4101) and PMs (NSV 98, Tubectomy 152).

Challenges Faced by IR3 Team:

MH-II has successfully advocated with the MOHFW to establish a cost center within the DGHS facilities and got clearance from the relevant offices of the MOHFW including the office of the Chief Accounts. However, a letter sent on the 8th September 20016 from the MOF to the Senior Secretary of the MOHFW enquiring about certain points (please see above) indicate that that money from one OP cannot be spent by another OP. In this case the Imprest funds belonging to CCSDP OP and cannot be spent by any of the OPs from the DGHS. As an alternative MH-II has initiated discussions with the DGFP, suggesting that they place one FWV in each of the Medical Colleges and District Hospitals. The appointed FWV

12 will be responsible for the DGFP Imprest money and supplies etc. in the DGHS facility. The deputed FWV would also send the performance reports and receive the Imprest money. MH-II advocated to get a MOU signed between BGMEA, DGFP and EngenderHealth Bangladesh which enables the RMG to access DGFP contraceptives free for their factory clinic. However, it appears that many of the garment owners are non-compliant with the tripartite MOU between BGMEA, DGFP and EngenderHealth Bangladesh and are unwilling to take FP commodities from the DGFP. To address this issue, IR3 team included a task in the PY4 Workplan to advocate with the BGMEA to include the availability of FP in the RMG clinics in their compliance list. Once FP is included as a compliance point, all of the RMGs will have to ensure FP services are available in their factory mini clinics.

MONITORING, EVALUATION, AND RESEARCH

In Q4 of PY3, the ME&R team accomplished the majority of the planned activities, including providing ongoing TA and support to all MH-II IR teams using data for decision making. The ME&R team routinely collects data from program staff, partners, NGOs, and private sector entities. The ME&R team verifies the Management Information System (MIS) data from the DGFP and assists the staff in reviewing the data consistency. Service statistics for LARC, PM, and injectable are calculated for CYP, the LARC and PM trends, and share these with the IR teams.

After incorporating the feedback from EngenderHealth HQ on the draft knowledge management (KM) plan for MH-II it has been finalized. A meeting was held with a mix of senior and mid-level staff on September 29, 2016 to share the KM plan and KM standards and practices prepared by HQ.

An orientation on basic gender for the new staff of EngenderHealth Bangladesh was held on August 5, 2016. Nineteen participants participated in the orientation. Mr. Fabio Verani, Senior Technical Advisor, Gender/Men as Partners, EngenderHealth HQ was the facilitator. In this quarter a draft gender policy was developed and shared with EngenderHealth HQ for their review and feedback.

A draft report on a study conducted by MH-II, called “Exploring menstrual bleeding among injectable contraceptive users and discontinuers,” was completed. The report was sent to EngenderHealth HQ for review after receiving the feedback the comments will be incorporated and the report submitted to USAID.

Challenges Faced by the ME&R Team: Data collection from DGHS facilities, private sector hospitals, and NGOs remains a key challenge. Additionally, data submitted by the NGOs and sub-awardees are often of poor quality (e.g., data is often inconsistent, transcription errors remain). To address these challenges, ME&R staff are providing hands-on coaching to the relevant sub-awardee staff on record keeping, accurately completing MH-II forms, and checking for errors prior to submitting their reports to MH-II.

PROGRAM MANAGEMENT

Staffing By the end of Q4, MH –II has 81 fulltime staff. Dr. Abu Jamil Faisel is the Project Direct lead on the project. The Technical Director position remained vacant for last 10 months. Out of the total staff, 57 are fulltime program staff and the remaining 24 were operations staff sharing their time with the FC+ project. Out of 57 program staffs seven Sr. QA & FPO Compliance Officers and seven Assistant Program Officer (Logistics) were posted out in the field and the remainder were based in Dhaka. There are no positions vacant or any recruitment pending at the end of this quarter. Joan Venghaus (currently working as the expat. Consultant to MH-II) has been selected as the Technical Director to the MH-II project and her recruitment formalities are in the process of being finalized. Finances During PY3 Q4, MH-II spent $1,349,158 against the accelerated WP budget of $$1,264,287. Q4 spending was about 7% higher the budget. Average monthly burn rate of the quarter was $449,719 which was about 8% higher than the required average monthly burn rate of the project. The project consistently maintained increased trend of burn rate for last two quarters and the trend is expected to be continued in coming quarters. Consistent higher burn rate of the MH-II indicates the project has successfully enhanced its capacity of higher resource mobilization. During the quarter, the project received fresh fund obligation of $5.9 million. This is the last obligation due from USAID. With the receipt of this obligation the project received full fund obligation to the award ceiling of $20.00 million. EH NY will submit quarterly financial report (SF425) to USAID in due course. Cost Share During PY3 Q4, MH-II collected $460,823 cost share against the budgeted target of $ $139,072. The cost share collection was 331% higher than the quarterly budgeted target. Accumulated cost share collection of MH-II stood at $ 4,564,042 against the MH-II required target of $2,222,222. Accumulated cost share collection is 205% higher than the required. Cash contributions, value of volunteer time, free office space workshop venue, corporate contribution to program, free FP logistics contributed by the DGFP, local and international sub-awards, MH-II vendors contributed the cost share collection. All cost share collections are adequately documented and reported to EH Master Tracker.

NEXT STEPS

From the next quarter MH-II will start the final project year. In Q1 of PY4 the project will give more emphasis on the following: • Capitalize on opportunities to promote LARC and PMs, especially PMs, by continuing and expanding upon the new approaches adopted by MH-II to date: NGO-supported

MSDTs by RTMI, NGO service provision, workplace interventions and community outreach, private facility service delivery, and support to DGHS facilities (particularly for PPFP) will be prioritized. • Coordinate the implementation of activities related to the National PPFP Action Plan developed with the GOB (DGFP, DGHS, and MOHFW) and NGOs and linking with the USAID-supported projects, MaMoni Health Systems Strengthening and NGO Health Service Delivery Project (NHSDP) (the largest USAID-funded NGO network in Bangladesh). • Emphasize will be on following -up all the interventions, particularly clinical follow up of all providers trained in LARC and PMs, PPFP, and injectable. During clinical follow up, on-site guidance and coaching will be given. • MH-II will implement comprehensive and coordinated SBCC activities for demand- generation and client mobilization, particularly in the DGHS, private sector, and NGO facilities during special days. for LARC and PMs • Expand the focus of PPFP activities beyond immediate PPFP to include the six weeks after deliver. • Strengthen the capacity of the providers to provide counseling on LARC and PM during all antenatal care (ANC), postnatal care (PNC), and immunization visits • Support NGOs to train male volunteers and organize community meetings for men. • Mainstream gender into all aspects of training, IEC/SBCC, and service delivery. • Collaborate with the MaMoni HSS project closely, in four districts (Habiganj, Lauxmipur, Noakhali, and Jhalakati) while implementing different MH–II activities.

Appendix 1: Activity Description and Achievements by IR

PY3/IR1 Workplan (October 1, 2015 –September 30, 2016) Activity Gantt Chart Achievements through Quarter 3

IR 1: Effective and High Quality FP Services Delivered Nationwide Partners/Collaboration RTMI, DGFP, NHSDP and selected Private Medical College Hospitals POC Khandoker Abu Jafor Md. Saleh and Mizanur Rahman Activity 1.1.1 INCREASE UPTAKE OF LARC & PM USING MOBILE SERVICE DELIVERY CARE TEAMS (MSDCT) This is an ongoing activity from the previous year Workplan. This activity is to support RTM to expand services of LARC and PM in the DGFP and NGO/private sector sites where there is no trained providers using its mobile service delivery care teams (MSDCT) covering PY1, PY2 and PY3 Districts Sub-IR1.1 Capacity of public- and private-sector service providers to provide LARCs, and PMs increased

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.1.1 a Support RTMI in development of X X X Quarterly Workplan of

quarterly Workplan RTM developed

Done in in Done Q1 Reviewed Done Reviewed

1.1.1 b Have quarterly program review ME&R Four (4) program review

meetings with RTMI meetings held

meeting meeting

1 meeting meeting 1 held meeting 5 held 1 held meetings 4 he

1 meeting 1 meeting 1 meeting 1 meeting 1

1.1.1c Conduct joint field visit with RTMI’s RTMI management 6 follow-up visits

management staff to monitor quality of staff conducted as mentioned in

1 visit 1 visit 1 2 visits 2

RTMI MSDCT field level activities, visits 2 the different quarters

and to coach the management staff to covering PY1, PY2 and FU visit FU

conduct monitoring visits PY3 Districts

2 FU 2 visit done FU 2 visit done 3 done up follow 6 done visits

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.1.1d Support RTMI to review and analyze ME&R will support X X X X Through quarterly ,

RTMI’s monthly and quarterly LARC, to analyze the program review meetings

751

performance report this support will be 2,494

PM and Injectable performances 585

–

provided. RTMI will be 1,

–

including those at NHSDP facilities 1,233

–

undertaking 3,750 special – days conducted in areas

where partner IUD , 0

organizations like BRAC, Vasectomy

, , Vasectomy

Shushilan, YPSA and ,

8,401, IUD IUD 8,401, 16,86

– – 941

BGMEA supported 1804

- activities are being carried - out including in the Districts of PY1 and PY2.

The mobile teams would Implant , . Female PM Female .

perform 73,143 LARC & PM Female .

1,851, Implant Implant 1,851, 2,982

–

PM and Injectable services –

926

1218

according to the following – –

estimation: NSV ,

Implant – 47,963 IUD ,

, IUD IUD ,

1,081, NSV 1,081, 2,446 -

IUD – 3,726 -

11877 8414

PM - Female PM – 8,564 -

568 1034

Male PM – 11,031 844

– – – –

Injectable – 1,860.

Implant Inj Implant Inj Female Inj PM Female Inj Quarter-wise Narrative Description of Activity

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Achievement: Task # 1.1.1 b: In this quarter one program review meeting was held with RTMI to discuss field visit findings, current challenges faced by RTMI, and budget reallocation. Task # 1.1.c: Three field visits conducted with RTMI staff at Manikganj, Khulna and Barisal. Based on field visit findings it has been decided that a joint program would be held in January in presence of all MSDCT members and MH–II Sr. QA & FP Compliance Officers. The purpose of the program is to build better coordination among the field staff of MSDCT and MH – II; to overcome the challenges faced to implement the program by MSDCT and to discuss on clinical monitoring, CTU, Infection Prevention, client mobilization from the community Task # 1.1.1d: The quarterly uptake of LARC & PM is mentioned below: Method Yearly Projection Achievements (Q1) Female sterilization 8,564 1,804 NSV 11,031 2,494 Implant 47,963 11,877 IUD 3,726 926 Total LARC/PMs 73,143 17,101 Injectable 1,860 765

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q2 Achievement Task # 1.1.1b: One joint meeting and refresher training was held on January 17-19, 2016 where all field & HQ staffs from RTMI and the Sr. QA & Compliance officers from MH - II were present. The aim of the meeting and the refresher training was to build collaboration and coordination between the Sr. QA & FP Compliance Officers and MSDCT from RTMI and to disseminate the latest updates related to Family Planning Contraceptives, Infection Prevention, ICV, Counseling and Medical Monitoring. The decisions were: involvement of the Sr. QA & FP Compliance officers to monitor the quality of the FP services provided by the MSDCT and to provide support in organizing the services; assist in BCC activities for client mobilization during special day.

- A follow-up meeting was held on February 15, 2016 to review the progress of the decisions taken during the joint meeting held in January. To address issues related to BCC activities a planning meeting was organized on March 22, 2016 where all the focal staff working on the demand generation s from MH - II, RTMI field and HQ staffs were present. The key action steps are: MSDCT from RTMI will work closely with the demand generation partners of MH – II to organize special days and client mobilization activities

- Special day services will concentrate on high and medium performing facilities with adequate attention towards local level BCC activities

- RTMI will design and carry out activities for client mobilization involving the GOB field staff in collaboration with local DDFP and UFPO

Task # 1.1.1c: Two visits were conducted to support the MSDCT. One visit was conducted by the Advisor of Service Delivery and Training Team and another visit was conducted jointly by the AOR of USAID and MH-II staff. Both the visits were to Sylhet division in January 2016. The findings showed that the paramedics from RTMI were performing well in providing IUD but the uptake for sterilization remains low. More collaboration with other organizations providing FP services NGOs (i.e. NHSDP, UPHCSDP) will help to increase the number of clients wanting a sterilization. Task # 1.1.1d: The quarterly uptake of LARC & PM is mentioned below.

Method Yearly Projection Achievements (Q1) Achievements (Q2) Female sterilization 8,564 1,804 941 NSV 11,031 2,494 1,751 Implant 47,963 11,877 8,414 IUD 3,726 926 1,218 Total LARC/PMs 73,143 17,101 12,324 Injectable 1,860 765 1,034

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q3 Achievement Task # 1.1.1a: Two meetings held (dated April 19 and May 22) during this quarter to review quarterly workplan as well as budget. The first meeting focused on to improve service quality and the second meeting focused on required supplementary activities and budget. Task # 1.1.1b: During Quarter 4 MH-II has strengthen its effort to increase the performance of MSDCT. Five meetings were held during this quarter of which three meetings were held with BCC partner NGOs to use their volunteers to mobilize clients during FP special days. It is expected that the performances of RTMI will be increased during the next quarter. Following table shows the quarter-wise performances of RTMI. Task # 1.1.1c: Table 1. Quarter-wise LARC and PM performances of RTMI Yearly Achievements Total FP Methods Projection Q1 Q2 Q3 Q4 (Q1+Q2+Q3+Q4)

Female sterilization 8,564 1,804 941 1,081 2,446

NSV 11,031 2,494 1,751 1,851 2,982

Implant 47,963 11,877 8,414 8,401 16,860

IUD 3,726 926 1,218 1,233 1,585 Total LARC/PMs 73,143 17,101 12,324 12,566 Injectable 1,860 765 1,034 844 448

In this quarter, the 13 paramedics employed by RTMI were followed up by MH-II trainers. Their knowledge and IUD insertion and removal skill were found as per standard. Q4 Achievement Task#1.1.1a: Based on the sub-award agreement RTMI developed their work plan up-to October 2016. During Q3 RTMI Workplan and budget were reviewed and revised. Based on a meeting decision held on May 22, 2016, a no-cost extension of the project was granted up to March 2016. During Q4 RTMI prepared a draft six months (October 2016 – March 2017) plan which is due to be finalized by October 2016. During Q4 four program review meetings were held with RTMI. The first meeting was held on July 14, 2016 to review the MSDCT service statistics and initiate additional activities to help increase their performance. The second meeting was held on July 24, 2016 where emphasis was on more follow-up visits being made by RTMI HQ Officials. During the follow-up visits officials arranged meetings with the district and Upazilla FP 20

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 managers to identify lack of service providers and plan service provision using the MSDCT. The last two meetings focused on the MSDCT next six months (October 2016 – March 2017) activity plan as well as a comprehensive plan to increase the LARC & PM performances. During Q4 MH-II program staff conducted joint field visits with RTMI’s management staff to monitor quality of RTMI MSDCT field level activities, and to coach the management staff to conduct monitoring visits. During this quarter six follow-up visits were conducted by RTMI management staff (Executive Director (ED), Project Coordinator (PC), Field Coordinator (FC)) and MH-II focal person to overseeing RTMI project activities. Out of six visits, one was a joint visit by the MH-II-point person for the sub-award, PC and FC. The Executive Director (ED) of RTMI visited Cox’s Bazar and met with the Deputy Commissioner (DC) and the DDFP and UFPO to extend support for effective organization of FP Special days to serve more LARC & PM clients. One joint visit took place in Sylhet district to build client mobilization linkages with SHIMANTIK project working in the urban areas. The performance for LARC & PM through MSDCT and hired surgeons from RTMI for this quarter (Q4) is mentioned below Based on sub-award agreement RTMI developed their Workplan up-to October 2016. During Q3 RTMI Workplan and budget were reviewed and revised. Based on a meeting decision held on May 22, 2016, a no-cost extension of the project was granted up to March 2016. During Q4 RTMI prepared a draft six months (October 2016 – March 2017) plan which is due to be finalized by October 2016. Task# 1.1.1c: During Q4 conducted joint field visits with RTMI’s management staff to monitor quality of RTMI MSDCT field level activities, and to coach the management staff to conduct monitoring6 visits. During this quarter six follow-up visits were conducted by RTMI management staff (Executive Director (ED), Project Coordinator (PC), Field Coordinator (FC)) and MH-II focal person to overseeing RTMI project activities. Out of six visits, one was a joint visit by the MH-II focal person, PC and FC. The RTMI ED met with the Upazilla and district administrative authority along with the DDFP and UFPO to organize FP Special day to serve more LARC & PM clients during his visit to Cox’s Bazar. The joint visit took place in Sylhet district to build client mobilization linkages with other project working in the urban n areas. Task# 1.1.1d: The performance for LARC & PM through MSDCT and hired surgeons from RTMI for this quarter (Q4) is mentioned below Table 1: Performance of LARC & PM through MSDCT and hired surgeons of RTMI in Q4 by type of methods Yearly Achievements Total FP Methods Projection Q1 Q2 Q3 Q4 (Q1+Q2+Q3+Q4) Female sterilization 8,564 1,804 941 1081 2,446 6,272 NSV 11,031 2,494 1,751 1851 2,982 9,078 Implant 47,963 11,877 8,414 8401 16,860 45,552

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 IUD 3,726 926 1,218 1,233 1,585 4,962 Total LARC/PMs 71,284 17,101 12,324 12,566 23,876 65,864 Injectable 1,860 765 1,034 844 448 3,091

Additional activities:

- One MSDCT staff meeting was held on August 14, 2016 to develop a six months’ plan. The meeting focused on the client mobilization activities and discussed how to overcome the challenges faced in the previous quarter. Orientation sessions were conducted in two batches for 57 volunteers from SHIMANTIK working in Sylhet Municipal areas on August 27 and 28, 2016. The volunteers 54 Female and 3 Male. The oriented was on effective communication with potential Family Planning clients.

Activity 1.1.2 STRENGTHENING POSTPARTUM FAMILY PLANNING (PPFP) This activity is for expansion of PPFP services with emphasis on scale up of national PPFP action plan, strengthen follow-up Partners/Collaboration DGHS, DGFPOGSB, UNFPA, NHSDP, Marie Stopes and other NGOs, EngenderHealth Global Clinical Support Team

Person of contact Dr. Sharmin Jahan and Fatema Shabnam

1.1.2a Conduct joint follow-up visits with ME&R will support All 160 PPFP facilities in

DGFP (CCSDP and FPCST officials) to identify low PY1 and PY2 were and/or DGHS supervisory staff at followed-up as mentioned

performing facilities

up visits up visits up visits up visits up

- - - -

PPFP service delivery sites where in the different quarters.

PPFP services initiated during PY1 & Besides these all sites will

26 facilities 26

PY2 using structured checklist to be followed-up over -

strengthen their capacity. telephone at least two

52 follow 52 follow 50 follow 28 follow 30

other times.

onsitevisits 31 onsite visits done visits onsite 31

38 onsite 12 visits telephone telephone facilities 10 site on

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.1.2b Develop an implementation X An implementation plan

checklist/follow-up card with PPFP and checklist/follow-up

messages to be used during counseling card with PPFP messages in all ANC and PNC visits and with developed and finalized

Immunization services

Done being being Done

implements

& reviewing &reviewing

started to use to started

Developed and and Developed

Preparatory phage Preparatory

Way of development development Wayof

1.1.2.c Support IR3 team to issue a joint IR3 team will take X A circular jointly signed

circular signed by DGHS and DGFP to lead for the issuance by DGHS and DGFP integrate PPFP counseling during all of the joint circular issued

ANC and PNC visit and with issued

Circular Circular

Completed Inprogress Immunization services in Q2 Done

1.1.2d Review follow-up cards (mentioned in X X X PPFP follow-up cards

1,1.2b) during FU and QA & FP reviewed during FU and

Compliance visits to see quality of QA & FP Compliance PPFP counseling conducted during visits in the PY1, PY2 and ANC, PNC check-ups and PY3 Districts.

Immunization services started Not

not yet started notyet

Not yet started yet Not FU of the activity activity of the FU

1.1.2e Print PPFP participants handbook for X 2000 copies of PPFP

the providers involved with PPFP Participant books provided

services which includes 1000 requested from CCSDP, DGFP t and 1000 copies to

be used by MH - II for

Done Q1 Q1 Done Q1 Done

training of providers from in Q1 Done NGO/private and USAID implementing partners. printed copies 2000

facilitate clinical orientation on PPFP received clinical

in all the potential public facilities of orientation on PPFP

PY3 districts

73 291 361 37 1.1.2g Conduct clinical training on immediate IR 2 will support X X X X Out of 450 service Postpartum IUD in selected public BCC activities in providers as mentioned

facilities of PY1, PY2 and PY3 these facilities above 160 received

districts. clinical training on PPIUD

26 76 09 07 1.1.2i Monitor and analyze the performances ME&R will provide X X X X 15,010 immediate PPIUD

of immediate PPFP of supported sites support to compile and PPBTL performed

(districts of PY1, PY2, PY3) and analyze the

PP BTL – 11,844

performance report PP IUD – 3,166

4,008

754 657 1,481

891 2968

4,726

- - –

1,527

– – – - Immediate PPFP - performances monitored

and analyzed

PPBTL PPBTL PPIUD PPBTL PPIUD PPBTL PPIUD PPBTL PPIUD Quarter-wise Narrative Description of Activity Q1 Achievement Task # 1.2.1a: ▪ Onsite follow up visit completed 10 facilities under PY1 and PY2 districts. Most of the facilities are performing female sterilization with C-section but less in IUD with C-section or normal delivery. ▪ 26 point persons at different facilities have been reached by telephone to understand the situation of their PPFP service provision using a structured checklist. Task # 1.2.1b: A job aid has been drafted with PPFP messages for counseling in all ANC and PNC visits and with immunization services. Task # 1.2.1e: 2000 copies of PPFP participants’ handbook sent for printing. Task # 1.1.2f: 73 service providers and facility managers received clinical orientation on PPFP at Rangamati & Manikganj districts. Task # 1.1.2g:

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 ▪ 26 service providers received clinical training on PPIUD and the participants were from Rangamati (15) and from Natore (11) ▪ PPFP services have been initiated in nine new facilities in this quarter.

Q2 Achievement Task # 1.2.1a: Onsite follow up visit completed in 38 facilities under PY1 and PY2 districts. Most of the facilities are performing female sterilization with C- section but less IUD are being inserted after normal delivery. Task # 1.2.1c: Integrate PPFP counseling during all ANC and PNC visit and Immunization services has been approved in the 65th NTC held on 02 December 2015 and a circular jointly signed by the Director General of DGFP and the Director General of DGHS was issued on the 16th March 2016. This circular states that the oral pill, Injectable and condom will be made available at all EPI centers. Task # 1.2.1b &1.2.1d: A job aid with key messages on PPFP has been developed for providers to use during client counselling for ANC, delivery at home and at health facility, PNC, during immunization visits and after abortion. This is now under final review by USAID/Dhaka. After receiving clearance from the USAID this will be printed and distributed. Task # 1.2.1e: 2000 copies of PPFP participants’ handbook has been printed and 1000 copies handed over to DGFP to be used for conducting PPFP training. From the 18 PY3 districts PPFP has been initiated in 8 districts during this quarter. The districts are Tangail, Rajbari, Faridpur, Feni, Khagrachari, Munshiganj, Narshingdi, and Netrokona. Task # 1.2.1f: Clinical orientations on PPFP for the service providers and facility managers was organized in 18t facilities, 291 participants attended. The facilities are MCWCs (8), District Hospitals (8), Medical College Hospital (1) and Upazilla Health Complex (1) and these facilities are located in 9 districts (Tangail Faridpur, Feni, Khagrachari, Munshiganj, Narshingdi, Rajbari, Netrokona, Gazipur) Task # 1.2.1g: A total of 76 different categories of service providers from the public and NGO sector received trainings on PPIUD. Public: 42 providers from Tangail and Faridpur NGO: 34 providers from different facilities under NHSDP (Sylhet, Chittagong and Rajshahi) Task # 1.2.1i: PPFP performances based on DGFP, MIS Method Yearly Projection Achievements (Q1) Achievements (Q2) PP BTL 11,844 2310 2968 PP IUD 3,166 462 657 Total 15,010 2772 3625

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

▪ 4 Mama U models and 4 Kelly Forceps distributed to the 4 DGFP regional training centers (Dhaka, Rangpur and Rajshahi) for use in demonstration of IUD insertion within 48 hours after delivery

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q3 Achievement Activity 1.1.2: Strengthening postpartum family planning (PPFP) Task # 1.2.1a: Onsite follow up visits of 12 PPFP facilities of PY1 and PY2 districts found that all of them are performing female sterilizations during Cesarean sections (C-sections) but, the number of IUD insertions are very low. PPFP performance review shows that it is increasing gradually. Following table shows the quarter-wise performances of PPFP up to quarter 3. Table 2. Quarter-wise performances of PPFP in MH-II working areas (DGFP MIS)

Yearly Achievement Total PPFP Method (Q1 +Q2 + Q3 + Q4) Projection Q1 Q2 Q3 Q4 PP BTL 11,844 2,310 2,968 4,008 9,286 PP IUD 3,166 462 657 1,481 2,600 Total 15,010 2,772 3,625 5,489 11,886 Task # 1.2.1b: During this quarter MH-II organized Field workers’ orientation in the Sadar Upazillas of six districts on use of the counseling job aid with key messages on PPFP to be used during ANC, PNC, and immunization visits. A total of 1,118 workers (628 from the DGHS and 570 from the DGFP) were oriented on the job-aid. Task # 1.2.1c: The circular issued during Q2, in this quarter MH –II distributed the circulars to different programs.

Task # 1.2.1e: Two policy amendments have been prepared based on PPFP policies and a letter has been sent to the LD, CCSDP to request that these changes are included in the Participants’ Handbook on PPFP. Task # 1.2.1f: During this quarter, clinical orientations on PPFP was organized in 10 facilities for service providers and facility managers. 361 participants (including doctors, nurses, FWVs, and administrative staff) attended the orientation session. A total of nine service providers (including doctors, nurses, and paramedics) from NGO Health Service Delivery Project (NHSDP) clinics received hands-on PPIUD training.

Q4 Achievement Task# 1.2.1a: Onsite follow up visits were completed in 31 facilities from PY1, PY2 & PY3 districts. All the facilities are performing female sterilization with C-section but not many IUD are being inserted after normal delivery and cesarean section (CS) Task# 1.2.1c: The circular issued on Q2, in this quarter MH –II distributed the circulars to the and convey the messages through different programs.

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task# 1.2.1e: An amendment has been prepared based on two changed policies on PPFP and sent a letter to LD, CCSDP to include this in the Participants’ Handbook on PPFP. Changed policies are: 1) Implant can be provided to clients immediately after delivery of a baby irrespective of parity of that particular woman; 2) Progesterone only pill (POP) can be provided to clients immediately after delivery of a baby irrespective of parity of that particular woman Task# 1.2.1f: In this quarter clinical orientations on PPFP for the service providers and facility managers was organized in 09 facilities MCWCs (2) and District Hospitals (1), NGO (6)} and these facilities are located in 7 districts (Barisal, Barguna, Jessore, Satkhira, Jhenaidah, Kushtia, Meherpur). Out of 18 PY3 districts, facilities having high number of deliveries of 2 districts have been reached through this events. 37 participants attended in these programs. Task# 1.1.2f: 1 doctor and 6 service Paramedics from NHSDP received training on PPIUD in Jessore. Task# 1.1.2f: see below Table 2. PPFP performance by method (DGFP MIS)

PPFP Yearly Achievement Total (Q1 +Q2 + Q3 + Q4) Method Projection Q1 Q2 Q3 Q4 PPBTL 11,844 2,310 2,968 4,008 4,726 14,012 PPIUD 3,166 462 657 1,481 1,527 4,127 Total 15,010 2,772 3,625 5,489 6,253 18,139

Activity 1.1.3 ADDRESSING USE OF FAMILY PLANNING METHODS WITH POST ABORTION CARE (PAC)/POST-MR SERVICES This activity is a continuation of PY2 with adding few components. Partners/Collaboration DGHS, DGFP, EngenderHealth Global Clinical Support Team Person of contact Dr. Shamima Parveen

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.1.3a Identify PAC/MR service providers X X Identified 40 PAC/MR who need LARC & PM training and service providers through organize need based training of the FU visits, training and providers through OGSB RH & FP orientation on PPFP in the

training center or DGFP training center PY1, PY2, and PY3

service service

providers from from providers

Districts, received new service

training on LARC & PM

86 service service 86 oriented providers 67 oriented providers 118 oriented providers 15 MCWCs 2

1.1.3b Conduct follow-up of all of the X X All 40 providers followed

providers trained as above. up through physical FU

visits or over telephone

Not started activity started Not FUfacilities 5 FUfacilities 0 FU 13 facilities facilities 13 FU

1.1.3c Monitor and analyze family planning ME&R will provide X X X X 1,000 LARC and PMs

- -

services with post abortion/MR support to compile provided by the 40 17 -

services of the trained 40 providers and analyze the providers during PAC/post LARC

LARC LARC

28, pill 28,

performance report MR services. MH – II does -

19, and 19, and

not collect MR statistics.

37 37

- 129)

Not started started Not activity FP (81) (81) FP (15) FP(360)LARC inj 138, condom 187, FP ( FP implant IUD Quarter-wise Narrative Description of Activity Q1 Achievement Task# 1.1.3a: ▪ 36 participants oriented on using of PAC during IUD training ▪ 50 participants oriented on PAC during PPFP training

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q2 Achievement ▪ MH – II has been implementing this activity focusing on the MCWCs with emphasis on FP counseling and the use of FP after abortion/MR. There is no separate reporting column for uptake of FP methods after MR in the DGFP MIS reporting format. MH – II will collect this information from the MCWCs where the activity would be initiated. Task # 1.1.3a: A detailed orientation on “use of FP with PAC and after MR” has been organized at 5 MCWCs: Tangail, Khagrachari & Feni (February 2016), Faridpur & Rajbari (March 2016) where 67 providers attended. Task # 1.1.3c: Report received from the 5 MCWCs showed 125 women came for MR services and 81 received a FP method post abortion. These are - Pill (41), Condom (22), Injectable (3), Implant (3) and IUD (12). As per providers’ opinion, some of the clients didn’t receive methods from the facility due to – (1) not decided at this moment (2) need to discus with their husband specially for LARC (3) planned to visit within 7 days but not came. Another group of women came for abortion and use MM Kit (Medical Abortion) from MCWC. They take one medicine at MCWC and another 4 medicine at home after 12 hours. So they don’t come for any method. Q3 Achievement Task # 1.1.3a: During the quarter MH-II organized orientation on use of FP during postabotion care (PAC) and after MR for 118 providers from six MCWCs. Task # 1.1.3c: Reports received from these six MCWCs showed that out of 200 women who received MR services only 124 chose to adopt a FP method (pill-50, condom-16, injectable-7, implant-19, and IUD-37). Major reasons for the 66 clients not choosing a FP method included: client not being able to decide at that moment, need to discuss the decision with their husband (especially for LARC methods), and their failure to visit the clinic within seven days as planned for follow up. Q4 Achievement Activity 1.1.3: Addressing use of family planning methods with post abortion care (PAC)/Post-MR services Task 1.1.3a: A detailed orientation on the use of FP with PAC and after MR were organized at 2 MCWCs: Barguna and Barisal (Sep 2016) where 15 providers attended the orientation sessions. Task 1.1.3c: Report received from the 13 MCWCs showed 460 women came for PAC and MR services and 360 received a FP method with MR services. Pill (187), Condom (07), Injectable (28), Implant (39) and IUD (97), Tubectomy (1), NSV (1). Activity 1.1.4 STRENGTHEN LARC & PM AND INJECTABLE SERVICES IN THE URBAN AREAS This activity is to strengthen LARC and PM in Dhaka City through collaboration with the PNGOs of UPHCSDP, and strengthening/initiating LARC & PM in selected private facilities with DGFP and SMC logistic support. Second component of this

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 activity is to work with some selected Pourashavas through collaboration with the Municipal Association of Bangladesh (MAB) for strengthening LARC and PM. Partners/Collaboration RTM, UPHCSDP, partner NGOs (PNGOs) of Urban Primary Health Care Service Delivery Project (UPHCSDP), Dhaka City Corporation, OGSB, MAB, selected Pourashavas Person of contact Khandoker Abu Jafor Mohammad Saleh and Dr. Murshida Rahman 1.1.4a. Organize special days at the PNGOs of IR 2 will provide X X X X 50 special days organized

UPHCSDP under Dhaka City support for demand and 3000 LARC & PM

Corporation to increase uptake of generation and performed LARC, PM and Injectable services of client mobilization Implant – 1588 the facilities and adjoining slums around the facilities IUD – 618 and nearby slums

Female PM – 176 postponed ME&R will provide Male PM - 618 support & conduct

DQA visit

Activity postponed Activity postponed Activity Activity postponed Activity

1.1.4b Organize special days at identified IR 3 will collaborate X X X 24 special days organized

pure private 10 health facilities in with DGFP and at 10 private facilities in

Dhaka having DGFP logistics and private sites for Dhaka and 500 LARC & lant

imprest fund support meant for availability of PM performed NSV) 4

50 ) poor/ultra-poor population living in the DGFP logistics and Imp 35

Implant – 610 ( slums. imprest fund support IUD – 121 Female PM – 34

Male PM - 34

47 S. days ( S. 47 days & Implant Not yet started yet Not days S. 13 &NSV 148 Implant (487 days S. 47 &NSV) 204

1.1.4c Collaborate with SMC to support X X X 20 selected facilities selected private health facilities/ started providing LARC &

providers trained through non-MIH Injectable services using

project to initiate LARC and Injectable SMC commodities services using SMC commodities in

Dhaka facilities

Not yet yet Not started 6 6 to work started facilities 20 to work started facilities 24 starting working

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.1.4d Collaborate with IR3 team and IR 3 team will X X 24 special days organized Municipal Association of Bangladesh collaborate with and 500 LARC &PM and (MAB) through an MOU with this MAB to select the Injectable services entity and DGFP to organize special four (4) provided days to provide LARC & PM services Pourashavas, and Implant – 300

using DGFP logistics and imprest fund will also collaborate IUD – 50 in 4 Pourashavas in PY3 Districts to with CCSDP to

test service delivery methodologies in obtain approval for Female PM – 10

the urban areas. getting logistic and Male PM – 10 Imprest fund Injectable - 130 through the local

DGFP Managers

IR 2 team will poned

support for demand t generation/BCC activities in the selected

Pourashavas

Would be start next quarter next start be Would On the way to start to work with MAB with to work start to the way On continued be not would activity The pos Activity 1.1.4e Monitor/track and analyze LARC, PM ME&R will provide X X X Special day performances

and injectable performances of the support for data through PNGOs and

supported facilities analysis private facilities monitored

and analyzed

Performances Performances Monitored Performances Monitored Performances Monitored Performance monitored Quarter-wise Narrative Description of Activity Q1 Achievement Task # 1.1.4d: MH-II signed an MOU with Municipality Association of Bangladesh (MAB) to provide LARC & PM including injectable services through their existing facilities. IR 1 in collaboration with IR3 conducted need assessment in five Pourashavas. These are Sadar, Bera & Ishaawrdi of Pabna, Singra of Natore and Kaliakoir of Gazipur districts.

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q2 Achievement Task # 1.1.4a: The assigned activity was postponed because of the cancelation of the MOU by the UPHCSDP. MH–II has planned an alternate way to reach the urban population by providing a sub-grant to a local NGO, PSTC to work in the urban areas in 11 districts (Dhaka, Narayanganj, Gazipur, Mymensingh, Jamalpur, Sylhet, Barisal, Jessore, Bagerhat, Rajshahi and Rangpur) through using volunteers. A resource pool was developed to orient and monitor the volunteers. IR1 team facilitated the training in collaboration with IR 2 team. The performances of the volunteers are covered in the activity # 2.3.5a Task # 1.1.4b: IR 1 & IR 3 team of MH–II in collaboration with DGFP has started to organize special days at private facilities in Dhaka. In this quarter 13 special days were organized in Dhaka.183 clients received the services. (35 implants and 148 NSV.) The service providers working at the DGFP performed the cases. Task # 1.1.4c: MH-II established strategic partnerships with private hospitals and/or clinics to provide FP services using SMC commodities. A letter of agreement was signed with 15 private health facilities. 6 out of 15 facilities have started offering service from March 2016. The facilities are involving the Reproductive Health Service Promotion Officers (RHSPO) to generate clients. IR1 staff in collaboration with IR2 organized a three-day training on FP, Communication and Counseling for the RHSPOs. The performances of the facilities are mentioned in the activity # 2.1.2a above Task # 1.1.4d: The executive body of the Municipal Association of Bangladesh (MAB) has been changed after the elections. In collaboration with IR3 team, a startup meeting was organized to sensitize and orient the new MAB members on FP. (link activity # 3.1.3d) ▪ Accelerated Activity: In collaboration with SMC, 73 doctors working in the private sector received training on LARC and Injectable in this quarter. MH – II will start to follow up them over phone. SMC has taken the responsibility to collect their performances. Q3 Achievement Task # 1.1.4a: MH–II began collaboration with the Population Services and Training Center (PSTC) to use their volunteers in 15 urban areas in 11 districts (Dhaka, Narayanganj, Gazipur, Mymensingh, Jamalpur, Sylhet, Barisal, Jessore, Bagerhat, Rajshahi, and Rangpur) for community demand creation for LARC and PM and refer clients to different facilities and the special day services. The performances of the volunteers are covered in the activity # 2.3.5a Task # 1.1.4b: In Dhaka MH-II in collaboration with the DGFP organized 47 special FP days at private facilities using hired surgeons. A total of 691 clients received LARC & PM (204 implants and 487 NSVs). Task # 1.1.4c: MH-II established strategic partnerships with 20 private hospitals and/or clinics to provide FP services using Social Marketing Company (SMC) commodities. In this quarter, a letter of collaboration was signed with five new private health facilities, all 20 facilities are now on board. Each facility involved engages Reproductive Health Service Promotion Officers (RHSPOs) to generate clients. Performance by facility for this activity can be found under Activity #2.1.2a. Task # 1.1.4d: A meeting was held with representatives from the newly developed executive body of the Municipal Association of Bangladesh (MAB) on 05 June 2016. To involve their staff in helping to streamline LARC and PM in the Urban areas. However, after the discussion it was agreed not to develop any project activity with them considering that there is only a short time left in the project and it would be difficult to get substantial results from working in collaboration MAB. (This is a link activity # 3.1.3d)

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Accelerated Activity: In collaboration with SMC, 52 doctors working in the private sector received training on LARC and Injectable in this quarter. Q4 Achievement Task# 1.1.4a: As mentioned in Q2 and Q3 quarterly progress report that the activity has been postponed due to cancellation of MOU by the UPHCSDP. MH–II has been continuing collaboration with PSTC to work in selected districts (Dhaka, Narayanganj, Gazipur, Mymensingh, Jamalpur, Sylhet, Barisal) for FP client referrals through its volunteers. The performances of the volunteers are covered in the activity # 2.3.5a Task# 1.1.4b: IRI in collaboration with the DGFP has organized special days at private facilities in Dhaka. In this quarter 47 special days were organized in Dhaka where 603 clients received LARC and PM services which include 504 NSV Institute of Reproductive and Child Health and 99 Implants. The DGFP service providers were use as hired surgeon for providing services. Task# 1.1.4c: MH-II has planned to establish strategic partnerships with 20 private hospitals and/or clinics to provide FP services using SMC commodities. Service delivery and training team of MH-II is providing support for training of the Reproductive Health Service Promotion Officers (RHSPOs) working in the MH-II supported sites The performances of the facilities are mentioned in the activity # 2.1.2a Activity 1.1.5 STRENGTHEN LARC & PM AND INJECTABLE SERVICES IN THE BGMEA CLINICS/WORKPLACES This activity is to strengthen LARC and PM in Dhaka City through collaboration with the BGMEA, NHSDP and PNGOs of UPHCSDP, and strengthening/initiating LARC & PM in selected private facilities with DGFP and SMC logistic support. Second component of this activity is to work with some selected Pourashavas through collaboration with the Municipal association of Bangladesh (MAB) for strengthening LARC and PM Partners/Collaboration BGMEA, NHSDP, UPHCSDP, Meridian Group International Person of contact Dr. Sayeeda Akhter Banu 1.1.5a Provide basic/refresher training/ hands X X 16 providers received

on coaching to selected BGMEA training/refresher

providers on Implant and Injectable training/hands on coaching

on Implant and Injectable training

No training training No planned No No planned training No planned

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.1.5b Provide support to organize special Special days will be

organized in

days in BGMEA clinics, and other GOB/NGOs clinics around factory collaboration with IR 2 team sites in Dhaka. The providers are paid

by respective organizations and not by special days special

MH – II.

20 special days special 20 10 special days special 10 26

15 special days special 15 days special 20 days special 20 days special 20 1.1.5c Monitor/track and analyze special day ME&R will provide X X X X 1125 LARC & Injectable support to analyze performed. performances of BGMEA clinics, and other GOB/NGOs clinics around the performances Implant – 344

factories in Dhaka and Chittagong. IUD – 46

2131, 2131,

1,759, 1,759,

Injectable - 735

–

– 2,890

Special days performance 4727

Pill Pill

- –

, , ,

monitored and analyzed ,

455 646

473

– –

–

Inj 4074 condom pills1,486, 2015) &Nov. (Oct Inj Condom

Inj Condom

1.1.5d Support Business for Social This activity will be X X FP integrated in the Responsibilities (BSR)/Change organized in curriculum used by Associate on Family planning issues collaboration with BSR/Change Associate including training and service delivery. IR 3 team and their trainers/peer

MH – II will provide technical support educators received

to update their curriculum related with orientation on family of BSR of FP issues and orient their trainers so planning methods to reach that they can deliver the correct out new garment factories

messages supported by BSR.

Not yet started started yet Not FP part reviewed Curriculum Q2 in Done Quarter-wise Narrative Description of Activity Q1 Achievement: Task #1.1.5b: 10 special days where organized in different BGMEA clinics.

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 1.1.5c: The BGMEA clinics served 1,486 clients who received 1 cycle of the pill and 4,074 clients received 6 pieces of condom each and 455 clients received injectable. (the performance includes the 10 special days at different garment factories) Task # 1.1.5d: Business in Social Responsibilities (BSR)/Change Associate are working at the RMG factories on health & Hygiene issues. MH-II is working with BSR to incorporate FP in their curricula. MH-II signed an MOU with BSR. A planning meeting was organized with BSR to establish collaboration. IR1 team will review the existing curriculum used by BSR and incorporate all the updated information based on WHO recommendation. Q2 Achievement Task # 1.1.5b: 26 special days where organized in different garment factories. The service providers from the BGMEA clinics organized these special days.

Task # 1.1.5c: During the period January – February 2016 the FP Performance at the BGMEA clinics (5) and including special days Quarters Pill Condom Injectable Implant Q2 (Jan – March) 2131 4727 646

Both these tasks are linked with the activity # 2.1.3f Task # 1.1.5d: IR1 Team has been working in collaboration with team 3 in reviewed the existing curriculum used by BSR related to Family Planning and Maternal Health. Basic information related to all FP methods has been included. FP has been included in the maternal health section as well. A training has been planned for the trainers of BSR in the first half of April 2016. This activity is linked with activity # 3.1.5d. BSR works with three NGOs namely Awaz Foundation, Change Associates and Mamata in different garments industries.

Q3 Achievement Task # 1.1.5b & Task # 1.1.5c: During this quarter 20 special FP days were organized in the garment factories by the service providers of BGMEA clinics. Quarter- wise results from this activity are presented in Table 3. Tasks associated with this activity are linked to Activity #2.1.3f. from the Table 3. Quarter-wise performances of the special days organized by the BGMEA clinics Yearly Performance FP Methods Total Remarks Projection Q1 Q2 Q3 Q4 Pill - 1,486 2,131 1,759 5,376 Condom - 4,074 4,727 2,890 11,691 Injectable 735 455 646 473 1,574 Implant 344 - - - IUD 46 - - - NSV 0 0 0 0 Tubectomy 0 0 0 0

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Task # 1.1.5d: IR1 team in collaboration with IR3 team reviewed and updated the existing curriculum used by BSR related to Family Planning and Maternal Health. Based on the findings the team organized a two-day TOT for the BSR trainers. The objective of the workshop was to train the trainers to disseminate messages on FP when training the peer educators from the RMG. This activity is linked with activity # 3.1.5d.

Q4 Achievement Task # 1.1.5b: During July – August, 2016 12 special days organized at different garment factories. The service providers from the BGMEA clinics organized these special days. Performances of special day in different garments factories: Inj.- 220; Implant-14; IUD-3; Condom -466 pcs; Pill -512. Task # 1.1.5c: During the period (July – August, 2016) FP Performance of special days organized by BGMEA are as follows: Pill -662; Condom – 2,076 pcs; Inj -267. (Both these tasks are linked with the activity # 2.1.3f)

Yearly Performance FP methods Total Remarks Projection Q1 Q2 Q3 Q4 Pill 1,486 2,131 1,759 662 6,038 Condom 4,074 4,727 2,890 2,076 13,767 Injectable 735 455 646 473 267 1,841 Implant 344 0 0 0 0 0 IUD 46 0 0 0 0 0 NSV Tubectomy

Activity 1.1.6 STRENGTHENING IUD SERVICES This activity is for implementation of the policy decision for providing IUD by the female SACMOs that was ere approved by the National Technical Committee (NTC) during PY2. This is continuation of the activity initiated during PY2 adding new initiate to boost-up IUD services Partners/Collaboration DGFP, UNFPA Person of contact Dr. Rushan Afroze and Dr. Shamima Parveen

Sub-Assistant Community Medical PY2 - 87 SACMOs Officers (SACMO)s and Family

PY3 – 32 FWVs

Welfare Visitors (FWVs) received

refresher training (during PY2 & PY3)

on IUD using structured checklist

providers followed followed providers

41 FWVs 41 87 phone over up followed providers 54 site on up done up follow No 1.1.6b Support trained FWVs, and female X X X X 80 special days organized,

SACMOs to organize special days on and 800 IUD performed

IUD to expand access to quality IUD

services

training

359 IUD performed training performed receiving after IUD 359 receiving performed after IUD 448 training receiving performed after IUD 359 13 special days (88 IUD performed) IUD (88 days special 13 provided IUDs 365

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.1.6c Support DGFP and conduct refresher X X 32 FWVs received

training for the newly recruited FWVs refresher training working in MNHI districts including counseling, side (PY1/PY2/PY3) including counseling effect and complication

and side effect management. management

35 FWVs 35 planned training No received providers 46 orientation Clinical during done training No quarter this

1.1.6d Monitor and analyze IUD ME &R will support X X X X IUD performances of

performances of trained female to monitor the trained female SACMOs, SACMOs and FWVs trained performances and FWVs monitored and

analyzed

erformances erformances erformances

P monitored monitored P monitored P monitored Performance monitored Quarter-wise Narrative Description of Activity Q1 Achievement Task # 1.1.6 a: 41 FWVs working at different Upazillas of Chittagong who received training in PY2 received followed up this quarter. Follow up occurred at facility level. 88 IUD clients accepted IUD and another 33 clients rejected mostly due to cervicitis, pregnancy, cervical erosion. The clients who rejected were advised for another contraceptive as per their choice. Task # 1.1.6c: 35 FWVs from different Upazillas of Jamalpur districts received refresher training on IUD.

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q2 Achievement Task # 1.1.6a: As a part of training 63 FWVs and 24 female SACMOs received training on IUD during PY2 and they were followed up over phone. The FWVs are performing but female SACMOs are infrequent performers. The reasons are: FWVs are the key person for IUD service delivery for the particular facility (FWC); FWV is known as the IUD provider in the community; female SACMO get chance to insert IUD whenever FWV is unavailable at the facility. Considering all of these issues IUD training for the female SACMOs have not been initiated in other districts. Task # 1.1.6d: Performances of IUD services (received through text message using mobile phones that was demonstrated to the female SACMOs and newly recruited FWVs during training). Below is their performance from January –March 2016

# Providers Districts # IUD inserted Period Received training # providers sent messages Chittagong (FWV) 24 out of 41 218 Jan – March 2016 Sunamganj (FWV) 11 out of 22 102 Jan – March 2016 Bogra (SACMO) 12 out of 24 39 Jan – March 2016 Total 359

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q3 Achievement Task # 1.1.6a: During the quarter all 54 FWVs who received refresher training on IUD in PY2 & PY3 were followed up. During follow-up providers’ knowledge level was found to be good but in some cases some skill gaps were identified. MH-II staff on-the-job coaching to those FWVs having problems with the skill. Task # 1.1.6b: IUD Performances of FWVs and female Sub-Assistant Community Medical Officers (SACMOs) trained by MH-II were monitored directly through text message sent to MH-II using their mobile phones. Below is the performance of those trained providers during April-May 2016: Table 4. IUD performances of FWVs and female SACMOs during Quarter 3 # Providers # IUDs Districts Received # providers sent Period inserted training messages Chittagong FWVs 33 out of 41 243 April – June 2016 Sunamganj FWVs 17 out of 22 133 April – June 2016 Bogra SACMOs 20 out of 24 72 April – June 2016 Total 70 out of 87 448 Task # 1.1.6c: During the quarter MH-II organized clinical orientation on IUD focusing on counseling, complication management and insertion and removal technique of IUD for 46 FWVs working at different Upazillas of Sunamganj.

Q4 Achievement Task # 1.1.6d: During PY2 and PY3 87 Family Welfare Visitors (FWVs) and female Sub-Assistant Community Medical Officers (SCAMOs) were trained by MH-II clinical program staff. Currently MH-II is monitoring the IUD performances of the FWVs and female SACMOs through text messages using mobile phones that was demonstrated to the female SACMOs and newly recruited FWVs during training. Some of the participants of Chittagong and Sunamganj district were engaged in Midwifery and EOC training that is why they were unable to perform IUD.Below is the performance of the trained providers from June- Sep, 2016. Table 3: IUD Performances of trained FWVs and female SACMOs in Q4

# Providers Districts Received training # providers sent # IUD inserted messages Chittagong FWVs 29 out of 41 189 Sunamganj FWVs 16 out of 22 109 Bogra Female SACMOs 21 out of 24 67

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Total 66 out of 87 365

Activity 1.1. 7 STRENGTHENING INJECTABLE SERVICES This activity is for implementation of the policy decision that was approved by the National Technical Committee (NTC) during PY2. This include implementation of policy decision for injectable training for the CSBA, FWAs and CHCPs in selected districts (Dhaka, B. Baria and Cox’s Bazar) and follow up services at BGMEA clinics Partners/Collaboration DGFP, DGHS, BGMEA, BRAC, Person of contact Dr. Ifterkhar Alam and Sayed Anowar Hossain

1.1.7a Support DGFP and organize TOT on X X 75 DGFP trainers received

injectable for the local trainers of TOT on Injectable DGHS & DGFP using GOB

curriculum for 3 districts (B. Baria, personnel personnel

Cox’s Bazar, and Dhaka) according to

a decision of NTC

32 TOT received personnel 31 TOT received in Q2 Done and in Q1 Done Q2 1.1.7b Support DGFP during cascade training X X X 1700 providers (CSBA of CSBA trained FWAs and CHCPs trained FWAs, new FWAs on Injectable involving the DGHS & and CHCPs) received DGFP trainers training on Injectable trained by the 75 DGFP Trainers

Expected to provide:

Total doses - 1,295,353 providers received received providers

1 dose - 14,503 by CSBA

received Providers 762 training received Providers 667 training training in completed was Training Q3 trained FWAs 556

involving GOB supervisors which & CHCPs (the new 500

includes local MO-MCH, UFPO, MOs FWAs will be followed up

of DGHS and UHFPOs by their own supervisors) 95 followed up which would

be 70% of the ones

up visits up visits up visits up

- - - trained. F/U will be done

through physical visit and and CSBAs

phone calls.

Follow yet not up started 36 CSBAs and 24 CSBAs 36 up followed CHCPs and 16 25CSBAs up followed CHCPs 59 up followed CHCPs

9 follow 9 follow 9 follow 9 1.1.7d Monitor/track the performances of IR 2 team and X X Performance of CSBA

trained CSBA trained FWAs & CHCP ME&R will provide trained FWAs & CHCP support to analyze monitored and analyzed

the performances

Not yet started the the started yet Not activity Performance started tracking Ongoing Ongoing Quarter-wise Narrative Description of Activity Q1 Achievement: Task # 1.1.7a: MH-II started this activity in the last quarter of PY2 and developed 34 trainers for Brahmanbaria district. The trainers started Upazilla level field workers training since September 2015. Total CSBA, CHCP, FWA and FWV were trained on injectable while 516 were trained during this quarter. The providers’ breakdown is: CSBA trained FWAs-147, CHCPs-223, FWAs- 228, FWVs- 81) Task # 1.1.7b: This activity has been started at Cox’s Bazar district where 32 doctors and Upazilla managers under DGHS and DGFP received “Training of Trainers on Injectable” with an aim to conduct training for the FWAs/CSBAs and CHCPs. The trainers of Cox’s Bazar started cascade training and in this quarter 44 CSBA received training on injectable in two batches. Task # 1.1.7c: One follow-up visit done with local manager which was conducted at Kasbah and Ashugonj Upazilla of Brahmanbaria.

Q2 Achievement

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 1.1.7a: MH – II supported the Field Service Delivery Program (FSDP) from the DGFP to organize a TOT on Injectable for Dhaka district. 31 doctors and Upazilla managers including 14 managers under the DGHS and DGFP working in 7 different Upazillas of Dhaka district received a TOT at the IEM conference room of DGFP. Task # 1.1.7b: The injectable training was completed in Cox’s Bazar district in February 2016 and since March the training has been started in Dhaka district. The trainers who received TOT are involved in conducting the cascade training with support from other DGFP trainers. MH – II provided financial and technical support based on need. In this quarter training has started in the Dhaka City Corporation in the two zones for FP service provision in Dhaka City Corporation. Below is the status of the training for this quarter:

Categories of participants received training District # Batches Total FWV FWA CSBA CHCP Others (NGO) Cox’s Bazar 22 68 73 84 178 45 448 Dhaka 13 81 126 - - 107 314

Orientation on record keeping and reporting was conducted on 31st January 2016 at the Upazila Family Planning Office, Sadar, Cox’s Bazar. A total of 46 (Forty- six) participants were attended (UFPA – 10; Statistical Assistant-1; FPI-35) Task # 1.1.7c: Follow up visit was conducted in nine Upazillas in B. Baria district for 60 service providers (36 CSBAs and 24 CHCPs) who received Injectable training. Providers’ knowledge and skill were assessed and need based feedback provided. Most of the CSBAa are providing 1st doses of Injectable and the CHCPs are providing the 2nd and subsequent doses. Some of the staff have not been able to start the services due to non availability of consent form and logistics. Local managers have been requested to address these issues.

Q3 Achievement Task # 1.1.7a & Task # 1.1.7b: In this quarter, MH-II completed injectable trainings of all CSBA-trained FWAs and CHPCs working in different Upazillas in Dhaka district. Additionally, all FWAs and FWVs also received injectable training as a part of the refresher training. Training outcomes for this this quarter can be found in Table 4. Table 5. Number of different categories of providers trained by MH-II during quarter 3 Categories of Participants Trained District # Batches Total FWV FWA CSBA CHCP Others (NGO)

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Dhaka 27 65 334 21 154 93 667

Task # 1.1.7c: During the quarter follow up visits conducted in six Upazillas of Cox’s Bazar District for a total of 41 service providers (25 CSBAs, 16 CHCPs) trained in injectable. It was found that all CSBAs started providing the 1st dose of injectable. On the other hand, out of 16 CHCPs 10 started providing 2nd and subsequence doses of the injectable. Remaining six CHCPs (Chakaria-3, Ukhiya-1, and Teknaf-2) could not begin services due to non-availability of logistics from FWAs. During follow-up some male CHCPs informed that although logistics are available but, their performance is low due to client preferences for female providers.

Q4 Achievement Task # 1.1.7c: Follow up visits were conducted at different Upazillas of Brahmanbaria and Cox’s Bazar districts. A total of 154 service providers (CSBA trained FWAs –59; CHCPs -95) were followed up working under 06 Upazillas (4 Upazillas of Cox’ Bazar: Ukhiya, Ramu, Pekua, Cox’s Bazar Sadar; and 02 Upazillas of Brahmanbaria: Brahmanbaria Sadar, Akhaura). All CSBA trained FWAs started providing the 1st dose of injectable. CSBAs are screening client using a selection criteria available in the consent form. During follow up visits 11 new participants (02 FWAs and 09 CHCPs) were present. They were provided with hands on coaching on how to provide Injectable services. Following table shows the number and categories of the Injectable trained participants followed during Q4. District Upazillas # Batches Categories of participants followed up CSBA trained FWA CHCP Total Brahmanbar Brahmanbaria Sadar & Akhaura 3 25 31 56 ia Upazilla Cox’s Bazar Cox’s Bazar Sadar, Ramu ,Ukhiya 6 34 64 98 & Pekua Upazilla Dhaka Nawabganj, Dohar, Keraniganj 4 12 69 81 Upazilla Total 13 71 164 235 Batches Task # 1.1.7d: MH-II with support from DGFP is monitoring and tracking the performances of trained CSBA trained FWAs & CHCPs in the selected districts (Brahman Baria, Cox’s Bazar, and Dhaka) Activity 1.1.8 STRENGTHEN LARC, PM AND INJECTABLE SERVICES AT NGOS (BRAC, NHSDP AND OTHER NGOS); AND COLLABORATE WITH FISTULA CARE PLUSPROJECT OF ENGENDERHEALTH

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 This activity is to collaborate with the selected NGOs for capacity building of providers to initiate/strengthen LARC and Injectable services and this is a continuation of PY2 activities Partners/Collaboration NHSDP, BRAC, DGFP and DGHS Person of contact Dr. Murshida Rahman 1.1.8a Provide support to the BRAC, NHSDP 60 providers received Don and other NGOs in training their clinical training on LARC e

clinical providers including gender & PM and Gender

orientation to initiate/strengthen LARC orientation (45 on only

and injectable services spread over the LARC and 15 on both

Districts of PY1, PY2 and PY3 session LARC and PM) from 45

1 session 1 1 3 sessions 3 2 sessions 2 sites as requested by

BRAC, NHSDP and other received oviders

NGOs

36 providers received received providers 36 trainings 6 providers received received providers 6 training 36 9 training 1.1.8b Monitoring and follow up visits with X X X X All trained 60 NGO Don

NGO supervisors to strengthen LARC providers followed up e

& PM and Injectable services of the through physical visits and

selected supported facilities over telephone

providers

providers providers

Not yet planned yet Not 69 59 59 up followed up followed

1.1.8c Monitor/track the performances of ME&R will provide X X X X 18,616 LARC& PM and

11 -

trained NGO providers support to analyze Injectable performed by

113 113 -

the performances the supported 60 sites ,

Implant – 6831

implant 9 9 implant

2,922

implant implant

, ,

IUD – 2012 ,

IUD 3,056

– 3833, -

Female PM – 775

n 355 n

330 330 Implant 316,

- -

Male PM – 1758 – Implant Implant

Injectable - 7240 UD

Injectable Injectable IUD im Injectable I 4,328, Injectable IUD Injectable 140 238,Implant

provide support for training, event their proposed provided to FC+ project

conduction/facilitation on FP related activities and team issues as per need finalize the joint

action plan

Not yet yet Not planned yet Not planned yet Not planned 3 batches of batches 3 IPtraining Quarter-wise Narrative Description of Activity Q1 Achievement Task # 1.1.8a: In this quarter, 4 trainings on IUD and injectable were organized for 36 paramedics. The paramedics were from BRAC (30), RTMI (3), OGSB (1) and Shimantik (1). Among these, 2 training were completed in October 2015 and as per telephonic follow up it has been found that most of them are started to perform. Task # 1.1.8c: FP Performance from BRAC Injectable -2922 IUD – 355 and Implant –9 Q2 Achievement Task # 1.1.8a: 2 batches of 6 day long trainings on “IUD and injectable” were organized attended by 11 paramedics. The paramedics were from BRAC (06), RTMI (05). 1 doctors recruited for RTMI received 18 days long training on LARC & PM. Task # 1.1.8b: A total of 59 providers (7 doctors & 52 mid wives/paramedics) service providers from BRAC were followed up in 5 batches. They had e received training on “IUD, Implant and injectable” during PY1 &PY2. Task # 1.1.8c: FP Performance of BRAC facilities: MH – II has been providing support such as refresher training, hands on coaching and follow up to BRAC to initiate FP services at their facilities including o PPFP. The performances below are from the facilities where MH – II initiated FP services in (PY1 + PY2 + PY3). BRAC has been purchasing FP commodities from SMC. The uptake of Implant is low due to high price. BRAC is trying to get the affiliation to get FP commodities from government.

FP methods October – December 2015 January – March 2016 Month Uptake of FP services Average # per facility Uptake of FP services Average # per facility Injectable 2922 97 3833 106 Implant 9 3 11 3.6 Interval IUD 293 11.7 249 8.3 Postpartum IUD 62 12.4 81 11.5

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q3 Achievement Task # 1.1.8a: During the quarter MH-II organized one batch of a six-day long training on IUDs and injectable was organized for 9 paramedics of BRAC. Task # 1.1.8b: MH-II also followed-up 69 providers (1 doctor and 68 midwives/ paramedics) of BRAC who received training on IUD, implant, and injectable during PY1, PY2, and PY3. They were followed up in eight batches at Mohammadpur Fertility Services and Training Center (MFSTC) in Dhaka. Although all the trained paramedics are performing but, performances of some are much lower than others. Their knowledge and skill assessments were all satisfactory. But, some of the paramedics need more skill practice. Task # 1.1.8c: MH-II has been providing support to BRAC to initiate FP services in their facilities, including PPFP. Table 5 shows performance of the facilities where MH-II initiated FP services in PY1, PY2 and PY3. BRAC has begun purchasing FP commodities from SMC. The uptake of implants is gradually increasing. BRAC obtained affiliation from DGFP for 14 centers, and as such, will be obtaining FP commodities from the DGFP. They are trying to get the affiliation from DGFP for their other centers. To date, BRAC provides FP services in 37 centers. Table 5. FP performances of BRAC centers who started proving FP services Performance FP Methods Oct – Dec Jan – Mar Apr – June July-Sept Total 2015 2016 2016 2016 Injectable 2,922 3,833 4,328 11,083 Implant 9 11 113 133 Interval IUD 293 249 273 815 PPIUD 62 81 43 186

Q4 Achievement Task# 1.1.8c: MH – II has been providing support to BRAC for refresher training, hands on coaching of the providers and follow up of the trained providers to initiate FP services at their facilities including PPFP. The performances (July & August) above are from the facilities where FP services have been initiated during PY1, PY2 and PY3 through MH – II support. Following table shows the Q4 performances by the trained BRAC service providers. Table 5: Method wise performance by MH-II trained BRAC service providers FP service Performance Total

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 provided Oct – Dec Jan – Mar Apr –June Jul – Sep 2015 2016 2016 2016 Injectable 2,922 3,833 4,328 3,056 14,139 Implant 9 11 113 140 273 Interval IUD 293 249 273 238 1,053 Postpartum 62 81 --Do 186 43 IUD

Task# 1.1.8d: In this quarter, a total of 52 providers (7 doctors & 45 nurses/mid wives/paramedics from BSMMU, Hope Foundation Hospital and Kumudini Hospital were trained on infection prevention and waste management” as part of the collaboration with the Fistula Care plus project of EngenderHealth.

Sub IR1.2 Training, support and performance improvement mechanisms institutionalized Activity 1.2.1 WORKING WITH MH – II SUB-AWARDEE “OGSB RH & FP TRAINING CENTER” TO STRENGTHEN ITS CAPACITY TO FUNCTION AS AN INDEPENDENT TRAINING CENTER This activity is to strengthen the capacity of the OGSB’s RH-FP Training Center with an added component of collaborating with DGFP and OGSB to set-up a Training Center Network involving MFSTC, MCHTI, and OGSB FP-RH Training Center. Partners/Collaboration OGSB, DGFP, MCHTI, MFSTC, NGOs, UPHCSDPs, Private sector facilities Person of contact Dr. Tahmina Akhter and Fatema Shabnam

1.2.1a Support OGSB RH & FP Training X Yearly Workplan

Center in the development of a yearly developed

workplan, where cost of the training is

paid for by the trainees’ organizations.

Done in Done Q1 Done Done

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.2.1b Organize joint meetings to support MFSTC, MCHTI, Two joint meetings held a

OGSB RH & FP training center to CCSDP Unit of as part of developing the

develop a training network involving DGFP training network

OGSB, MFSTC, MCHTI, CCSDP unit

of DGFP and other NGOs used for 1 meeting 1

practical training sessions meeting 1

Meeting held with held Meeting & NHSDP CCSDP in held meeting No thisquarter in held meeting No thisquarter No meeting held in held meeting No quarter this

1.2.1c Support OGSB RH & FP training X X X OGSB RH & FP develops

center develop a sustainability plan a sustainability plan and and accordingly initiates the process of initiates the process of charging fee for different training sustainability through

courses charging fees for training

A marketing plan plan marketing A prepared been has plan marketing A prepared been has On the way to the way On development plan marketing A prepared hasbeen

1.2.1d Organize program review meetings Grants and Finance 4 program review

s with management of OGSB RH & FP team will participate meetings held

training center to monitor the progress

of development of the training network

meeting meeting

1 meeting 1 meeting 1 meeting 1 meeting 1

as per project goal

1 meeting 1 2 held 2 held meetings 4 held

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.2.1.e Monitor/track training performances of ME&R team will Reviewed and analyzed

OGSB RH & FP training center and conduct DQA performances of OGSB

follow up of activities as per project RH & FP Training center. goal and workplan

192 providers as identified

batches)

(8 batches)

( 5 batches 5

Name of Batch x Total batches 5 from PY1, PY2 and PY3

5 batches 5 batches 4 the training Participant Districts trained through 19 different batches IUD 7 x 6 42

Implant 6 x 10 60

received Tr. Tr. received

received Tr. Tr. received Counseling 3 x 15 45

Infection 3 x 15 45

)

prevention

5 batches &providers 58 batches 5 providers

providers (3 training received providers

104 72 37 batches Quarter-wise Narrative Description of Activity Q1 Achievement Task # 1.2.1a: With the support from MH - II, OGSB prepared the Workplan for the period of October 2015 – September 2016 where cost of training conduction included Task # 1.2.1c: To organize training on IUD and Implant, OGSB contacted with NHSDP. They also organize practical session at the GOB facilities and also NGO facilities. Facilitator from DGFP participates in the facilitation of training organized by training center. Task # 1.2.1d: OGSB prepared their brochure to disseminate information about training center and participate in the scientific seminar organized by OGSB to search prospective organization with training need to develop sustainability of the training center. Task # 1.2.1e: OGSB organized following different training in this quarter. Name of the training # of batches # of providers received training Training on FP Counseling 2 36 Training on IUD and Implant 1 9 Training on IUD 1 7 Training on Implant 1 9

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q2 Achievement Task # 1.2.1c: OGSB RH & FP Training center developed a draft marketing plan. One of the focus of the plan is to develop a brochure, to distribute it at meetings with key stakeholders, communication through email, arrangement of a seminar, and development of a face book page. The brochure has been developed and distributed by OGSB through different programs and events. Task # 1.2.1d: Two meetings held in this quarter with the President, General Secretary, OGSB and Director, OGSB Hospital and other concerned persons were present. The key discussion points were how to increase the client flow at the hospital particularly Family Planning clients. Task # 1.2.1e: Training performances: 104 participants received different trainings organized by OGSB in this quarter. The participants were from different NGOs and private facilities. The trainings conducted by OGSB RH & FP training center is given below: Number of participants (batch) Name of the training Projection Q1 Q2 Total 1. Training on Counseling 45 36 10 (1 batch) 46 2. Training on Infection prevention 45 62 (3 62 batches) 3. Training on IUD 42 7 24 (3 31 batches) 4. Training on Implant 60 9 8 (1batch) 17 5. Training on IUD and Implant 9 9 Total 192 61 104 (8) 165

▪ The trainers conducted onsite follow up visit in 4 districts and 9 service providers from different facilities were followed up after they had received IUD training 3- 5 months earlier. All the participants are providing IUD services and following the standard technique, in Jamalpur (3), Panchagarh (3), Sylhet (2) and Dhaka (1) district. Q3 Achievement Task # 1.2.1d: During the quarter two meetings were held with the President, General Secretary, OGSB, and Director, OGSB Hospital and other stakeholders. The first meeting was to discuss budget reallocation, recruitment of the project manager and clinical trainer, renovation of the training center and procurement of logistics for the training center. During the second meeting, newly recruited program manager was oriented on the program and USAID rules, importance of ensuring 100% follow-up, and to develop a revised training plan for the project extension period. Task # 1.2.1e: During the reporting quarter OGSB RH & FP Training center has organized five batches of different categories training for 72 participants coming from NGOs and private facilities. This was the first time that OGSB FP Training Center has started organizing their trainings as part of their sustainability plan

Number of participants Name of the training Projection (batch) Total Q1 Q2 Q3 Counseling Training 45 36 10 (1) - 46 IP Training 45 - 62 (3) 31(1) 93 IUD Training 42 7 24 (3) 9 (1) 40

Implant Training 60 9 8 (1) 15 (2) 32 IUD and Implant Training 9 - 9 Generic TOT Course 17 (1) 17 Total 192 61 104 (8) 72 (5) 237

Follow up: The trainers of OGSB RH & FP Training center conducted onsite follow up visits for 13 service providers from different facilities in four districts— Manikganj (1), Narayanganj (3), Chittagong (5) and Dhaka (4)—after receiving IUD and implant training 3-5 months prior. All participants were found to be providing IUD and implant services and following the standard technique. Q4 Achievement Task # 1.2.1d: In this quarter 4 meetings were held with the President, General Secretary, OGSB and Director, OGSB Hospital and other concerned persons. The key discussion points during the first meeting were: arranging a dissemination meeting on labor ward protocol and training center activity, revise staff manual and financial policy of OGSB and it was agreed that the same policy should be followed by all projects under OGSB and Institute of Reproductive and Child Health (IRCH), procure logistic for training center as per revised budget. In the second meeting it was decided to create a separate bank account as part of the sustainability plan for the training center, selected two members to take responsibility for sustainability of training center that would be finalized in the Executive Committee (EC)meeting of OGSB, identified private medical college as a potential subscriber of training. In the third meeting the program manager of the OGSB RH & FP training center was assigned to prepare training cost to sell the training and update the brochure of training center including training cost. In the fourth meeting the minutes of the previous meeting were followed up. In the meeting a decision was taken to issue a letter to the private medical colleges in Dhaka to place the final year’s medical student in the training center for 3 days. This is as part of their Family planning ward placement focusing hands on coaching and make budget accordingly. The meeting also identified other potential organizations who can buy the training.

Task # 1.2.1e: In this quarter 37 participants received different trainings organized by OGSB. The participants were from different NGOs and private facilities. The trainings conducted by OGSB RH & FP training center is given below:

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Table 6: OGSB organized trainings and number of participants Number of participants Name of the training Projection (batch) Total Q1 Q2 Q3 Q4 Training on Counseling 45 36 10 (1) - 30 (2) 76 Training on Infection 45 - 62 (3) 31(1) - 93 prevention Training on IUD 42 7 24 (3) 9 (1) 7 (1) 47 Training on Implant 60 9 8 (1) 15 (2) - 32 Training on IUD and Implant - 9 - - - 9 TOT on Generic Course - - 17 (1) - 17 Total 192 61 104 (8) 72 (5) 37 (3) 274

Follow up: The trainers conducted onsite follow up visits in 4 districts (Khulna, Jessore, Satkhira and Sylhet). 21 service providers from different facilities were followed up after receiving IUD (9) and Infection Prevention (12) training. All the participants (paramedics) of IUD trainees followed up, are providing services in their facilities in Khulna, Jessore and Satkhira districts and are performing to standard.

Activity 1.2.2 STRENGTHEN QUALITY ASSURANCE (QA) AND FP COMPLIANCE IN PUBLIC, NGO AND PRIVATE SECTOR FACILITIES This activity is to support the public, private and NGO sector to strengthen capacity of the clinical supervisors which would include CCSDP officials and FPCST to improve quality of care for LARC, PM services including PPFP and injectable services as well as QA & FP Compliance ICV through joint QA and FP Compliance visits. While working with the CCSDP officials and FPCST their capacity would be strengthened in terms of properly filling out FU visit checklists, providing feedback to the providers and providers finding the feedback to be helpful. Partners/Collaboration DGFP, DGHS, NGOs, private sectors facilities, EngenderHealth Global Clinical Support Team Person of contact Dr. S M Nizamul Haque and Dr. Rezaul Karim

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.2.2a Support Sr. QA & FP Compliance X Monthly/yearly QA and

Officers of MH – II to develop their FP Compliance visit plan

monthly/yearly plan for QA & and plan for organizing Done Done

Compliance visit and organization of special service days Done

Support Support Support provided

special days developed provided

1.2.2.b Sr. QA & FP Officers collect district X X X X District and Upazilla-wise and Upazilla-wise monthly plan for monthly LARC and PM LARC & PM service delivery service delivery plan days/dates from UFPOs to make joint collected by the Sr. QA & plan for organization of additional FP Officers service delivery days for LARC, PM

and Injectable services.

Monthly collected Monthly collected Monthly collected Monthly collected Monthly

1.2.2c Organize and conduct QA and FP DGFP and DGHS 100 QA & FP Compliance

Compliance visits (100) and follow-up visits conducted in the up up

visits (75) jointly with the DGFP PY1, PY2 and PY3 up

up up

- -

up visits up visits up visits up visits up

- - - officials, FPCST & DGHS - Districts of which one counterparts with emphasis on third would be joint visits. problem solving. The joint visits will Out of 100 visits, 75 will build the capacity of the FPCST be follow up visits

Supervisors in terms of filling the conducted. visits

checklists; providing constructive

feedback to the supervisees, e supervisory visits would become more

of problem solving etc. follow 20 + visits first

25 first visits + 15 follow 15 + visits first 25 follow 20 + visits first 25 follow 20 + visits first 25 25 69 ($2 first visit & 27 follow up up follow & 27 visit first ($2 69

84 (48 first visits & 36 follow & 36 visits first (48 84 don visits) follow &14 visits first (58 72 done visits) follow & 26 visits first (46 72 done visits)

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.2.2 d Collaborate with the DDFP and 1000 special service UFPOs to jointly plan and organize FP delivery days organized to

special days to be facilitated by the QA perform - 30,583 LARC,

& FP Officers for LARC & PM and PM and Injectable Injectable services at DGFP facilities Male PM - -6,580

Female PM - -3,395

300 special days special 300 days special 250 days special 200 250 special days special 250 Implant -16,830

IUD – 1,291

special days days special

Injectable - 2,487 doses 1

326 special days special 326 days special 370 days special 793

1.2.2.e Collaborate with the CS/DDFP and 12 DGHS/12 newly

UH&FPOs to identify interested recruited DGFP doctors

DGHS and /or newly recruited DGFP received on the job doctors in PY1, PY2, and PY3 training to develop skills Districts to build their skills on LARC on LARC and PM. Their

& PM under the direct guidance and performance would be

4 doctors trained doctors 4 trained doctors 6 trained doctors 6 trained doctors 8

supervision of the Sr. QA & FP followed-up through Compliance Officers physical FU visits and

over telephone.

Training not yet yet not Training started DGHS of training No conducted doctors 15 DGHS doctors doctors DGHS 15 trained DGHS of training No conducted doctors

1.2.2f Collect client perception about the ME&R will do data X X X X Collected data analyzed to

quality of LARC and PM on the processing and see quality of services

services received analysis provided and ICV

Not yet yet Not started yet Not started yet Not started yet Not started 1.2.2g Support IR3 team to do advocacy with IR3 team will do X Circular issued by DG,

the MOHFW through DG, DGFP. The advocacy to issue DGHS to all concerned to DG, DGHS will issue a circular to the circular allow existing OT of UHC ed allow existing Operation Theater (OT) to provide LARC & PM

of the Upazilla Health Complex services particularly IUD

(UHC) to provide LARC & PM insertion and removal. A services particularly for IUD insertion separate IUD insertion and and removal removal room may not be

obtained.

District based circular circular based District issued be would bas over handed 31 circular on over handed OT 250 based over handed 18 circular on

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.2.2h Orient all new EHB staff and in- X All new EHB + in country

country partners/sub-awardees on partner + sub-awardee

USAID statutory policies, regulations staff oriented on USAID

and FP compliance monitoring tools. statutory policies

Done Done Done Done Done 1.2.2i Make sure that USAID e-learning X All EHB Staff completed course on FP completed every year by e-Learning course on FP

all EHB staff, collect & post and obtained certificates certificates to EH/BCO intranet page

and forward to USAID Dhaka

Done Done Done Done 1.2.2j Develop an on-line file on FP On-line file on FP Compliance visit findings in the Compliance visit findings

homepage of EngenderHealth developed in the home

Bangladesh according to the HQ page of EHB. And all requirements and keep all related compliance related

documents in that file documents uploaded

Done Done Done Done Done Done 1.2.2k Conduct FP compliance review X X X X FP Compliance review

meetings with USAID staff as part of meetings held

the quarterly review meetings

Meeting Meeting held Meetings held Meetings held Meeting Meeting held 1.2.2l Take necessary actions for any issue Necessary steps taken and

that impedes the quality and FP documented in case of any

compliance and documentation done violation of quality and FP

compliance

N/A N/A N/A N/A 1.2.2m Monitor/track performances of QA & ME&R will Analyzed data available FP Compliance Officers collaborate for data

analysis

Monitored and and Monitored analyzed and Monitored analyzed and Monitored analyzed Monitored and and Monitored analyzed

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Quarter-wise Narrative Description of Activity

Q1 Achievement: During this quarter a District-wise plan for QA and FP Compliance was developed. Monitoring visits occurred in different DGFP and DGHS facilities of PY3 Districts, not including facilities of PY1 and PY2 Districts, and follow-up monitoring visits in different facilities of PY1 and PY2 Districts. This plan was shared with all the Sr. QA and FP Compliance Officers in an orientation session held at EHB on 29 November2015, which advised them to follow the plan to implement the QA and FP compliance monitoring visits. In the orientation session, they were provided guidance on how to collect relevant data on QA and FP compliance monitoring visits and how to report it through the excel sheets in a better way. They were oriented on the organization of special LARC and PM service delivery days and using hired surgeons in the Upazillas where the post of MO (MCH-FP) is vacant. They were also oriented how to do MH-II follow-up activities including PPFP, BCC materials distribution, and the implementation of changed policies. They were provided orientation on USAID e-Learning course on “US Abortion and FP Requirements-2013”, and afterwards they independently obtained the certificate. According to PY3 Workplan, most of the first QA and FP Compliance monitoring visits and follow-up visits should be done jointly with the Regional Supervisor, FPCST/QAT of the DGFP and DGHS counterparts, with an emphasis on problem solving. In this regard, a meeting was held with the Line Director (CCSDP), DGFP and his unit officials on 4 November 2015 and reached a consensus for these joint visits. During this quarter (Oct/15 to December/15), a total of 84 QA and FP Compliance monitoring visits were conducted by the Sr. QA and FP Compliance Officers at DGFP, DGHS and NGO service delivery facilities in 27 Districts Among these visits, 48 visits (8 MCWCs, 37 UHCs, 1 FWC and 2 NGO clinics) were first visits and 36 visits (5 MCWCs and 31 UHCs) were follow-up visits. The summary of the visited facilities are mentioned below in a matrix. (See Appendix-3 for detailed findings)

# of facilities conducted first visit # of facilities conducted follow-up visit Grand Quarter MCWC UHC H&FWC NGO Clinic Total MCWC UHC H&FWC NGO Clinic Total Total Q1 8 37 1 2 48 5 31 0 0 36 84

MH–II’s Senior QA and FP Compliance Officers, who provided assistance in organizing 291 special LARC and PM service days by conducting facility walk through, reviewing the findings of the site visits, sending job-aid and IEC/BCC materials, supporting DGFP doctors by providing on-site coaching, and using hired surgeons to perform 6045 LARC, PM and injectable services during this quarter (including: 657 female sterilizations, 508 NSVs, 4,300 implants, 178 IUDs, and 402 injectables). Following are the service provisions of special FP days mentioned above.

Performances Yearly Methods Achievements (Q1) Q1 Q2 Q3 Q4 Projection Female Sterilizations 657 3,395 657 Male Sterilization (NSV) 508 6,580 508 Implant 4300 16,830 4300

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 IUD 178 1,291 178 Injectable 402 2, 487 402 Total LARCs, PMs & Injectable 6,045 30, 583 6,045

The Line Director (CCSDP) of the DGFP requested MH-II to provide LARC and PM comprehensive training to 44 DGHS doctors posted in different Upazilla Health Complexes (UHC) under Chittagong, Sylhet and Barisal Division. In these UHCs, the posts of MOs (MCH-FP) are vacant. After being trained they will provide LARC and PM services in the UHCs where they are posted. A meeting was held with the LD (CCSDP), DGFP on 4 November 2015 and a subsequent triparty meeting held with the Director (PHC), DGHS, LD (CCSDP), DGFP and Sr. Program Staff of MH-II on 12 November 2015 to set the modalities of the training program. The first batch of the training program involved 6 trainee doctors from different UHCs of Barisal Division from 26 December2015 in the Mohammadpur Fertility Services and Training Center (MFSTC) and till the 31 December 2015 for theoretical part only. For practical part to build capacity and skill development they will be located in different UHCs of Barisal Division for two weeks (first two weeks of January2016) where hands-on coaching will be provided by the Regional Supervisor, FPCST/QAT, Sr. QA and FP Compliance Officer and other trainer doctor in Barisal Division organizing special LARC and PM service delivery days.

During this quarter, a meeting was held with the Additional Secretary, Health Economics Unit (HEU), MOHFW and the Sr. Officials of the Quality Improvement Secretariat under HEU of MOHFW on 3 December 2015 to discuss about the integration of MH-II QA and FP Compliance activities with the quality improvement (QI) initiative of the QI Secretariat of the MOHFW. In the meeting, a consensus has been reached that MH-II Sr. QA and FP Compliance Officers will be part of the QI activities of the MOHFW. Each of the Sr. QA and FP Compliance Officers will be given a specific task to work for QI initiative of the MOHFW. These are organizing QI committee meetings at the district level, facilitating the meeting, developing minutes of the meeting and training of the members of the committee on QI process.

▪ In this quarter one Sr. QA & FP Compliance Officer joined on 3rd January 2016 to look after Dhaka division and she is located at EH B office and one Sr. QA & FP Compliance Officer assigned for Chittagong region resigned from the job in March 2016 due to ill health. Task # 1.2.2a & 1.2.2b: Sr. QA & FP Compliance officers prepared their monthly QA & FP Compliance visit plan and special day plan in consultation with local mangers. As a part of their planning and collaboration with RTMI, ‘Joint Action Plan Development Meeting’ between RTMI MSDCT and MH-II Sr. QA and FP Compliance Officers was held on 17 January 2016 followed by a Refresher Training on “Updates on Family Planning, Infection Prevention and Medical Monitoring” held on the 18 & 19 January 2016 involving all RTMI MSDCT members and Sr. QA and FP Compliance Officers. During the refresher training emphasis was given on Contraceptive updates, ICV and counseling, facilitative supervision, medical monitoring and coaching and Infection prevention. They were also oriented on “USAID statutory policies, regulations and FP compliance monitoring tools”.

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 1.2.2c: The summary of the QA & FP Compliance visit is mentioned in the table below. The detailed findings are mentioned in Appendix-2. A circular from the CCSDP unit of the DGFP has been issued on the 23rd February 2016 regarding joing QA & FP compliance visits with the regional supervisors, FPCST /QA T of the DG FP. During this quarter 11 joint visits have been conducted.

# of facilities conducted first visit # of facilities conducted follow-up visit Grand Quarter MCWC UHC H&FWC NGO Clinic Total MCWC UHC H&FWC NGO Clinic Total Total Q2 10 45 0 3 58 0 14 0 0 14 72

Task # 1.2.2d: MH–II’s Senior QA and FP Compliance Officers, who provided assistance in organizing 326 special LARC and PM service days by conducting facility walk through, reviewing the findings of the site visits, sending job-aid and IEC/BCC materials, supporting DGFP doctors by providing on-site coaching, and using hired surgeons to perform the services. Below are the service statistics from the special FP days:

Performances Yearly Achievements Methods Q1 Q2 Q3 Q4 Projection (Q1 +Q2) Female Sterilizations 657 460 3,395 1,117 Male Sterilization (NSV) 508 488 6,580 996 Implant 4,300 4,792 16,830 9,092 IUD 178 161 1,291 339 Injectable 402 341 2, 487 743 Total LARCs, PMs & Injectable 6,045 6,242 30, 583 12,287

Task # 1.2.2e: Three batches of 18 days “Basic training on LARC and PM” for DGHS doctors were organized in this quarter. 15 doctors from Barisal, Chittagong and Sylhet divisions participated in the training. The trainings were organized by three regional training centers (Dhaka, Barisal and Chittagong) and conducted by the regional trainers. Sr. QA and FP Compliance Officer working in Khulna region was closely involved to providing hands on coaching to the doctors working for Barisal region. Task # 1.2.2g: As per discussion with DD(FP), a circular was circulated which allows the existing OT in the UHC to be used for providing LARC & PM services particularly IUD insertion and removal. In this quarter 31 OT in different districts have been handed over to the DGFP.

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 1.2.2h, 2i & 2j: All new staff joining EngenderHealth Bangladesh and MH-II Sub-Awardees were oriented on the US Governments Laws and Policy Requirements on Family Planning and Abortion related issues. A total of 123 EngenderHealth Bangladesh core staff and all the program staff including MH-II Sub- Awardees, technical and program staff, completed the e-Learning course on ‘US Abortion and FP Requirement-2016’ and were given a certificate. The list of the participants has been sent to USAID, Dhaka. The electronic copies of all these certificates are kept on-line in the Compliance File at EngenderHealth Bangladesh. The hard copies of the certificates are kept in a file at the EHB office. ▪ The Sr. QA and FP Compliance Officers conducted ICV sessions for the FP Managers and DGFP field workers and NGO workers from 12 Upazillas from 8 Districts and distributed stickers on ICV to the field workers. The total number FP Managers and field workers oriented on ICV was 838. Along with the ICV sessions they also received an updated on LARC and PM including PPFP. Q3 Achievement Task # 1.2.2a: During May 2-8, 2016 an orientation session was organized for the newly requited Assistant Program Officer (APO) (Logistics) on their roles and responsibilities, updates on FP methods, MH-II activities, human resources (HR), information technology (IT), and financial issues. Facility visits were also organized at Azimpur Maternal and Child Health Training Institute (MCHTI), MFSTC, Mohammadpur, and Tejgaon UHC. Participants were also oriented to USAID statutory policies, regulations, and FP compliance monitoring tools. Task # 1.2.2c: In this quarter Sr. QA and FP Compliance Officers conducted 72 visits out of which 46 were first visits and 26 were follow-up visits (Table-7). 31 of these visits were conducted as joint visits with the Regional Supervisor of the FP Clinical Supervision Team/Quality Assurance Team (FPCST/QAT) and the DDFPs from different districts. Table 7. Number of first visits and follow-up visits conducted at different categories of facilities

# of facilities conducted first visit # of facilities conducted follow-up visit Gran Qua MC UHC H&F NGO District Total MC UHC H&F NGO Total d rter WC WC Clinic Sadar WC WC Clinic Total Hospital Q3 12 30 1 2 1 46 3 20 0 3 26 72 On May 29, 2016 all Sr. QA and FP Compliance Officers, Coordinators of QA and FP Compliance, and Program Managers (QA and FP Compliance) participated in the workshop on supervision and monitoring by FPCST/QAT Regional Supervisors organized at DGFP. Program Mangers (QA and FP Compliance) presented the QA and FP Compliance activities conducted by MH-II where the DG, DGFP, and Directors from different units of the DGFP and several Divisional Directors, FP participated.

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 1.2.2d: During the quarter APO (Logistics) organized 370 special LARC and PM service days. Support provided during the special days include facility readiness, review of the findings from previous site visits, sending job-aids and IEC/BCC materials, supporting DGFP doctors by providing on-site coaching, and using hired surgeons to perform services (Table 8). Table 8. Quarter-wise LARC and PM and injectable performances during special FP days organized by MH-II

Performances Yearly Achievements FP Methods Q1 Q2 Q3 Q4 Projection (Q1+Q2+Q3) Female sterilization 661 459 507 3,395 1,627 NSV 508 515 739 6,580 1,762 IUD 167 162 163 1,291 492 Implant 4,309 4,792 4,408 16,830 13,509 Total LARC and PM 5,645 5,928 5,817 28,096 17,390 Injectable 400 336 438 2,487 1,174 Total LARC and PM and 6,045 6,264 6,255 30,583 18,564 injectable

Task # 1.2.2g: As a part MH-II advocacy efforts, 250 DGHS OTs were handed over to the DGFP at the Upazilla level (Dhaka-82, Chittagong-62, Rajshahi-41, Barisal-0, Khulna-39, Sylhet-9, and Rangpur-17).

In connection with this, Sr. QA and FP Compliance Officers met with their respective DDFP issued a circular to Upazilla FP Managers under their jurisdiction regarding the utilization of OT for IUD insertion. Sixty-nine UHCs from these eight districts are currently utilizing the OT for IUD insertion (Jessore, Magura, Dinajpur, Rangpur, Noagaon, Kushtia, Chuadanga, Moulvibazar, and B. Baria).

Task # 1.2.2h: Dr. Levent Cagatay, Deputy Team Leader, Clinical Support Team, EngenderHealth, New York visited Bangladesh from May 8-13, 2016. On May 8, 2016, he facilitated a discussion on in-country capacity building to ensure clinical quality (ECQ) and the implementation of activities under EngenderHealth’s ECQ framework and subsequent reporting. On May 9, 2016, he facilitated a session on the Clinical Support Standard and Guide, FP Compliance standards of practice (SOP), EngenderHealth’s policy for clinical staff direct provision of clinical care and surgical procedure, and complication and mortality reporting protocols. All clinical staff including Sr. QA and FP Compliance Officers and APO (Logistics) participated in this session. On May 10, 2016 he observed a QA and FP compliance monitoring visit conducted at Narayanganj MCWC by the Sr. QA and FP Compliance Officer, Dhaka Region.

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Additional activity: Sr. QA and FP Compliance Officers had the opportunity to attend the DGFP monthly meeting at the District and Upazilla level to conduct a session on informed choice and volunteerism (ICV). In this session, all FP Managers, field workers, and local NGO managers and workers were present. In this quarter, 45 sessions were conducted in different Districts and Upazilla meetings where 198 FP Managers and 2,329 field workers were oriented to ICV. In addition to session facilitation, stickers on ICV were distributed to field workers, they received updates information on LARC and PMs (including PPFP) (CTU), and policy change issues were discussed. Q4 Achievement Task# 1.2.2a: To standardize the knowledge, skill and practice on LARC & PM, a ‘Clinical Skill Standardization Workshop’ was conducted involving Sr. QA and FP Compliance Officer and other Clinical staff of MH-II and MIH project from July 24-28, 2016. Task# 1.2.2b: Sr. QA & FP Compliance officers prepared their monthly QA & FP Compliance visit plan and special service day plan in consultation with the local DGFP managers and in collaboration with RTMI. Task# 1.2.2c: The summary of the QA & FP Compliance visits is mentioned in the table below. The detailed findings are mentioned in Appendix-3. In this quarter out of 69 visits, 23 joint visits have been conducted with the Regional Supervisor FPCST/ QAT and with the DDFPs. Table 7: By facilities conducted first visit and follow-up visit

# of facilities conducted first visit # of facilities conducted follow-up visit Grand MC UHC H&F NGO DGHS Total MC UHC H&F NGO Total Total WC WC Clinic facilities WC WC Clinic 6 28 1 7 0 42 3 24 0 0 27 69

Task# 1.2.2d: Senior QA and FP Compliance Officers with support from the Assistant Program Officer (APO) (Logistics) provided assistance in organizing 793 special LARC and PM service days by conducting facility walk through, reviewing the findings of the site visits, sending job-aid and IEC/BCC materials, supporting DGFP doctors by providing on-site coaching, and using hired surgeons to perform the services. Below are the service statistics from the special FP days:

Table 8: FP methods wise service statistics from special FP days Performances Yearly Achievements Methods Q1 Q2 Q3 Q4 Projection (Q1 +Q2+ Q3+Q4)

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Female Sterilizations 657 460 507 1,142 3,395 2,769 Male Sterilization 508 488 739 3,928 (NSV) 2,166 6,580 Implant 4,300 4,792 163 221 16,830 713 IUD 178 161 4,408 10,681 1,291 24,190 Injectable 402 341 438 883 2, 487 2,057 Total LARCs, PMs 6,045 6,242 6,255 15,093 30, 583 33,657 & Injectable

Task# 1.2.2e: Because of non-effectiveness of the training of DGHS doctors MH-II has dropped the issue of training of the DGHS doctors. As such no further training courses has been supported by MH-II.

Task# 1.2.2g: As a part of MH – II advocacy efforts, Sr. QA and FP Compliance Officers met with the respective DDFP from Nilphamari, Gaibandha and Joypurhat Districts and requested them to issue a circular to the Upazilla FP managers under their jurisdiction regarding utilization of separate room/ OT for IUD insertion. Accordingly, the DDFP of these three Districts issued a circular regarding the above mentioned issue. So, 18 UHCs of these three districts are utilizing separate room/ OT for IUD insertion.

Task# 1.2.2h: Dr. Levent Cagatay, Deputy Team Leader, Clinical Support Team, EngenderHealth, New York visited Bangladesh during July 31- August 5, 2016. During August 1-2, 2016 he participated MH-II, PY4 Work planning workshop. He also facilitated a ‘Training Skill Standardization Workshop’ organized for the Sr. QA and FP Compliance Officers and other clinical staff of MH-II and MIH project during August 3-5, 2016 at BRAC CDM, Rajendrapur, Gazipur. Additional activity: • The Sr. QA and FP Compliance Officers have been using the opportunity of attend the DGFP monthly meeting at District and Upazilla level to conduct a session on ICV. In these session all FP managers, field workers, local NGO manager & workers are present. In this quarter, 53 Sessions were conducted in different Districts and Upazilla meetings where 284 FP Managers and 2,744 field workers have been oriented on ICV. Stickers on ICV were distributed to the field workers; updated information on LARC and PM including PPFP and policy change issues were discussed.

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 • MH-II is one of the members of the Quality Improvement Council (QIC) of USAID. The first meeting of the QIC was held on 18 August 2016 in the Conference Room of MaMoni HSS, Save the Children, Gulshan, Dhaka. In the meeting there were discussions on various issues relating quality improvement initiatives of the MOHFW at DGHS facilities and how QIC will support their initiatives. The Sr. QA and FP Compliance Officers attended a national workshop on ‘Joint GO-NGO Collaboration plan for quality improvement for health service delivery in Bangladesh’ from August 28 to September 1, 2016 organized at Dhaka by the Health Economics Unit of the MOHFW.

Activity 1.2.3 PARTNER WITH BKMI TO USE ICT TO STRENGTHEN TECHNICAL UPDATE/DISSEMINATE FP INFORMATION AND HAVE OPPORTUNITY FOR SELF- ASSESSMENT. This activity in collaboration with BKMI is to disseminate information using ICT as a method of long-distance learning, as well as self-assessment of the participants participating in the course. Partners/Collaboration BKMI, DGFP, selected service sites, hired IT firm Person of contact Dr. Ahmed Ifthekhar Alam

1.2.3 a Work with BKMI and IR 2 team to Team 2 will take X X Plan for ICT based

have discussion with DGFP based on lead for this activity distance learning program

their need develop and implement plan including e-learning

inQ3 started

for the ICT based distance learning courses developed started

Not yet yet Not yet Not

Work plan plan Work Developed Developed program and e-learning courses developed.

1.2.3 b Develop the technical update course Team 2 X X Curriculum and MCQ tests

content, curriculum and multiple for distance learning

choice questions (MCQ) tests with course developed t

been been started

emphasis on ICV for distance learning started

Not yet yet Not yet Not

A sample sample A

developed developed

No further further No

developed. version has has version and e-learning courses advancemen

1.2.3 c Take support of in-house IT staff and In house IT staff, X Website for the distance

BKMI to update the existing website BKMI learning course available

e-learning course

Not yet yet Not started yet Not started yet Not started Not started

Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.2.3d Participate/facilitate sessions in the X Sessions facilitated during

long-distance technical update the long-distance training

session

Not yet yet Not started yet Not started yet Not started Not started

1.2.3e Work with ME&R Team and BKMI to ME&R team to X A plan developed

develop a plan of monitoring/follow- follow up distance up of use of the long distance/e- learning training

learning training courses

Not yet yet Not started yet Not started yet Not started Not started Quarter-wise Narrative Description of Activity Q1 Achievement: No tasks of this activity were carried out. Q2 Achievement: MH – II recently recruited a Senior Program Officer with ICT and communication background. After the recruitment two meetings held and an outline of working on the subject matter has been decided. Q3 Achievement: Task # 1.2.3b: Bangladesh Knowledge Management Initiative (BKMI) is a USAID supported NGO that leads the BCC activities including the ICT implementation of ICT based BCC activities including development and implementation of plan for the ICT based distance learning program and e-learning courses. This activity in collaboration with BKMI is to disseminate information using ICT as a method of long-distance learning, as well as self-assessment of the participants participating in the course Based on the initial requirement received from BKMI, an eLearning course was prepared and incorporated into the portal. A basic sample version of technical update course curriculum and multiple choice question tests were developed. The full curriculum will be developed upon approval from the DGFP and USAID. Q4 Achievement In this quarter there was no further development n regarding the use of IT based technology for giving technical updates and FP information dissemination.

PY3/IR2 Workplan (October 1, 2014 –September 30, 2015) Activity Gantt Chart

Achievements through Quarter 3

IR 2: Demand for FP Services, especially LARC and PM Increased Sub-IR 2.1 Communication intervention promoting social norms for delaying, spacing, and limiting births implemented Activity 2.1.1 DISSEMINATION OF IEC/IPC MATERIALS AT DISTRICT HOSPITALS, MATERNITY AND CHILD WELFARE CENTERS (MCWCS), UHCS, H&FWCS, NGOS/PRIVATE SECTOR HEALTH FACILITIES Partners/Collaboration CCSDP, Logistics & Supply, and IEM units of DGFP, Hired agency for doing the initial distribution of IEC/BCC materials POC Bashir Ahmed/ Saleh Ahmed Shareef Tasks Task Description Inter-Team Implementation Time Benchmark/ Quarterly Achievement of # Collaboration Frame Deliverables Benchmark/ Deliverables Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2.1.1.a MH – II, BKMI, and SIAPS SIAP, BKMI, and x x x x DGFP’s distribution x x projects will work with the DGFP IEM and L&S unit of channel and system in L&S, and IEM units on adjusting DGFP place and operation to the DGFP’s logistic and supply order and distribute systems to enable the ordering and IEC/BCC materials distribution of SBCC materials to by the end of PY3 public, and selected NGO/private DGFP facilities to be in place and

operating. meeting held was with the

1 meeting was held with LD LD with held was meeting 1 of units IEM L&S, ofMIS, DGFP

2.1.1.b Develop/adapt, print/reprint, At the time of x x At least 7 types of - Ro , ,

IEC/BCC materials including PPFP developing new IEC/BCC materials man

for public and selected NGO/private IEC/BCC materials are printed for Ban aid health facilities of PY3 Districts seek feedback from distribution in 1183 ner - and FU Districts of PY1 and PY2. Team1 and 3 sites of 18 districts of - Leaf let PY3, and 2,459 of - Tiha

PY1 and PY2 districts

rt aid - - IUD Flo w - char t - Flip Cha rt - FP poc ket flip chart, FAQ BookletFP leaflet and PPFP

boo

Printed Roman banner, Tiahrt leaflet, , IUD flow chart

on Leaflets printed and Developed job PPFP printed and Developed job counseling PPFP printed and Developed k LARC/PM Printed 2.1.1.c Distribute and orientation on Hired Agency x 592 615 614 Distributed and x 633

IEC/BCC materials to public, oriented at least one Facil

selected private and NGOs facilities staff member from ities each facility on Orie IEC/BCC materials in nted half of the above sites 2,50 (1821) from public, 5 selected private and staff Completed in Q2 NGO facilities

2.1.1.d Distribute IEC/BCC materials to SIAP, BKMI, and x x x Distributed IEC/BCC public, selected private and NGOs IEM and L&S unit of materials in facilities using DGFP channels of DGFP remaining half (1821) distribution of the above

mentioned public, selected private and NGOs facilities. MH – II, BKMI and SIAPS are working

on developing the Completed in Q2 methodology of the orientation on IEC/BCC materials to

be done in the future.

Redistributed leaflet to 3,362 facilities facilities to3,362 leaflet Redistributed districts 2 PY and ofPY1 2.1.1.d Share IEC/BCC materials All the team members x IEC/BCC materials x distribution situation and develop will participate in the distribution and

follow-up plan. follow-up plan sharing follow-up plan is in ities

meeting. place

IEC/BCC IEC/BCC

FP facilFP

Through L&S

matterial I 637 unitdistributed

2.1.1.e Work with IEM and CCSDP units ME&R will provide x x x x Progress measuring of DGFP on how to measure the TA to develop tools to methodology

utilization of IEC/BCC materials measure the utilization developed and

to be finalized distributed by MH-II. of IEC/BCC materials. implemented. Tools yet

2.1.1.f Conduct follow-up visits (use All team members of 915 915 910 902 All facilities of PY3, Foll Foll structured checklists) to see the use MH-II will follow-up PY2, and PY1 where ow ow of IEC/ BCC materials at facility distribution of BCC IEC/BCC materials up up by level materials at time of have been distributed by their field visit and are followed-up phon phon e- over telephone through physical visit e- 1414 and over telephone. 652 ME&R will conduct Phys DQA visits as per ical M&E Plan follo Completed in Q2 w up- 215 Quarter-wise Narrative Description of Activity Q1. 2.1.1.c MH-II distributes IEC/BCC materials to 1,183 public and selected private and public facilities in 18 districts. 2.1.1.d The L&S and IEM units of DGFP would distribute and orient facility staff on IEC/BCC materials in 9 districts. To engage L&S and IEM units of DGFP for IEC/BCC material distribution, MH-II along with BKMI and SIAPS has developed a draft concept note on how to engage L&S and IEM units of DGFP for IEC/BCC materials distribution and orientation. 2.1.1.c An agency has been hired by MH-II through a competitive bidding process to distribute IEC/BCC materials to public and selected NGO/private facilities. The agency will also orient facility staff on how to use SBCC materials to improve the quality of FP counselling and demand generation activity. This activity will commence in January 2016. 2.1.1.b MH-II has procured 7 types of IEC/BCC materials for distributions. These are Roman Banner (250), Leaflet (600,000), Tiahrt (700), IUD Flowchart (700), Flipchart (700), and FP pocket book (5000). Roman Banner Leaflet Tiahrt IUD Flowchart Flipchart FP Pocket book 250 600,000 700 700 700 5000 2.1.1.f MH-II developed an IEC/BCC materials follow-up strategy to see the use and availability of the materials distributed by MH-II. The follow-up will be conducted through self-administered checklists, physical visits and phone calls. Three-part time staff has been hired telephone follow-up. So far these staff followed 652 facilities through phone calls. In addition, MH-II also engaged senior official of IEM unit of DGFP for IEC/BCC materials follow-up. In the reporting quarter To implement the follow-up activity smoothly through self-administered checklists and phone call, IEC unit of DGFP has issued a directive in this regards. Q2. 2.1.1.a In PY1 and PY2, MH-II distributed FP IEC/BCC materials to public and private facilities through a hired agency. MH-II planned to distribute the materials in 9 districts through the Logistic and supply unit of the DGFP to mainstream the IEC/BCC material distribution and in the rest of PY3 districts (9), material will be distributed through the hired agency. To distribution IEC/BCC materials through L&S unit of DGFP and to include a line item in eLMIS, MH-II along with BKMI and SIAP developed a concept note and shared it with IEM unit with aim that IEM unit would facilitate the process to include a line item in

70 eLMIS and distribution IEC/BCC material through L&S unit of DGFP. The plan says that distribution of IEC/BCC material by L&S unit will start from the first month of Q3. National Technical Committee approved Implant as a PPFP method, the said method needs to be included in the existing PPFP IEC/BCC materials. Additionally, some new job aids and IEC/BCC are required for counsel and creating demand for FFP services. MH-II has revised the existing materials and have developed new PPFP materials and shared with USAID. Based on the feedback, MH-II will revise job-aid and BCC materials for IEM Technical Committee’s approval. MH-II is expecting that Job-aid and BCC materials be approved by the first week of Q3. 2.1.1. c. Through a hired agency, MH-II distributed 7 types of IEC/BCC materials, Roman Banner (634), Tiahrt Chart (633), Flipchart (633) Leaflets (633,000), Family Planning (FP) Pocket Booklet (3817), FP FAQ Booklet (3815) IUD and Insertion Flowchart (633) to 634 publics, private and NGOs facilities in Barisal, Bhola, Brahmanbaria, Feni, Khagrachari, Rangamati, Bandarban, Rajbari and Faridpur districts. In addition, the hired agency also provided orientation to 2,705 staff of these facilities on how to use IEC/BCC materials during FP counseling and IPC.

Roman Banner Tiahrt Chart Flipchart Leaflets FP Pocket book FP FAQ booklet IUD Flowchart 634 633 633 633,000 3817 3815 633 2.1.1.f in PY1 and PY2, MH-II had distributed IEC/BCC materials to 2459 public, selected private and NGO facilities. To see the use and availability of the IEC/BCC materials, MH-II developed IEC/BCC material follow-up checklists and followed up 1629 facilities t by telephone (1414) and physical visited 215 facilities) t. The phone follow-up findings showed that 99% facilities received the IEC/BCC materials distributed by MH-II and more than 90% informed that they are using the materials during FP counseling and IPC sessions. MH-II also engaged IEM unit to follow-up facilities to see the use of IEC/BCC materials. They sent the IEC/BCC materials follow-up checklist developed by MH-II to 309 UFFO in Jan 2016. To date only 10% (32) of the UFPO sent back the filled in checklist. Q3 Achievement: Task# 2.1.1a: The three USAID implementing partners—MH-II, BKMI, and the Systems for Improved Access to Pharmaceuticals and Services Program (SIAPS)— organized a meeting with Line Directors (LDs) of the Information, Education, and Monitoring (IEM), Logistic and Supply (L&S,) and MIS Units to explain the effort undertaken to establish a system of ordering, distribution, and reporting on IEC/SBCC materials and other products. Subject to the approval of the DG of the DGFP, all Directors agreed to integrate IEC/Social and Behavior Change Communications (SBCC) reporting into the DGFP eLMIS Dashboard. A meeting with DGFP will be held during the second week of July 2016 to move this effort forward.

Task# 2.1.1b: MH-II updated three PPFP job-aids and two IEC/SBCC materials and obtained approval clearance from the IEC Technical Committee during this quarter. Using the PPFP counseling job aid, field staff will counsel women attending ANC and PNC visits during the Expanded Program on Immunization (EPI) and satellite session. In this reporting quarter, MH-II printed 10,000 PPFP job-aids, 6,000 PPFP counseling job-aids, and 900,000 PPFP leaflets. Based on follow up findings from the IEC/SBCC material distribution process, MH-II printed 1,650,000 copies of LARC and PM leaflets and redistributed these leaflets to 3,362 facilities from PY1 and PY 2 districts through IEM and the L&S Unit of the DGFP (See Activity #2.1.1.d).

Task# 2.1.1.c: MH-II planned to distribute IEC/SBCC materials in 18 districts from PY3, of which 50% are using a hired agency and 50% through the L&S Unit of the DGFP. This distribution of IEC/SBCC materials was completed in the second quarter of PY3 (See Activity #2.1.1c of Q2). Additional distribution of IEC/SBCC materials will be done in Q4.

Task# 2.1.1.d: This quarter, 500 LARC and PM leaflets per facility were distributed in 3,362 facilities (MCWC, UHC/Sadar clinic, and the UH&FWC) from PY1 and PY2 districts through the DGFP’s L&S channel. In addition, MH-II will distribute IEC/SBCC materials in nine districts from PY3 through the L&S channel by Q4.

Task# 2.1.1.e: A draft checklist was developed in consultation with ME&R team to measure the utilization of IEC/SBCC materials distributed by MH-II. After reviewing this information, the checklist will be shared with the IEM Unit of the DGFP for review and feedback.

Q4 Achievement Task# 2.1.1a: During this quarter DG, DGFP approved to include BCC line items into the dashboard of the eLMIS. The minutes of this decisions were issued on the 8th August 2016.By this time SIAPS has included SBCC line items in the inventory management of DGFP and eLMIS. Now the policy decision makers can generate the information from the eLMIS to determine the SBCC materials' in stock. An initiative will be taken to include the SBCC in the reporting formats of DGFP in the PY4. Task# 2.1.1b: MH-II printed 500 Roman banner (137 roman banners were in store), 1,000 Tiahrt, 700 Flipchart, 350,000 Leaflet on LARC/PM (287,000 leaflets were in store), 5,500 FP FAQ booklet and 1,100 IUD insertion flowchart for distribution at the facility of nine districts of PY3 through L&S unit of DGFP and printed 2,400,000 PPFP leaflets for distribution at the facility of PY1, PY2 and PY3 districts. In addition to that MH-II printed 700 Festoon on Court Yard Meeting and 450 Festoon on PPFP FP for distribution at the facility of Feni district where compliance culture intervention is being implemented. Task# 2.1.1c: Activity completed in Q2 Task# 2.1.1d: Through the logistic and supply unit of DGFP, distributed Roman Banner (637), Tiahrt Chart (637), Flipchart (637) Leaflets (637,000), Family Planning (FP) Pocket Booklet (4,117), FP FAQ Booklet (4,114) IUD and Insertion Flowchart (637) to 637 publics facilities in Jhalakati, Pirojpur, Barguna, Munshiganj, Manikganj, Shariatpur, Narshingdi, Netrokona and Tangail districts. In addition, MH-II distributed 2,264,000 PPFP leaflets to 4,528 public facilities of 56 districts of PY1, PY2 and PY3 of MH-II. Table 9: Number of SBCC materials distributed through logistic and supply unit of DGFP and by MH-II Roman Tiahrt Flipchart Leaflets FP Pocket FP FAQ IUD PPFP Banner Chart book booklet Flowchart leaflets 637 637 637 637,000 4,114 4,114 637 2,264,000

Activities 2.1.2 DEMAND CREATION AND MARKETING ACTIVITIES IN SELECTED FOR PROFIT PRIVATE HEALTH FACILITIES Partners/ Collaboration Private health facilities, DGFP and DGHS, NGO and UPHCSDP, SMC, Meridian Group International POC Saleh Ahmed Shareef/Shahid Hossain 2.1.2.a Continue providing training and 400 400 400 400 At least 1600 clients Total Tota 1,53 3,977 client material support to Reproductive received FP, FP l FP 8 who Health Service Promotion Officers especially injectable, Clien Clie clien received FP (RHSPO) from 11 private sector and LARC services ts- nts- ts services facilities in Dhaka. Team-1 will provide using SMC supplies 939 1194 recei (LARC & clinical training to (Inj, (Inj ved Injectable build the capacity of LAR LAR FP 1,326) C C servi service providers of and and ces selected private health PM PM- (Inj facilities. 253) 210) LAR C and PM- 574) 2.1.2.b Select, negotiate, and sign MoU Team-1 will provide 10 10 New 20 facilities in 10 5 5 Completed in Q3 with new private health facilities to clinical training to Dhaka agreed to scale-up RHSPO interventions. build the capacity of implement RHSPO newly selected private intervention health facilities’ service providers. ME&R will provide support to develop 15 15 30 persons, trained on - 19 35 M&E plan for newly LARC/PM (1-2 persons from each selected private health facilities. facility).

At least 2400 clients 469 1194 1896 received FP services, client clien clien especially Injectable, s ts ts and LARC services recei recei recei using SMC supplies ved ved ved FO FO FO servi servi servi ces ces ces (LA (Inj (Inj RC LAR LAR and C C PM and and clinet PM PM s-73) cline cline ts- ts- 210) 210) 2.1.2 c Increase awareness among people Team-1 will organize - 5 FP 49 No living around the clinics where FP special days as per 75 FP special service days FP require special services day will be their plan. 10 20 20 25 days organized and (clie spec made for organized (through distributing implemented nts- ial special leaflets, promotion banners/posters 68) day day and conducting IPC) (750 clie nts) 2.1.2 d Collect information, compile ME&R 1 Outline best practices 1 1 Ongoing relevant data and develop outline of methodologies and Meridian will support lessons learned for write-up on best write up developed analysis and practices from for-profit health documentation. facilities through the activities of the RHSPOs. Dissemination on best practices will be done in next year. Quarter-wise Narrative Description of Activity Q1 Achievement:

2.1.2.a/2.1.2. b MH-II will continue providing support to 10 private health facilities of PY2 and will work with another 20 new facilities in PY3. In the reporting quarter, private health facilities selected in PY 2 has disseminated information on FP issues to 1,233 (male-191 and female-1042) clients and of them, 469 clients chose to adopt an FP method. (Pill-123, Condom-159, ECP-35 injectable-79, implant-18, IUD-16 and Tubectomy-39 (PPIUD-07 and PPBTL-37). Pill Condom ECP Injection Implant IUD Tubectomy 123 159 35 79 18 16 39 In Q1 of PY3, 28 private health facilities were approached to work with MH-II to create demand for FP information and services among their clients. Of them, 12 facilities have agreed and signed a MoU with MH-II. Eight private facilities principally agreed to work with us and MOUs will be signed in January 2016. Q2: 2.1.2.a MH-II Continued following up the activities of the RHSPO interventions. PY 2 10 private facilities provided FP services to 1194 clients (Injectable-119, Implant-21, IUD-25, Tubectomy 45 (44 cases were post-partum Tubectomy) Condom 506, Pill 401, ECP 77. Pill Condom ECP Injection Implant IUD Tubectomy 401 506 77 119 21 25 45

2.1.3.f In addition, Five FP special days were organized in the private health facilities and 68 clients received FP services (Injection-30, IUD-03, Implant-07, NSV- 28). Injection Implant IUD NSV 30 07 03 28 2.1.2.b. Till Q2, 15 facilities signed a Letter of Agreement to work with MH-II. MH-II, provided training to 12 RHSPOs from 6 new private facilities. Rest of the facilities recruited their RHSPO in March 2016 and their training will start from 2nd week of April 2016 Along with orientation on how to use these materials, MH-II distributed IEC/BCC materials to 6 new private facilities and IEC/BCC materials will be distributed to the rest of the facilities after the training of the RHSPO. MH-II conducted 16 monitoring visits for PY2 private facilities to provide support to enhance the skills of RHSPOs to increase demand for LARC and PM services. Q3 Achievement: Task# 2.1.2 a. MH-II continued to follow up with the activities of 10 private facilities selected in PY2. During reporting quarter, these facilities provided FP services to 1,1538 clients (Table-9).

Table 9: Type of FP service received from 10 private health facilities

Pill Condom ECP Injection Implant IUD Tubectomy Total

631 283 50 439 30 21 84 1,538

Task# 2.1.2.b: During the reporting quarter, MH-II signed a Letter of Collaboration with five new private facilities after which the project provided a three-day training on FP for RHSPOs on generating demand for LARC and PM services. The newly selected facilities were also decorated with LARC and PM information so that clients coming to these facilities received maximum exposure of FP information.

Q4 Achievement Task# 2.1.2.a: MH-II Continued to follow up the activities of five private facilities which were selected in PY2 of MH-II project and discontinue six facilities due to unsatisfied performance. In the reporting quarter, 13 facilities (old-05 and newly signed 08) provided FP services as below: Table 10: Performance of private health facilities by methods Pill Condom Injection Implant IUD Tubectomy NSV Total 1,511 1,140 1,036 38 56 182 14 3,977 ECP 53 Task# 2.1.2.b: In this reporting quarter MH-II continued follow-up for newly signed private facilities and RHSPOs of these facilities to create demand for LARC and PM services. As a result, nine newly signed facilities activate FP services and others on the process. Activity 2.1.3 WORKPLACE INTERVENTIONS ON FAMILY PLANNING IN THE SELECTED GARMENT FACTORIES. Partners/ Collaboration BGMEA, garments factories, private health facilities, UPHSDP, NHSDP, DGFP and DGHS, Meridian Group International POC Saleh Ahmed Shareef /Shahid Hossain 2.1.3.a Continue FP information ME&R will conduct 4,000 4,000 4,500 12,500 garments 5,348 3,00 26,9 Out of dissemination to garment workers DQA as per M&E workers from 15 6 41 18,364 , in group sessions by Workplace plan factories of PY1 and received Coordinator (WPC) and Peer PY2 received information Educators. information on FP and Total 1,639 sources of FP services. clients Ensured supply of pills referred and condoms at the facilities and factories.

2.1.3.b Collect information, compile Meridian will support x Outline of best practices Outline relevant data and develop outline of analysis and methodologies and of best lessons learned for write-up on best documentation. write up developed practices practices from workplace shared interventions. Dissemination best with EH practices will be done in next year. HQ 2.1.3.c Work with BGMEA to select new Meridian will support 20 20 new garment 20 - - Complete garment factories to implement scale-up strategy. factories agreed to d in Q1 workplace interventions and implement workplace increase private investment. interventions on FP issues 2.1.3.d Skill building of newly selected 20 x Trained 20 mid–level 42 - - On the factories to create awareness on FP and management staff and and job issues among their workers. 100 100 senior garments 116 training - workers of newly 6 selected factories conducte

At least 25,000 d- garments workers of the newly selected factories received information on FP issues and where to receive services. 2.1.3.e Provide on the job training to 60 30 10 x The first two group 60 30 5- 6 Workplace Coordinators (WPC) sessions in each and Peer Educators to conduct selected factories are group sessions on FP issues. organized jointly by MH-II staff and WPC.

2.1.3.f Facilitate the process of organizing Team-1 will help 15 10 25 25 1,125 FP client 26 26 30 15special additional special FP services day. organize FP special received services (284 (382 (254 days services days from 75 FP service Inject Injec organized Injec days organized in able, table table garment premises for LAR , Total 424 , garments workers. C LAR clients LAR Clien C C received ts) Clie Clie IP nts) nts) services

2.1.3.g Provide support to garment Team-1 will build 31 List of referral - 31 - Complete factories to conduct facility capacity of referral facilities are prepared d in Q2 mapping exercise to establish facilities if required. by each factory referral linkages for FP services.

2.1.3.h Provide orientation to selected ME&R will act as 5 10 Selected BGMEA 5 10 _ 15 BGMEA officials on the follow up resource person in officials are checklists to the monitor progress orientation session. conducting follow-up of workplace interventions visits and submitting report to MH-II and

BGMEA 2.1.3.i Provide need based support to 50 Selected 25 factories 69 Complete selected factories to provide LARC clinics who want to clini d in Q3 information and services from their provide injectable and cal own clinics (not from BGMEA LARC services. staff Clinic). were train ed to prov ide injec table servi ce

2.1.3.j Develop a system to make FP Team-3 and 1 will A system of 12 commodities available in the help establish linkage identifying and factories selected health centers of garments between BGMEA collecting FP started to factories. health facilities and commodities by the get FP clinics in selected factory clinics from commoditi garments factories the BGMEA Health es who are willing to Centers was supplied provide FP services. established. FP by GoB commodities (pill, condom and injectable) are available in 25 garment clinics 2.1.3.k Develop and implement Meridian will support 10 Innovative 2 garment communication plan for factory- development of counselling factories based campaign (SMS, leaflets, and communication approaches/strategies selected job aids to counsel injectable and strategy. and tools developed for other short acting contraceptive and implemented to disseminat Team-1 will guide on

clients to LARC methods). increase the use of ion developed

clinical issues plan Action LARC methods in the developing the plan. workplace. Quarter-wise Narrative Description of Activity Q1. 2.1.3.a In partnership with BGMEA, MH-II has been rolling out workplace interventions on FP issues in 14 garments factories from PY2. In the reporting quarter, 10,480 garments workers have been educated on FP issues and 2,035 workers received FP methods including LARC and PM (72 LARCs PM). 2.1.3.f In order to increase the access of garments workers to LARC services, 10 special FP service days were conducted in the garment factory premises. To sustain FP program, MH-II will build the capacity of the clinical services providers from these factories and build the capacity of the Workplace Coordinator (who will educate their workers on FP issues) and how to organize special days in their garments factory using their own resources. 2.1.3.c/ 2.1.3.d To scale-up workplace interventions, MH-II along with BGMEA has selected 30 garments factories in PY3 and trained their mid-level management staff (32) and senior garment workers (116) who will work as Workplace Coordinator and Peer Educators respectively to implement workplace interventions in their garment factory. Workplace Coordinator and Peer Educators will begin educating their staff on FP issues from Q2. Q2.MH-II Provided support to BGMEA to get affiliation of their 05 Clinic in Gazipur#2, Narayangonj#1, Hemayetpur#1 and Ashulia#1, Narayanganj has already got Govt. affiliation and the other 4 is currently in the process.

2.1.3.a The workplace intervention has been ongoing in 45 readymade garments factories. To create awareness on FP methods, IEC and BCC materials have been disseminated to 30,000 garments workers which will increase their knowledge and eliminate the myths and misconceptions regarding FP. Moreover, a number of sessions have been conducted to ensure effective communication on Family planning in the workplaces.

MH-II continued to provide support to factories as and when required. To increase demand for LARC and PM services, Peer Educators and Workplace Coordinators conducted 554 batches of FP session at workplace for 13,937 (Female: 9,478 and Male: 4459). In addition to group session, Workplace Coordinators conducted 85 video shows at workplace on FP issues. A total of 4,397 attended the video show.

MH-II, BGMEA and DGFP signed a triparty agreement through which the garment factories will be able to procure free FP commodities from DGFP. MH-II has also taken an initiative to build the capacity of the selected factories so that garments workers can get LARC services from their factory’s clinic.

2.1.3.f MH-II provided support to organize 26 Special FP Service Day at garments factory premises and referred 3006 workers. From the special day services, 2,764 workers chose to adopt an FP method (Injection-167, Implant-11, IUD-04 and Tubectomy-04, condom-1,042 and Pill-1,536)

Condom Pill Injection Implant IUD Tubectomy 1042 1536 167 11 04 04

2.1.3.g. Provided support to 31 garment factories to conduct facility mapping exercise to establish referral linkages for FP services. The referral facilities provide the 2.1.2. b FP services to

Q3 Achievement: Task# 2.1.3.a &b: In this reporting quarter, 26,941 garment workers attended 1,079 group education sessions on FP issues. These sessions were organized by mid- level management staff of the garment factories who had earlier received a TOT on FP and RH issues from MH-II. This activity is considered one of the project’s best practices. MH-II has initiated the process of documenting the interventions successes with support from the Population Council, a partner of the MH-II project.

Task# 2.1.3f: To increase access among garment workers to LARC and PM services, 30 special FP service days were organized by BGMEA clinics within garment factory premises. For this intervention 2,711 clients chose to receive a FP method (Table-10).

Table 10: Type of FP service received from workplace

Pill Condom ECP Injection Implant IUD Tubectomy NSV Total 1,189 1,232 36 227 20 3 2 2 2,711

Task# 2.1.3i. To increase access to FP services, 69 clinical staffs (including nurses, paramedics, and Medical Assistants) from 30 MH-II supported factories were provided training on pills, condoms, and injectable.

Task# 2.1.3j. This has been in connection with the DGFP providing short-acting methods to mini-clinics within garment factories under the tripartite Memorandum of Understanding (MOU) between the BGMEA, DGFP, and MH-II. According to this agreement, garment factory workers have free access to short-term FP methods from the local DDFP/UFPO office without the mini-clinic requiring affiliation with the DGFP.

Task# 2.1.3.k In the MH-II supported garment factories, information dissemination on FP methods are done through group session which labor intensive and time consuming interventions. To equip the garment workers with FP information, MH-II has planned to send text message on family planning methods and source of FP services. In line with that MH-II drafted a concept note on short messaging system (SMS)-based demand generation for FP services for garment factory workers and to dispel myths and misconceptions associated with FP services, especially LARC and PM methods. This concept note will be shared with USAID in the next quarter soon.

Q4 Achievement Task# 2.1.3a: This quarter till the end of September 2016, 18,364 garment workers received information on FP and sources of FP services through 704 group sessions conducted by the workplace coordinators and peer educators (mid-level staff of the garments). Total 1,639 clients were referred. The method wise breakdown is as follows: Condom Pill ECP Injection Implant IUD Tubectomy NSV Total (pieces) (cycle) (pieces) 602 578 9 291 13 1 1 0 1,494

Task# 2.1.3b: MH-II has developed a write-up on best practices from workplace intervention and it has been shared with EngenderHealth HQ for their review and finalization. Task# 2.1.3e: In this quarter six on the job trainings were conducted for the work place coordinators and peer educators in different garment factories. Task# 2.1.3f: In this quarter till the end of September, 2016, 15 FP special days have been organized at the garment factories premises where 424 clients received FP services (condom, pill, injectable, implant, IUD, Tubectomy, and NSV). Table 11: Number of client received FP services from FP special day organized at the garment factories premises by methods Condom Pill Injection Implant IUD Tubectomy NSV Total 246 106 65 7 0 0 0 424

Task# 2.1.3h: In selected garments factory health facilities 15 follow-up visits conducted by the designated BGMEA officials using a monitoring tool. Task# 2.1.3j: In this reporting period twelve health centers of the garment factories started to collect FP commodities (pill, condom and injectable) from the GOB FP offices after a letter had been issued from the DGFP to select a focal person to collect FP commodities from the FP offices of respective garment factory to make the system more effective and it will be available very soon. The rest of the factories are on the process of receiving the three commodities as well. Task# 2.1.3k: MH II developed the technical detail of SMS campaign and shared and received approval with and from DGFP and USAID. Initial SMSs have also been selected and will be shared with DGFP and BGMEA for finalization. A meeting with BGMEA has been conducted in this regard and we have got the approval to disseminate in two of the selected garment factories. Sub-IR: 2.2 Accurate knowledge of FP, especially LARCs and PMs, increased among community leaders, families, and clients SUPPORT TO THE DGFP, DGHS, BCC WORKING GROUP, CCSDP AND UNFPA UNIT OF THE DGFP TO Activity 2.2.1 INCREASE USE OF LARC AND PM SERVICES Partners/Collaboration CCSD, DGFP, DGHS, UNFPA, BCC Working Group POC Bashir Ahmed/ Waliul Islam/Shahid Hossain 2.2.1.a Provide support to CCSDP and 6 6 x x Provided TA on 35 7 NA Orientation IEM unit of DGFP to build the technical in-depth conducted skills of satisfied IUD and NSV discussion related to with users to generate new IUD and LARC and PM to satisfied NSV clients. DGFP in 12 users (IUD, workshops. TA also NSV users) provided to develop a tracking system to monitor the performance of the oriented satisfied NSV and IUD clients.

2.2.1.b Provide training and supply BCC Team-3 will provide x x x x 28 DGFP staff and Trai Material materials to CCSDP unit of DGFP capacity building 750 Volunteers ned distributed to scale up YMC intervention in 14 schedules for the received training 1195 in the Upazillas (2 Upazillas of one volunteers. volu previous Required IEC/BCC District from each of the 7 nteer quarter materials provided to s Divisions) CCSDP in 14 Distr Upazillas where ibute YMC interventions d FP will be implemented. flipc 28 DGFP staff and hart, Han 750 Volunteers d received training book 750 volunteer will , reach at least 750,000 Rom an YMCs. bann er (CY M), LAR C/P M Leaf let, Volu nteer job- aid on FP, Bag, Umb rella, and Note book

2.2.1.c Coordinate with UNFPA at the x 1 x 1 One coordination - 2 Atte district-level to have synergy meeting every 6 nded between UNFPA’s district level months attended for 2 (five districts) FP campaign and UNFPA FP campaign meet MH-II activities. in each of the five ing districts (10 meetings). 2.2.1.d Participate in BCC Working Group x x x x Participated in BCC 1 Attended 2 and sub group meetings. Working Group and meetings sub group meetings (estimated 6 meetings). 2.2.1.e Disseminate MH-II achievements, All teams will write- x x x x Quick updates x 1 1 Published lessons learned through quick up achievements and published in every quick updates, social media, and provide key lessons learned. quarter and one updates write-ups in the DGFP’s newsletter. article on MH-II (newslette achievement r) published in DGFP

newsletter.

2.2.1.f Participate in national and Members from the At least two events x - Obse Observed international days such as Safe each team will observed rved population

Spec 1 event 1 Motherhood Day; World Population participate. event 1 day 2016

Day; National FP/MCH service ial

delivery days. FP servi ce day Quarter-wise Narrative Description of Activity

Q1.2.2.1.a DGFP is providing orientations to the satisfied IUD acceptors and NSV clients to further generate new FP clients especially new IUD and NSV clients. MH-II is providing technical support to the CCSDP unit of DGFP to conduct these orientations. In the reporting period, a total of 35 sessions have been conducted and 675 IUD acceptors and 175 NSV clients have been orientated in Magura, Feni, Shariatpur, Bandarban, Khagrachari, Kishoreganj, Rajshahi, Nilphamari and Jhalakati districts. In most of the places where NSV satisfied acceptors workshop has been conducted we have started seeing a positive increase in the number of NSV acceptors. 2.2.1.b In order to scale up the YMC intervention the CCSDP unit of DGFP had planned to recruit 750 volunteers but they were not able to recruit these volunteers yet. Once they recruit, MH-II will provide necessary support to implement this initiative. 2.2.1.c In the reporting period, MH-II has attended three meeting on the National FP campaign progress review meeting. This year UNFPA is implementing a National FP campaign in five (Narshingdi, Barisal, Jhenaidah, Sirajganj and Rangpur) districts where MH-II will be working in two districts (Barisal and Narshingdi) in PY3. 2.2.1.d During this period MH-II has attended a workshop on ICT intervention in SBCC organized BCC working groups held on 28 October 2015. The objectives of this workshop were to use ICT in designing SBCC materials and attended 18th BCC working group meeting held on 15 December 2015. In this working group meeting the special focus was given on PPFP and greater collaboration with other stakeholders to avoid duplication. 2.2.1.e In order to disseminate MH-II achievements and lesson learned through quick updates and social media, 6 events information have been posted into Facebook and two success stories have been posted into the e-bulletins published by IEM unit of DGFP. Q2.2.2.1.a To create demand for FP services, especially IUD and NSV methods, CCSDP with the support from MH-II built the capacity of 79 IUD clients and 172 NSV clients through 7 batches of orientation session in Rangamati and Moulvibazar districts. The satisfied IUD and NSV users worked with the FWAs to increase demand and dismiss myths and misconceptions about IUD and NSV methods. Analysis of 69 Upazillas’ performance data shows that the uptake of NSV services increased by 16% due to these interventions. 2.2.1.b For scaling up of YMC intervention, CCSDP unit of the DGFP has issued a circular on 28 February 2016 to recruit 1195 volunteers for 14 Upazillas in 7 districts (1. Jamalpur: Islampur and Dewanganj; 2. Rangamati: Rajasthali and Baghaichari; 3. Cox’s Bazar: Ukhia, Ramu; 4. Noakhali: Begumganj and Hatia; 5. Sunamganj: Dharmapasha and Jagganthpur; 6. Sirajganj: Shahajadpur and Kazipur; 7. Barguna: Amtoli and Bamna). CCSDP has planned to complete the recruitment process of YMC volunteers by March 2016 and then MH-II will provide TA to build the capacity of the YMC volunteers and will distribute IEC/BCC materials for demand creation. 2.2.1.c In order to ensure effective coordination, UNFPA and MH-II meet periodically and share information. In the reporting quarter, MH-II attended two meeting organized by UNFPA. To strengthen demand generation efforts, MH-II distributed FP IEC/BCC materials in UNFPA national FP campaign areas. In this reporting period MH-II has attended an International Congress on AIDS in Asia and the Pacific (ICAAP-2015) in Dhaka from 12 to 14 March 2016. In this conference MH-II set up a stall and distributed different IEC/BCC materials among the conference participants.

Q3 Achievement: Task# 2.2.1.b: In this quarter, MH-II provided support to the CCSDP Unit of the DGFP to train 1,195 volunteers to disseminate FP information among young married couples (YMCs) (aged between 15-24 years) as part of the DGFPs YMC project. To create demand and counsel YMCs, MH-II provided 1,195 FP flipcharts, handbooks for volunteers, Roman banners for the conduct of courtyard meetings (CYMs), FP job aids on FP methods, a bag, an umbrella with FP messages, and a notebook. The project also produced and disseminated 239,000 LARC and PM leaflets. The DGFP’s YMC intervention/project is being implemented in 14 low performing Upazillas in seven low performing districts in Bangladesh. (See Activity #2.1.1b of Q2.)

Task# 2.2.1.d: During this reporting period, MH-II attended a BCC Working Group Meeting held on June 20, 2016 where project staff presented on the development and distribution of IEC/SBCC materials through hired agency and the L&S channel of the DGFP.

Task# 2.2.1.e: MH-II Quick Update #6 was completed and circulated during this quarter. The MH-II project’s Facebook page has been updated with new program information and 300 new Facebook account holders liked MH-II page. users have been engaged.

Task#2.2.1.f: DGFP observed FP and MCH services during the week of May 14th during which MH-II provided 310 banners with service week information and 325,000 PPFP leaflets for distribution among community members throughout the week.

Q4 Achievement Task# 2.2.1a: To create demand for FP services, especially IUD and NSV methods, CCSDP with the support from MH-II built the capacity of 30 IUD clients and 47 NSV clients through 2 batches of orientation session in Sadar Upazilla of Barguna district and Kuakata Pourashava under Khepupara Upazilla of Patuakhali district. The satisfied IUD and NSV users worked with the FWAs to increase demand and dismiss myths and misconceptions about IUD and NSV methods. Task# 2.2.1d: MH-II attended HPN BCC e-Toolkit Sub-Group meeting held on 25th July and 26th September 2016 to discuss the programs. As per decision of that meeting the soft copy of the IEC/SBCC materials were sent to the Information, Education, and Monitoring (IEM)unit of DGFP to upload into the e-Toolkit. Task# 2.2.1d: MH-II Quick Update #7 was completed and circulated during this quarter. Task# 2.2.1f: MH-II observed the Population Day-2016 and set up a stall at the venue and distributed different IEC/BCC materials among the participants.

Sub-IR 2.3 Client Identification and referral increase through community facility links Activity 2.3.1 STRENGTHEN COMMUNITY-FACILITY LINKAGES THROUGH ON BCC AND ADVOCACY WORK TO INCREASE REFERRALS for LARC AND PM SERVICES THROUGH SHUSHILAN IN KHULNA – A DISTRICT BASED NGO. THIS SUB-GRANT will END IN PY3

Partners/Collaboration GO and NGO FP service delivery facilities, Meridian Group International POC Waliul Islam/Bashir Ahmed 2.3.1.a Review performance and provide ME&R will conduct 1,850 1,850 1,850 1,850 At least 90 % of 7400 1,817 1,89 2748 Out of supportive supervision to Shushilan DQA as per M&E referred clients received 8 refer 2,899referr project staffs to achieve objectives plan injectable or LARC and red ed clients of the project. PM services from and 1,778 nearby 13 public 1757 received facilities clien injectable, ts LARC and have PM servi ces 2.3.1.b Collect information, compile All senior team Outline of best Doc Documen relevant data and develop outline of members will review practices ume tation lessons learned for write-up on best best practices and methodologies and ntati on process practices. Dissemination best provide comments write up developed has been practices will be done in next year. proc ess develope has d and start shared ed with EH, HQ 2.3.1.c Provide guidance for organizing FP Team-1 will help 400 clients received special days through building the organize FP special LARC and PM capacity of the NGOs so that they service days (Implant, IUD can do the activity in future by 10 5 5 5 Tubectomy, and 12 13 11 20 special days, 152 themselves. NSV) services during LARC and 25 special FP services PM days organized in methods areas where received Shushilan is working. 2.3.1.d Negotiate and provide support to Integrated LARC and Integ rated Shushilan to integrate LARC and 1 1 1 x PM in their 3 other 1 x PM related information in their programs. The FP outcome of issue

other 3 programs where applicable integration would be s in and develop a sustainability plan measured by the the number of referrals one made. A prog sustainability plan ram calle developed. d Sha wdhi kar Quarter-wise Narrative Description of Activity Q1.2.3.1. a A total of 2057 prospective FP clients were referred and 1,817 of them chose to take method. (Injectables-885, Implants-646, IUD-165, Tubectomy-91, NSV-30). Injection Implant IUD Tubectomy NSV 885 646 165 91 30

Out of 1,817, clients 130 clients received FP services from 12 special days organized by Shushilan with support from EHB (Implant-79, IUD-28, Tubectomy-20 [PPFP-17] and NSV-03).

2.3.1.b 130 clients received FP services from 12 special days organized by Shushilan with support from EHB (Implant-79, IUD-28, Tubectomy-20 [PPFP-17] and NSV-03). To build the capacity of Shushilan to organize FP special day with minimal support from MH-II, FP special day organization guidelines are being developed. The guidelines will be finalized and orientation on the guidelines will be completed by January 2016.

Injection Implant IUD Tubectomy NSV 885 79 28 20 03

As part of integration, Shushilan have been using their community based volunteers working in one Upazila of Satkhira district. In the reporting quarter, 20 volunteer generated 385 FP clients (Tubectomy-13, NSV-07, IUD-35, Implant-70 and Injectable-260).

Injection Implant IUD Tubectomy NSV 260 70 35 13 07

Q2: 2.3.1.a A total 1,898 clients received services against 2474 referred cases (Injectables-875, Implants-701, IUD-218, Tubectomy-73 and NSV-31); of the total clients 169 received FP services from 13 special FP days which as organized due to the advocacy effort of MH-II and Shushilan (Implants-135, IUD-02, Tub-28 and NSV-04). Review of reports shows that the uptake of IUD has increased from Q1 (165) to Q1 (218). Injection Implant IUD Tubectomy NSV 875 701 218 73 31 2.3.1.c 13 special FP days which as organized due to the advocacy effort of MH-II and Shushilan (Implants-135, IUD-02, Tub-28 and NSV-04) Implant IUD Tubectomy NSV 135 02 28 04 As per plan, Shushilan has organized 21 Pot Songs and Drama shows in difference places in their working areas to increase demand for LARC and PM services, in each show approximately 300 people from the community attended. Shushilan has now integrated FP issues in their Shawdhikar Program. 4 Q3 Achievement: Task# 2.3.1a: A total of 1,757 clients chose to receive an FP service (injectable-780, implant-602, IUD-289, tubectomy-69, and NSV-17) against 2,748 referred clients. A total of clients 110 chose to uptake of FP services during 11 special FP days organized by MH-II and Shushilan (implant-88, IUD-4, Tubectomy-14, and NSV-4). Shushilan’s progress report shows that the uptake of IUDs has been steadily increasing from 165 in Q1 to 218 in Q2 and 289 in Q3, as Shushilan volunteers spend more time discussing FP myths and misconception at the community level and provide improved counseling on IUD special days.

Task# 2.3.1b: With support from the Population Council, the best practices (project brief) documentation process on this activity has started.

Task# 2.3.1.c: Community-based volunteers from Shawdhikar (a different project of Shushilan) have been working in Shyamnagar Upazilla of Satkhira district. In the reporting quarter, 20 Shawdhikar volunteers served 333 FP clients (tubectomy-10, NSV-6, IUD-34, implant-77, and injectable-206). With support from MH-II, Shushilan integrated FP in to Shawdhikar project activities, which are funded by a different donor.

Task# 2.3.1.d: As per the Workplan, Shushilan organized 13 Pot Songs and drama shows in difference locations within in their working areas to increase demand for LARC and PM services. Approximately 300 community members attended each show.

Q4 Achievement Task# 2.3.1.a: During this quarter volunteers from Shushilan referred a total 2,899 clients and received services 1,778 (Injectables-685, Implants-718, IUD-279, Tubectomy-78 and NSV-18); Volunteers from Shushilan are sparing more time in discussing myths and misconception at the community level and better counseling during the IUD special days.

Task# 2.3.1b: A project brief on ‘Volunteer Networks for Family Planning’ documentation has been developed and will be shared with EH-HQ for review. Task# 2.3.1c: In the reporting quarter, Shushilan organized 20 special FP days which as organized due to the advocacy effort of MH-II and 152 clients (Implant-103, IUD-30, Tubectomy-15 and NSV-4) received LARC and PM services. The QA team from MH-II attended the special days. Task# 2.3.1d: Community based volunteers named Shawdhikar have been working in Shyamnagar Upazilla of Satkhira district. In the reporting quarter, 20 volunteers from Shawdhikar generated 517 FP clients (Injectable-360, Implant-91, IUD-33, Tubectomy-26 and NSV-7) As per plan, Shushilan has organized 04 Pot Songs and Drama shows in different places in their working areas to increase the demand for LARC and PM services, each show attracted approximately 400 people from the community attended. In addition, Shushilan created a video documentary on the pot song drama. In this quarter, Shushilan integrated FP information into their another program named Nirapod.

Activity 2.3.2 STRENGTHEN CLIENT MOBILIZATION AND REFERRALS FOR LARC AND PM Services USING BRAC FIELD FUNCTIONARIES. THIS SUB-GRANT WOULD END IN PY3 Partners/Collaboration DGFP, DGHS, NGOs POC Sushanto Shekhar Roy/ Shahid Hossain 2.3.2.a Review performance and provide ME&R will conduct 27,500 27,50 27,50 27,50 At least 50% referred 10,35 16,5 18,1 Out of supportive supervision to BRAC DQA as per M&E 0 0 0 clients (110,000 8 31 66 18,528 field staffs to achieve objectives of plan clients) received referred the project. injectable, and LARC clients 17,273 clients received inj. and LARC PM 2.3.2.b Collect information, compile All senior team x x Outline of best - - Draft relevant data and develop outline of members will review practices project lessons learned for write-up on best the write up on the methodologies and brief practices. Dissemination best Best Practices and will write up developed prepared practices will be done in next year. provide their and comments

shared internally 2.3.2.c Provide guidance for organizing FP Team-1 will help 12 15 15 8 50 additional special 11 18 60 30 FP special days by building the organizing FP special FP services days FP FP FP days capacity of the NGOs so that they services days organized and 500 days days Days Clients can organize activity in future by clients received Clie 742 themselves services nts Clien Clie Guideline on how to ts- nts- 1414 organize FP special 299 491 days and used by 5 NGOs Quarter-wise Narrative Description of Activity Q1. 2.3.2.a In this quarter BRAC organized (from October to November 2015), a total of 10,358 clients (10% of PY3 projection) were referred and out of which 9,990 clients received a FP method (Injection-8129, IUD-124, Implant-1612, NSV-22, Tubectomy-103). Injection Implant IUD Tubectomy 8129 1612 124 103 2.3.2.c Two hundred ninety-nine (299) clients received LARC services (Implant: 293, Tubectomy: 4, and NSV: 02) from 11 special days organized in October and November 2015. Considering the performance of Q1, MH-II provided technical assistance to BRAC to develop accelerated action plan. These are: organize additional special FP days to meet the demand; organize workshop for religious leaders; conduct additional courtyard meeting for demand creation and meeting with male community etc. To build the capacity of BRAC to organize FP special days with minimal external support from MH-II, guidelines on the organization of FP special day is under development. The guidelines will be finalized and orientation on the guidelines will be completed by January 2016. Implant NSV Tubectomy 293 02 04

Q2: 2.3.2.a A total of 16,531 (15% of PY3 projection) clients were referred and out of which 15,759 clients selected an FP method (Injection-13,027, IUD-201, Implant-2429, NSV-24, and Tubectomy-78). From the total referred clients, 17% chose a LARC or PM methods. Injection Implant IUD Tubectomy 13027 2429 201 78 In the reporting quarter, BRAC organized 18 special days and from these special days, 491 clients received LARC methods (Injection- 8, IUD-15 and Implant: 468) The 18 special days’ h were organized from January to 15th March 2016. Injection IUD Implant 08 15 468 BRAC has to organize special FP service delivery days to meet the additional demand for FP services. To build the capacity and to ensure the quality of FP special day, MH-II developed a guideline on how to organize FP special day and provided orientation on how to use to 14 mid-level project staff of BRAC. To dismiss the myths and misconception, BRAC along with MH-II organized 14 batches of orientation sessions on “FP in the Light of Islam” for religious leaders in different Upazilla of Chittagong districts. A total of 280 religious attended the FP sessions. Q3 Achievement: Task# 2.3.2.a: A total of 18,166 clients were referred for FP services, of which 17,428 chose to adopt an FP method (injectable-15,119, IUD-169, implant-2,066, NSV-11, and tubectomy-63). From the total number of referred clients, 17% chose a LARC or PM, all others chose a short-acting method.

Task# 2.3.2.c: In the reporting quarter, BRAC organized 60 FP special days during which 1,414 clients chose a LARC or PM (injectable-110, IUD-27, implant- 1,267, tubectomy-5, and NSV-5).

BRAC conducted 42 batches of Sayhasto Shebika (SS) orientation programs on FP methods and myths and misconceptions associated with LARC and PM methods in different Upazillas of Chittagong district between May and June 2016. A total of 796 Sayhasto Shebikas attended the orientation program.

With support from MH-II, BRAC organized five batches of orientation sessions on FP and RH for 107 Community-based Skilled Birth Attendants (CSBAs) in Chittagong district in collaboration with the DGFP and DGHS. The objective of the session was to engage CSBAs to create demand for PPFP services among the pregnant women.

In this quarter, MH-II provided BRAC a large quantity of IEC/SBCC materials for various activities, including 450 PPFP job aids, 135,000 PPFP leaflets, eight FP manuals, 3,000 volunteer job aids, and 100 volunteer guide books.

Q4 Achievement Task# 2.3.2a: From July to September 2016, A total of 18,528 clients were referred for FP services, of which 17,273 clients chose to adopt a FP method (Injection- 15,094, IUD-130, Implant-1,941, NSV-15, and Tubectomy--98). Task# 2.3.2c: From July to August 2016, BRAC organized 30 FP 92 special days and during these special days, 742 clients received LARC & PM methods (Injection- 61 IUD12 Implant 660, Tubectomy 6, NSV3). BRAC conducted 47 batches of Sayhasto Shebika (SS) and 13 batch of Sayhasto Kormi orientation program in different Upazillas in Chittagong district from 19th June 2016 to 30th August 2016. A total of 885 Sayhasto Shebika and 205 Sayhasto Kormi attended the orientation program. Activity 2.3.3 ENGAGE PRIVATE HEALTH FACILITIES AND GARMENT FACTORIES IN CHITTAGONG TO INCREASE The USE OF INJECTABLE, LARC AND PM SERVICES THROUGH YPSA Partners/Collaboration NGOs (especially USAID implementing partners), private and GOB FP services delivery facilities, BGMEA and Bangladesh Export Processing Zone Authority (BEPZA) POC Sushanto Shekhar Roy/Shahid Hossain 2.3.3.a Review performance and provide ME&R will conduct 300 300 300 300 At 85% referred 1994 1913 4,62 2,964 supportive supervision to YPSA DQA as per M&E client (1200) clients 4 field staffs to achieve objectives of plan referred for LARC the project. and PM services. 2.3.3.b Collect information, compile Meridian will support x x Outline of best - - relevant data and develop outline of analysis and practices lessons learned for write-up on best documentation. methodologies and practices. Dissemination best write up developed. practices will be done in next year. 2.3.3.c Provide support to YPSA to expand Meridian will support x x x x Within BEPZA x x their program to other BGMEA and scale-up strategy. (Chittagong)/CEPZA BEPZA factories. 188 factories will have access to FP information and services.

2.3.3.d Provide support to YPSA to make Team-3 will provide x x Commodities (oral x x FP commodities available from support to get clinics pill, condom, DGFP in Chittagong BGMEA and affiliated with DGFP injectable and IUD of CEPZA health facilities on a DGFP source) routine basis. available in the CEPZA health facilities. The commodity availability system from DGFP established as soon as the CEPZA and BGMEA Chittagong

facilities are affiliated Application related documentation are are documentation related Application with DGFP authority. BEPZA by processed being

2.3.3.e Provide guidance for organizing FP Team-1 will help 5 15 15 10 675 clients received 11 10 special days through building the organizing FP special LARCs from 45 Speci FP capacity of the NGOs so that they services days special FP service al speci can do the activity in future by days organized in the Day al Days themselves workplace.

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Clien 105 ts Clie recei nts ved recei LAR ved C & LAR PM C & servi PM ces servi ces (Inje

ctabl (Inje 429 revivedClients services FP e 86, ctabl Impl e 57, ant Impl 44) ant 47,

IUD

1) 34 special FP Days Quarter-wise Narrative Description of Activity Q1. 2.3.3a In the reporting quarter, 1,994 clients were referred, of which 1,635 chose to adopt an FP services (Injection-940, Implant-576, IUD-63, Tubectomy-56). Injection Implant IUD Tubectomy 940 576 63 56

2.3.3e YPSA organized and conducted 39 FP special days with the technical support from the DGFP/MSC/MAMATA at Community and workplace under Chittagong city. Out of 1,635 FP clients, 630 clients received FP services from 39 FP special services day. Of the total FP special services day, 11 were organized in garments factories and the other 28 were in or near slums areas where YPSA educates slum dweller on FP issues.

To build the capacity of YPSA to organize FP special day with minimal external support from MH-II, guidelines on FP special day organization is being developed and will finalized in January 2016. Then YPSA will be given orientation on the guidelines In this quarter YPSA has been providing support BEPZA to expand the workplace intervention at CEPZ Chittagong areas. To enhance the capacity of referral facilities to provide quality LARC and PM services, MH-II trained 8 female doctors from (7 from MOMOTA and 1 from South Point Hospital) Q2. 2.3.3a In this reporting quarter Jan, 16-Feb-16, 1913 clients were referred, of which 1419 received FP services (Injection-984, Implant-347, IUD-54, and Tubectomy-32 NSV-2). Injection Implant IUD Tubectomy NSV 984 347 54 32 02 2.3.3e YPSA organized and conducted 28 FP special days up to March’16 with the technical support from DGFP/MSC/MAMATA at Community and workplace under Chittagong city. Out of 1419 FP clients, 566 clients received FP services from 36 FP special services day. Number of the total FP special services day, 10 were organized in garments factories and the other 26 were in or near slums areas where YPSA educates slum dweller on FP issues. MH-II provides orientation to the YPSA program staff about FP special day guideline and distributes the materials and handout to the participants. In this quarter YPSA conducted 130 group education sessions for the Garments workers. Total participants 3,058 (Male-505 female-2,553) and referred 159 FP clients.134 clients received FP services (Injectable -87, Implant-47). In this quarter YPSA extended their number of volunteers and orient the new 20 volunteers who are working in the different slums in Chittagong city. All 40 volunteers are involved in slums intervention in Chittagong city area. Q3 Achievement: Task#2.3.3a: During this reporting quarter, 4,624 clients were referred for an FP service, of which 3,827 chose to receive a method of FP (Table 11).

Table 11: Method wise FP service uptake of the clients referred by YPSA

Injectable Implant IUD Tubectomy NSV Total

3,080 537 134 75 01 3,827

Task#2.3.3.d: To make the FP services available in the BEPZA Hospital, MH-II began providing support to get their hospital affiliated with the DGFP. By the end of Q4, the hospital is expected to receive affiliation.

Task# 2.3.3e: YPSA organized 34 FP special days with technical support from the DGFP, Maries Stopes, and Mamata, during which 429 clients selected an FP method (Injectable- 204, Implant-223, IUD-02). Fifteen of these special days were conducted in clinics within garment factories.

Additionally, YPSA conducted 118 group education sessions on FP for a total of 2,891 (465 males and 2,426 females) garment workers. Of these, 316 were referred, 295 of which chose to receive an FP services (injectable-246, implant-49).

Q4 Achievement Task# 2.3.3a: During this reporting period 3,124 clients were referred, of which 2,439 received FP services (Injection-1938, Implant-369, IUD-64, and Tubectomy-68). Injection Implant IUD Tubectomy NSV Total 1,938 369 64 68 0 2,439

Task# 2.3.3b: One project brief has been prepared on community engagement and shared internally for the feedback and comments after incorporating the comments the brief will be send to EngenderHealth HQ for their review. Task# 2.3.3c: With the support from field services of DGFP, MH-II provided training to the service providers of mini clinics of 14 garment factories in Chittagong. After this training the mini clinics can procure free pill, condom and injectable from the GoB outlet. Task# 2.3.3d: MH-II is providing support BEPZA Hospital to get affiliated with DGFP. It is expected that the hospital will get the affiliation by Q1 of PY4. Task# 2.3.3e: YPSA organized 25 FP special days with the support from DGFP/MSC/MAMATA at the community and workplace under Chittagong city. 382 clients (injectable-213, implant-168 and IUD-01) received FP services from 25 FP special services day. Number of the total FP special services day, 10 were organized in garments factories and the other 15 were in or near slums areas where YPSA educates slum dweller on FP issues. Injection Implant IUD Total 213 168 01 382

Task# 2.3.3f: In this quarter YPSA conducted 246 group education sessions for the garments workers. Total participants 6,117 (Male-1-067 female- 5,05) and referred 256 FP clients.259 clients received FP services (Injectable -192, Implant-57). YPSA also conducted 13-word sensitization meeting with local influential leaders with collaboration of Chittagong city corporation at different ward of Chittagong city. Total participants 298 (Male-168, Female- 130). In the same period, MH-II provided BCC/IEC FP Festoon (5) Flip Chart (20) Raman banner (5) Volunteers Job Aid (30) and Hand fan on FP issues to the garments workers (1,600).

ENGAGE DIFFERENT COMMUNITY GROUP/VOLUNTEERs ON DEVELOPING LARC & PM REFERRAL Activity: 2.3.4 NETWORK (CLIENT MOBILIZATION TO ACTUAL SERVICES RECEIVED) Respective CCSDP/DDFP offices, RTMI, selected district based NGOs, hired IT firm, Union Information and Services Partners/Collaboration Center POC Rabiul Hossain/ Bashir Ahmed 2.3.4.a Train YPSA’s 100 microcredit Team-1 build the 2 training sessions 1 group leaders to disseminate FP capacity of referral organized for 100 x X x x x 100 Complete information to their beneficiaries centers to provide microcredit group d in Q2 and community people (12, 000) in LARC and PM leaders with 50 Comilla (PY 2) and Feni district of services if required. participants in each PY1. session. 2.3.4.a Engage YPSA’s microcredit group Team-1 will build the 100 300 400 400 Use microcredit 202 622 989 Referred 2 leaders to disseminate FP capacity of service LARC LAR LAR LAR group leaders (100) to LAR LA LA 1,089 information to their beneficiaries providers of 14 public & PM C & C & C & reach 12,000 C & RC RC clients for and communities in Comilla and referral centers to Client PM PM PM gatekeepers and PM & & FP Feni districts. provide LARC and s Clien Clie Clien eligible couples (1200 Clie PM PM services PM services if ts nts ts LARC & PM nts Clie Clie and of

required. Received clients) nts nts which 711 with FP especially have ME&R will provide LARC and PM received support to develop information and services M&E plan and will referral. Inject. conduct DQA visits as per plan LARC & PM 2.3.4.b Engage women empowerment Team-1 will build the 550 1000 1050 1250 Use women 521 2,27 4,49 5,834 group of Mukti (Kushtia based capacity of service LARC LAR LAR LAR empowerment group 3 5 referred LAR NGO) to disseminate FP providers of 29 public & PM C & C & C & leaders (160) to reach clients of C & LA LA information to their group members referral centers to Client PM PM PM 18,660 gatekeepers which PM RC RC and community people. provide LARC and s Clien Clie Clien and eligible couples 4,960 Clie & & PM services ts nts ts with FP messages reviewed nts PM PM especially for LARC injection and PM services and

ME&R will provide refer clients from 28 Clie Clie LARC & support to develop unions of Kushtia nts nts PM M&E plan and will District. conduct DQA visits as per plan 2.3.4.c Train district (Barguna, Barisal, Team-1 will build the 2,466 2,46 2,466 MoU signed with 5 - 3,43 4,09 4,103 1 Rangamati, Faridpur, and Rajbari) capacity of referral 6 NGOs to use their 9 7 clients LAR LAR based NGO volunteers to centers to provide 400 volunteers to LA referred of C & LAR C & LA disseminate FP information to LARC and PM disseminate FP RC which PM C & PM RC among their community. services if required. information and refer & 3,830 Clien PM Clien & received clients from their PM ts Clie ts PM injectable communities clie nts clie LARC & nts nts PM

Engage district based NGOs to use ME&R will provide x X x x 400 volunteers of 5 x x x Done in Q 2.3.4.c their volunteers to disseminate FP support to develop NGOs reached 24,000 2 2 information among their M&E plan and will gatekeepers and community. conduct DQA visits as eligible couples with per plan FP especially LARC and PM information 2.3.4.d Work with BKMI and IR 1 team to Team-1 will provide x X x Implemented in one x x x No meeting have a discussion with the DGFP ICT based training to district headquarter held with based on their need, develop an selected services on pilot basis. BKMI implement plan for the ICT based providers. distance learning program and e- learning courses. Quarter-wise Narrative Description of Activity Q1. 2.3.4.a 2. MH-II has engaged 50 microcredit group leaders of YPSA in Comilla. These group leaders were trained by MH-II and now they are disseminating information on FP issues in the community. These volunteers have referred 160 FP clients. MH-II will also engage 50 microcredit group leaders of YPSA in Feni. Training program for micro-credit group leader will start January 2016 2.3.4.b. With technical assistance from MH-II, Mukti, a district based women empowerment organization, has engaged 160 volunteers in 5 Upazillas in the Kushtia district to create demand for LARC and PM services. These volunteer were trained by MH-II on FP issues. In the reporting quarter, these volunteers referred 350 LARC & PM clients to the public facilities and all of them received FP services.

2.3.4.c1 Through VPKA Foundation community based volunteers, MH-II will create demand for LARC and PM services in Rajbari and Faridpur districts. With the suggestion from DDFP, this NGO has been selected. Approximately, 240 volunteers will work in the vacant position of FWA and in hard to reach areas. DDFP will participate in the volunteer selection process to reduce duplication. . 2.3.4.a2. Through YPSA, MH-II has engaged microcredit group members in Comilla and Feni to create demand for LARC and PM services. In the reporting quarter, MH-II has trained 50 microcredit group members from YPSA in Feni on family planning issues to create demand for LARC and PM services. These volunteer have recently started disseminating FP information in the working areas while micro-credit group members have referred 2,139 prospective LARC & PM clients and 1,846 of them received LARC and PM methods. 2.3.4.b . In the reporting quarter, Mukti referred 2273 clients for FP services. 2.3.4.c1. In the he reporting quarter, MH-II provided ToT to all the management staff and supervisors from VPKA Foundation working in Rajbari and Faridpur. Those who received the ToT have provided orientation to 240 volunteers on how disseminate information on FP issues correctly and appropriately. After receiving the orientation, 240 volunteers of VPAK foundation have referred 5,233 prospective LARC and PM clients. Of the total referred clients, 3,439 received services. Mukti has referred a total of 2,744 prospective LARC and PM clients and 2,273 LARC & PM clients received services Q3 Achievement: Task# 2.3.4.b: In the reporting quarter, volunteers from Mukti referred 4,495 FP clients to the nearest FP facilities of Smiling Sun, Marie Stopes, UPHCSDP, or government facilities. Of the total clients referred, 3,929 chose to take a FP method (Table 12).

Table 12: Method wise FP service uptake of the clients referred by Mukti Volunteers

Injectable Implant IUD Tubectomy NSV Total

3,317 397 27 182 6 3,929

Task# 2.3.4.c1: During the reporting quarter, VPKA volunteers referred 4,377 FP clients to the nearest GOB FP facility, among which 4,097 decided to use an FP method (Table 13).

Table 13: Method wise FP service uptake of the clients referred by VPKA Volunteers

Injectable Implant IUD Tubectomy NSV Total

2,424 1,290 128 157 98 4,097

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Task# 2.3.4.a2: In this reporting quarter, volunteers from YPSA’s microcredit groups referred 1,638 FP clients to the nearest GOB FP facility for counseling. Of these, 989 chose an FP method (Table 14).

Table 14: Method wise FP service uptake of the clients referred by Micro-Credit Group members of YPSA

Injectable Implant IUD Tubectomy NSV Total

827 101 23 35 3 989

Task#2.3.4d: Two coordination meetings were held with BKMI to develop strategies and a workplan to include ICV in the eLearning course previously developed by BKMI for field-based staff of the DGFP. As planned, MH-II is developing the script for the eLearning course, which will be completed by the end of August. To set the topology of the eLearning course, one small-scale demo version has been developed by Bangladesh Knowledge Management Initiatives (BKMI) for demonstration of EHB staff.

Q4 Achievement Task#2.3.4b: In Q4 of PY3 Mukti volunteers (200) working in all Upazillas of Kushtia district referred 5,834 FP clients and out of which 14% referred clients received LARC and PM services. These clients mostly received services from Smiling Sun, Marie Stopes, UPHCSDP & government facilities. For details see the table below Task#2.3.4c: During this quarter, VPKA volunteers (240) working in all Upazillas of Rajbari & Faridpur districts referred 4,103 FP clients and out of which 40% referred clients received LARC and PM services. These clients mostly received services from Smiling Sun, Marie Stopes, UPHCSDP &Government Facilities. For details see the table below Up to August 2016, YPSA microcredit volunteers (80) from Chagolnaya Upazilla in Feni district & Adorsho Sadar Upazilla in Comilla district referred 709 FP clients to Smiling Sun, Marie Stopes, UPHCSDP and government facilities for FP services. Out of which, 35% referred clients received injectable, LARC and PM services. For details, see the table below. Table 12: Referred clients received FP services by NGO Name of No of clients Number of referred clients received Injectable, LARC and NGOs referred PM services Injection Implant IUD Tubectomy NSV Total Mukti 5,834 4,197 459 33 254 17 4,960 VPKA 4,103 2,268 1,183 139 154 86 3,830

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Microcredit 1,089 571 70 22 43 5 711 Volunteers of YPSA Total 11,026 7,036 1,712 194 451 108 9,501

Activity- 2.3.5 DEMAND GENERATION IN THE URBAN AREAS TO INCREASE USE OF LARC AND PM SERVICES Create demand in the slums of 4 municipality area for LARC and PMs Partners/Collaboration UPHCSDP NGO, City Corporation, BRAC, Community Radio

POC TBD/Rabiul Hossain /Shahid Hossain 2.3.5.a Create demand in selected urban Meridian to support x x x x UPHCSDP partner x x - N/A areas through Urban Primary Health strategy development. NGOs working in 6 Care Service delivery Project divisional UPHCSDP partner NGOs headquarters have integrated FP in outreach activities, including PPFP. 2.3.5.b Provide support/TA to UPHCSDP Team-1 will provide X x x x Field workers and X x - N/A to create demand for LARC and PM training to clinical clinical staff from in their working areas. services providers. UPHCSDP are trained to disseminate and provide LARC and PM information and services. 2.3.5.c Use community radio to x x x x Adolescent listeners’ x x One disseminate DGFP approved groups reached communi information on LARC and PM. through 3 community ty radio radio stations has dissemin ated FP informati on in Sitakund u

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2.3.5.d Establish referral networks with 7,980 7,980 7,980 MoU signed with 5 - 4,93 11,8 Referred 14,085 NGOs working in the slums. NGOs (Other than 9 56 UPHCSDP NGOs) refe clients and

working in the rre of which divisional d 5,412 received headquarters (Khulna, injectable Barisal, Chittagong, and LARC Rangpur and & PM Rajshahi) providing LARC and other short acting methods. Quarter-wise Narrative Description of Activity Q1. 2.3.5.c MH-II conducted a day long discussion with the representatives from Community Radio Stations namely Radio Sagor Giri, Radio Lokobetar, Radio Chilmari, Radio Bikrompur and Radio Mukti, and drafted a plan of action to disseminate FP information through community radio. The plan along with deliverables will be finalized by the first week of January 2016. 2.3.5.d It has been revealed from secondary information that Population Services and Training Center (PSTC), a leading national NGO, has a good urban based SRH program in the major cities of Bangladesh. Considering their experience and coverage of SRH program, MH-II signed a MoU with PSTC to engage their 665 volunteers to generate demand for FP services in 11 major cities namely Rangpur, Rajshahi, Dhaka, Jamalpur, Gazipur, Narayanganj, Sylhet, Mymensingh, Barisal, Jessore, Bagerhat. To engage the volunteers effectively, MH-II will provide TOT to the mid-level program staff of PSTC. They will then be able to train volunteers to disseminate FP information correctly and appropriately and refer prospective FP clients to the nearest FP service facility. MH-II expects to generate over 15,000 new FP clients from the urban slum areas. TOT for Mid-level staff of PSTC will be conducted in the first week of January 2015. 2.3.5c MH-II selected two community Radio stations Sagor Giri and Radio Padma community to create demand in selected areas Chittagong (mostly costal belt) and Barisal districts and Rajshahi district. These community radios will begin airing DGFP approved Radio Commercial for demand creation for FP services. Their listener groups will be oriented on FP issues and will start disseminating and referring the clients to the nearby facilities. Q2. 2.3.5.d MH-II provided a 3-day TOT on FP methods to 16 mid-level program staffs from PSTC and these staff provided a one-day orientation to 345 volunteers (till the end of March, 2016) who are working in the selected slums of 11 major cities (name of districts are mentioned above para) in Bangladesh. The volunteers have started disseminating information on FP methods through interpersonal communication, home visits, group sessions. ECP Pill Condom Injection Implant IUD Tubectomy NSV 25 1546 1348 1282 605 73 35 07

Q3 Achievement: Task# 2.3.5.c: In this reporting quarter, FP information was disseminated through Radio Sagorgiri FM 99.2 in Sitakundu Upazilla. The DGFP approved the information on LARC and PM services, which was disseminated regularly and before all FP special days. Moreover, during the FP service week, MH-II

103 disseminated FP information using 10 community radios throughout the country. Radio Commercials developed by the DGFP have been disseminated to the people living in the Stiakunda Upazilla a total of 874 times during the family planning service delivery week.

Task#2.3.5.d: In this reporting quarter, PSTC volunteers working in urban areas in 11 districts referred 11,856FP clients to the nearest FP facilities of Smiling Sun, Marie Stopes, UPHCSDP, or a GOB facility. Among the total number of referred clients, 5,187 chose to uptake of LARC and PM FP method (injectable-3543, implant-1,249, IUD-197, tubectomy-124, and NSV-74) and 4,218 chose short acting method (pill-2,344, condom-1,874,).

Q4 Achievement Activity- 2.3.5: Demand generation in urban areas to increase use of LARC and PM services Task# 2.3.5c: In this reporting quarter, FP information was disseminated through Radio Sagor Giri FM 99.2 in Sitakundu Upazilla. The DGFP approved the information on LARC and PM services, which was disseminated regularly and before all FP special days. Task# 2.3.5d: In this reporting quarter, PSTC volunteers (510) referred 14,085 FP clients to the nearest FP facilities of FPAB, Smiling Sun, Marie Stopes, UPHCSDP and GoB facilities. Among the total number of referred clients, 5,412 chose to take a FP method (injectable-4,146, implant-942 IUD-168, tubectomy-109, and NSV-47). Number of Number of referred clients received injectable, LARC and PM Referred clients services Injection Implant IUD Tubectomy NSV Total 14,085 4,146 942 168 109 47 5,412

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PY3/Sub-IR1 Workplan (October 1, 2015 –September 30, 2016) Activity Gantt Chart

Achievements through Quarter 4

IR 3: Supportive Enabling Environment to Advance Access to LARC and PM and Other FP/RH Services Sub-IR3.1 Key policy issues related to LARC and PM including PPFP identified , revised or developed Activity # 3.1.1 IDENTIFICATION OF NEW BARRIERS AT DIFFERENT LEVELS AND INITIATION OF CORRECTIVE MEASURES Partners/Collaboration MOHFW, MOLGRD&C, DGFP, DGHS, Private Sector, NGOs, MIH, FC+, Stakeholders working on SRHR issues in Bangladesh, Avenir Health POC Md. Abul Quiyume/Azmal Hossain/ Nahid Anjum Siddiqui

Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 3.1.1.a Periodic review to identify SRH policy and All MH-II senior 1 1 1 3 brainstorming sessions— 1 advocacy related issues with MH –II staff staff would be one with 20 MH-II senior

and other relevant stakeholders of engaged for the staff and 2 with 40 relevant

MOHFW, MOLGRD&C, NGOs, Private brainstorming stakeholders of DGFP, sectors, etc. sessions DGHS, NGOs and Women’s groups working

on SRHR issues in

Done in Q1 Done in Q1 Done Bangladesh held in Q1 Done Report on barriers and recommendations identified

3.1.1.b Review and revise the policy barrier matrix All IR teams X X X X Policy barrier matrix

in line with the above review and Medical especially, revised

Eligibility Criteria (MEC) of WHO, Capacity Building

Done Done Done CDC/US and service access barriers Advisor, and Done identified by MH-II project Avenir Health

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providers, champions and leaders by Avenir Health, LARC and PM service

public, private and NGO facilities to ME&R to support providers and champions categorize their roles in advocacy for mapping developed through the offices of CS and DDFP.

This is available and shared Done in Q2 Done with the DGFP, DGHS, in Q2 Done

NGOs and Private sector available list is A stakeholders 3.1.1.d Organize local level advocacy workshops Support from all 3 4 4 3 14 local level advocacy 0 10 15 6 for showcasing service providers’ critical IR teams meetings (non-technical in roles in the LARC & PM services and nature) held with the planning for ensuring service provisions. participation of 30 service These would be held in Districts of PY1, PY2, and PY3 where provider biases are providers in each event more prevalent in connection with PPFP. held 3.1.1.e Organize an advocacy training for the MH- All IR teams, 1 1 training on advocacy 0 1 II Sr. QA and Compliance Officers, RTM especially support techniques, and content

mobile service delivery care team members of PM (QA/FP held with participation of

and selected staff of MIH and FC+ and compliance) to 20 participants which MH-II facilitate the includes all of the Sr. QA & training FP Compliance Officers; all

of the mobile service Done in Q2 Done ME&R team in Q2 Done delivery team members of would analyze RTM; some selected staff data for advocacy members of MIH and FC+.

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CAG to set-up ‘Cost Center’ at DGHS (QA & FP all Medical College

service centers for FP services Compliance), LD Hospitals and District

(CCSDP), JS (FW Hospitals under DGHS

going going going

- - -

of MOHFW) is and going

On On

substantially On taken to PY4 taken

important On

3.1.1.g Support DGFP to organize and conduct All team’s efforts 2 5 - - Meetings with 50 FP 0

advocacy meetings for the implementation are required service providers each at 7 Q3

of changed policies specially during divisional level held going

field trip of MH-II -

Integrated Integrated Done in Done staff with3.1.1.d 3.1.1.h Advocacy to the MOHFW, DGHS and This is a joint X X X X DGHS/MOHFW allows a

DGFP for a better place for IUD service effort with Team-1 separate IUD insertion

delivery at the Upazilla Health Complex and therefore, a room/or the procedure to be

going going going

- -

(UHC) substantial carried out in the OT of the -

254 OTs 254

On On involvement of the UHC On team is required over Handed 3.1.1.i Advocacy with the MOHFW for the Support from PM X X - - Planning unit of DGFP sent finalization of the action plan developed in (QA/FP the draft plan to MOHFW;

connection with the National Population Compliance) is 2 inter-ministerial

Policy 2012 using BDHS 2014 & Urban considerably consultation meetings on

Health Survey 2013 Health and important the draft action plan is held Population indicators as baseline and with the participation of 30

dissemination of the same officials of different

Finalized Finalized ministries and Ministerial Finalized action plan of the Q1 in Finalized Population Policy 2012 is finalized

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

3.1.1.j Advocacy with the MOHFW for the Support from all PPFP Action Plan finalized,

finalization and implementation of the IR teams and advocacy done to include

PPFP Action Plan particularly from these in relevant OPs of

Done Done Done PD DGHS and DGFP Done Quarter-wise Narrative Description of Activity Q1: Task # 3.1.1.a: As a part of a periodic review and SRH policy and advocacy related issues were identified during a brainstorming session conducted on 17December 2015. The staff from MH –II, MIH, Fistula Care Plus, MH-II sub-awardees (RTMI, OGSB, YPSA, BRAC, and Shushilan), and MH-II collaborative partners like PSTC and Mukti participated in this session. The specific objectives were: to review the policy issues with the policy barrier matrix that the Policy Advocacy team updates periodically; and, to brainstorm among the participants on new policy barrier, prioritize the issues and solicit participant insights on addressing priority issues. The key policy barrier issues identified in the brainstorming session are: no mechanism for private facilities to report their FP performance to the DGFP, no specific guidance/strategy from DGFP to organize FP special day/ services in the workplaces; no designated counselor for FP counseling; FWA’s involvement in the Community Clinics in 3 days in a week; affiliated NGO clinics don’t get Imprest fund as advance; etc. Task # 3.1.1.c: A simple checklist was developed for the mapping of LARC and PM service providers, champions and leaders by public, private and NGO facilities to categorize their roles in advocacy. The checklist was also shared with the LD, CCSDP/DGFP so that the mapping can be completed by them. The LD advised to start this mapping after the field placement of 235 Medical Officers (MCH-FP) who have been recently been recruited by the Ministry of Health and Family Welfare. Task # 3.1.1.d: To conduct local level advocacy workshops for showcasing service providers’ critical roles in the LARC & PM services and planning for ensuring service provisions, a letter along with the agenda of the workshop was sent to the LD, CCSDP/DGFP for organizing such events in two PY3 districts—Manikganj and Munshiganj. Due to heavy workload of CCSDP, they advised to hold those kinds of workshops in the next quarter. Task # 3.1.1.f: Advocacy for setting up cost center in the DGHS system has continued since PY2. This quarter, MH-II organized a meeting between LD, CSSDP/DGFP and the Chief Accounts Officer of the Ministry of Health and Family Welfare. According to the meeting decision, all district FP offices have been requested by CCSDP to send last years (September 2014-August 2015) PPFP performances of the District General Hospitals, Medical Colleges and Specialized hospitals. Out of 64 districts only 29 districts have sent the report although repeated follow-ups with the district FP offices were performed by MH-II. This PPFP performance in the different DGHS facilities will help determine the amount of money to be allocated against each of the facilities as the Imprest fund. Task # 3.1.1.h: Three meetings (1 with LD, CCSDP/DGFP; 1 with Director, PHC/DGHS and 1 jointly with LD, CCSDP/DGFP and Director, PHC/DGHS) have been held as a part of advocacy for a better place for IUD service delivery at the Upazilla Health Complex (UHC). The last meeting decided to issue a joint circular allocating an Operation Theatre in favor of the FP unit of the UHC with the signature of both DGs of DGFP and DGHS. This circular is expected to be issued in early next quarter.

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 3.1.1.i: The action plan for the Population Policy-2012 has been finalized and now ready for printing by the Planning Unit of DGFP. To finalize the action plan in the reporting quarter 2 meetings were held—1 with the Population Policy Action Plan Development Committee (held on 14th December 2015) and 1 with the Population Policy Action Plan Development Committee Sub-Committee (held on 22nd December 2015). Q2: Task # 3.1.1.d: As a part of local level advocacy workshops for showcasing service providers’ critical roles in the LARC & PM services including PPFP, 10 events were organized and conducted jointly by the MH-II and DGFP. The meetings were held in Munshiganj district on 19 January 2016, Tangail on 15 February 2016, Manikganj on 17 February 2016, Barguna on 22 February 2016, Barisal on 23 February 2016, Bhola on 24 February 2016, Netrokona on 15 March 2016, Shariatpur on 27 March 2016, Faridpur on 28 March 2016 and Rajbari on 29 March 2016. Multisector stakeholders including DC, CS, DD-FP, Upazilla Chairmen, UNO, UHFPO, UFPO, Obs/Gyn. Consultant, MO (MCH-FP), DD-IFB, President/Secretary of Imam Samiti, Journalists, attended the workshops. The key outcomes of the events are: commitments by the different stakeholders to help FP program like commitment by the CS to allocate an OT to the DGFP that will increase quality FP services; commitment by the DGHS providers for more PPFP services; commitment by both DGHS and DGFP providers for ensuring implementation of all changed policies including 100% counseling on FP focusing PPFP during each ANC, PNC and immunization services; and so on. DGFP has also issued call-up letters for the remaining 8 PY3 districts—6 April in Narshingdi, 16 April in Jhalakati, 17 April in Pirojpur, 23 April in Khagrachari, 25 April in Rangamati, 27 April in Bandarban, 7 May in B. Baria and 8 May in Feni. Notably, instead of supporting DGFP to organize and conduct advocacy meetings for the implementation of changed policies separately, the issue has been incorporated as one of the local level advocacy issues and being discussed in those advocacy workshops accordingly. Additionally, MH-II has supported DGFP in organizing and conducting CCSDP OP budgeted Upazilla level LAPM advocacy meetings. In the reporting quarter total of 15 Upazilla level advocacy meetings were held in Naogaon, Bhola, Jhenidah and Satkhira districts where 979 DGHS and DGFP officials and field staff attended. Task # 3.1.1.e: On 17 February 2016, an advocacy training was provided to the MH-II Sr. QA and Compliance Officers, RTMI mobile service delivery care team members so that they can negotiate with the local program managers on certain local level advocacy issues like implementation of changed policies, ensuring privacy for IUD insertion at UHC and thereby advocacy for OT allocation for FP services in the upgraded 50-bed UHCs, resolving Imprest fund and logistical issues at the DGHS facilities through a local arrangement between DGFP and DGHS managers and/or providers, etc. Task # 3.1.1.f: In the reporting quarter there is substantial progress on the issue of setting-up cost center in the DGHS facilities. After intensive follow-up by the MH- II staff, LD, CCSDP succeeded to receive district-wise PPFP performances of DGHS facilities in the first week of February 2016. On 16 February 2016 LD, CCSDP sent that report of the district-wise PPFP performances and an estimated cost against those performances to the CAO, MOHFW. On 24 February 2016, the CAO of MOHFW provided positive opinion in a letter to the LD, CCSDP with copy to the Secretary, MOHFW recommending of opening up of cost center in the DGHS facilities. The recommended ceiling of the Imprest fund against Dhaka Medical College Hospital, Sir Salimullah Medical College Hospital, Bangabandhu Sheikh Mujib Medical University and all Medical College Hospitals located in divisional towns is BDT 150,000 and BDT 100,000 against other Medical College Hospitals, Specialized Hospitals and Sadar Hospitals located in district towns. On 3 March 2016 LD, CCSDP forwarded the above mentioned letter of the CAO, MOHFW to the Secretary, MOHFW with copy to the Additional Secretary, MOHFW who is also the Chairperson of the PPFP Committee of the MOHFW to take action in favor of opening up cost center in the DGHS facilities. The next steps, are expected to take place in the following quarter, if the Secretary, MOHFW agrees to the opinion of

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 CAO he would send the CAO’s letter to the Secretary of Ministry of Finance for endorsement and then the Secretary, Ministry of Finance after giving his endorsement would send the letter back to the Secretary of MOHFW for issuance of a circular in favor of opening up of cost center in the DGHS facilities. Q3: Task # 3.1.1.c: MH-II has done a mapping exercise of family planning service providers of DGFP to find out the current situation of the service provision status throughout the country. Then this effort was expanded to see the status of other counterparts. The service provision through organizing special day with hired surgeon of Mayer Hashi - II project of EngenderHealth Bangladesh, Marie Stopes Clinical Society (MSCS), Research, Training and Management International (RTMI) and Marketing Innovation for Health (MIH) was also mapped alongside of DGFP service providers. Some very interesting features in the mapping are: DGFP has a total number of 387 doctors who are located at district and Upazilla level. In 161 Upazillas of 62 districts, MH-II/EHB, MSCS, RTMI and MIH is serving simultaneously whereas 28 Upazilla of 19 districts are fully underserved. Task # 3.1.1.d: As a part of local level advocacy workshops for showcasing service providers’ critical roles in the LARC & PM services including PPFP, 15 events were organized and conducted jointly by the MH-II and DGFP. The meetings were held in Narshingdi district on 06 April 2016, Jhalakati on 16 April 2016, Pirojpur on 17 April 2016, Bandarban on 25 April 2016, Rangamati on 27 April 2016, Khagrachari on 28 April 2016, Feni on 08 May 2016, Brahmanbaria on 11 May 2016, Sherpur on 13 June 2016, Mymensingh on 15 June 2016, Jamalpur on 16 June 2016, Bogra on 19 June 2016, Natore on 21 June 2016, Sunamgonj on 26 June 2016 and Moulavi Bazar on 28 June 2016. Multisector stakeholders including DC, CS, SP, DD-FP, Upazilla Chairmen, UNO, UHFPO, UFPO, Obs/Gyn. Consultant, MO (MCH-FP), DD-IFB, President/Secretary of Imam Samiti, Journalists, attended the workshops. The key outcomes of the events are: commitments by the different stakeholders to help FP program like commitment by the CS to allocate an OT to the DGFP that will increase quality FP services; commitment by the DGHS providers for more PPFP services; commitment by both DGHS and DGFP providers for ensuring implementation of all changed policies including 100% counseling on FP focusing PPFP during each ANC, PNC and immunization services; and so on. Additionally, MH-II has supported DGFP in organizing and conducting CCSDP OP budgeted Upazilla level LAPM advocacy meetings. In the reporting quarter MH-II supported CCSDP/DGFP to organize and conduct 3 Upazilla level advocacy meetings held in Madaripur district where 288 DGHS and DGFP officials and field staff attended. Task # 3.1.1.f: The Secretary, MOHFW agrees to the opinion of CAO and had sent the CAO’s letter to the Secretary of Ministry of Finance for endorsement. The next step is that the Secretary, Ministry of Finance after giving his endorsement would send the letter back to the Secretary of MOHFW for issuance of a circular in favor of opening up of cost center in the DGHS facilities. Task # 3.1.1.h: For ensuring better places for IUD services delivery at the Upazilla Health Complexes, MH-II did local level advocacy so that DGHS hands over Operation Theatre to the DGFP. So far, 254 DGHS OTs have been handed over to DGFP at Upazilla level across the country. Division-wise breakdown of those allocations are: Dhaka- 82, Chittagong- 62, Rajshahi- 41, Barisal- 0, Khulna- 43, Sylhet- 09 and Rangpur- 17. Task # 3.1.1.i: The action plan for the Population Policy-2012 which was finalized in 1st quarter got endorsement from the MOHFW during this reporting period. Upon request of the DGFP, MH-II supported DGFP to print 2,500 copies of the action plan. To implement the action plan, the printed copies are shared with all ministries, divisions, directorates and departments those are made responsible in the action plan.

110

Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 3.1.1.i: To review the progress of implementation of the PPFP National Action Plan and also to finalize the same, a meeting of the ‘PPFP National Action Plan Group’ consisting members from the DGHS, DGFP and development partners including USAID and UNFPA and NGOs working on RH/FP issues in Bangladesh was held on 14 April 2016 at the CCSDP Conference Room in DGFP. To finalize the Action Plan, the meeting formed a 3-member sub-group comprising representatives from CCSDP, MH-II and UNFPA. It is expected that this sub-group will submit their revised final draft to the committee by next quarter. Q4: Task # 3.1.1.d: As part of local level advocacy workshops to show the critical roles the service providers play in the LARC & PM services including PPFP, 6 events were organized and conducted jointly by MH-II and the DGFP. The meetings were held in Cox’s Bazar district on 31 July 2016, Comilla district on 07 August 2016, Thakurgaon district on 21 August 2016, Nilphamari district on 22 August 2016, Lalmonirhat district on 18 September and Kurigram district on 20 September 2016. Multisector stakeholders including Deputy Commissioners (DC), Civil Surgeon (CS), Superintend of Police (SP), Deputy Director (DD) of FP, Upazilla Chairmen, Upazilla Nirbahi Officer (UNO), Upazilla Health & Family Planning Officer (UHFPO), Upazilla Family Planning Officer (UFPO), Ob/Gyn. consultant, MO (MCH- FP), Deputy Director-Islamic Foundation Bangladesh (DD-IFB), President/Secretary of the Imam Association, and journalists attended the workshops. The key outcomes of the events are: commitments by the different stakeholders to help the FP program like commitment by the CS to allocate an OT to the DGFP to increase the quality of the FP services; commitment by the DGHS providers to provide more PPFP services; commitment by both DGHS and DGFP providers for ensuring the implementation of all of the changed policies including 100% counseling on FP focusing PPFP during each ANC, PNC and immunization services; and so on. Task # 3.1.1.f: The Secretary, MOHFW agrees to the opinion of Chief Accounts Officer (CAO) and had sent the CAO’s letter to the Secretary of Ministry of Finance for endorsement. The next step is that the Secretary, Ministry of Finance after giving his endorsement would send the letter back to the Secretary of MOHFW for issuance of a circular in favor of opening up the cost center in the DGHS facilities. Task # 3.1.1.h: For ensuring better places for IUD services delivery at the Upazilla Health Complexes, MH-II did local level advocacy with the DGHS to hand over OTs to the DGFP. So far, 254 DGHS OTs have been handed over to the DGFP at the Upazilla level across the country. Division-wise breakdown of those allocations are: Dhaka- 82, Chittagong- 62, Rajshahi- 41, Barisal- 0, Khulna- 43, Sylhet- 09 and Rangpur- 17. Activity # 3.1.2 PROVIDE SUPPORT TO THE NATIONAL TECHNICAL COMMITTEE (NTC) TO REVISE AND DEVELOP NEW POLICIES. Partners/Collaboration MOHFW, DGFP, DGHS, NTC members, Avenir Health, EngenderHealth Global Clinical Support Team POC Md. Abul Quiyume/Azmal Hossain 3.1.2.a Continue support to DGFP to organize For technical 1 1 1 1 4 NTC meetings held with 0 1 0 0 NTC meetings as and when required information 40 participants in each for support from approval of policy Team-1 is required decisions

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 3.1.2.b Present findings of pilot experiences Team-1 needs to - 1 - - Experiences shared at the NA NA NA (started in PY2 and led by IR1 Team) to lead this task as NTC meeting with 40 NTC members to approve nation-wide the intervention participants provision of 1st dose of injectable would be led by contraceptive by trained FWAs/CSBAs the team

(assuming successful piloting) toNTC Sent 3.1.2.c Advocacy with DGFP and DGHS so that For technical X X - - NTC approved implant as NTC approves implant as an immediate information an immediate PPFP method

PPFP method support of Team-

A circular issued to the

1, particularly DGFP, DGHS and NGO Capacity Building

sites at the field level going

Advisor, - On

EngenderHealth Approved Done in Q2 Done Global Clinical in Q2 Done Support Team, WHO is required 3.1.2.d Approval of PPFP counseling in all ANC This is a joint X X X X Received NTC approval,

and PNC visits by NTC effort with Team-1 and a joint circular is issued

with instructions referring

to SOPs and guidelines to

the DGFP, DGHS and going

NGO sites field for -

Approved Done in Q2 Done providing PPFP counseling in Q2 Done during all ANC and PNC visits

112

Immunization services and availability of effort with Team-1 and a joint circular is issued

short acting methods (pills, condoms and and substantial to the DGFP, DGHS and

injectable) at the Immunization centers involvement of the NGO sites at the field level going

team is required for providing PPFP - On

counseling and FP services Approved Done in Q2 Done during Immunization in Q2 Done services Quarter-wise Narrative Description of Activity Q1: Task # 3.1.2.a/b/c/d: On 2 December 2015, NTC issued the Minutes of the 65th NTC meeting held on 6 August 2015. The decisions on 3 MH-II raised issues are: (1) Implant can be provided to clients immediately after delivery of a baby irrespective of parity of that particular woman. However, NTC wants to have more clarifications on the pros and cons of introducing Implant as the immediate PPFP method. Final decision would be taken after discussion with the MEC expert from WHO headquarter who is supposed to visit Bangladesh and clarify the issue in a special NTC meeting soon. (2) A circular will be issued to provide PPFP information during each ANC, PNC and immunization visits jointly signed by the DG of DGFP and DG of DGHS. Short acting FP method services such as pills, condoms and injectable should be available at the Immunization sites. (3) Due to recent few policy changes, and the WHO recommendation on MEC, the relevant section of the Family Planning Manual will be reviewed. The revised parts of the FP Manual will be printed separately and that will be added as addendum with the existing Manual. Q2: Task # 3.1.2.c: On 15 March 2016, NTC issued the Minutes of the 66thNTC meeting held on 10 February 2016. The decisions on 1 MH-II raised issue is “NTC approved Implant and Progestin-only-Pills (POP) as immediate PPFP method and as such Implants and POPs can be provided to clients immediately after delivery irrespective of the woman’s parity. Note that the 65thNational Technical Committee (NCT) meeting sought additional clarification on the pros and cons of allowing contraceptive implants as immediate postpartum family planning (PPFP) method. Then MH-II invited an Medical Eligibility Criteria for Contraceptive Use (MEC) expert from the World Health Organization (WHO) in Geneva who made several presentations to the representatives of the Bangladesh Medical Association (BMA), Obstetric and Gynecological Society of Bangladesh (OGSB), Directorate General of Family Planning (DGFP), and Directorate General of Health Services (DGHS) service providers, research and training institutes, and finally to the NTC (08 February at OGSB Dhaka; 09 February at BMA, Chittagong; 10 February at DGFP, Dhaka and 11 February at MFSTC, Dhaka). The policy was approved during the 66thNTC meeting, thereby expanding the FP choices available to the 3.1 million postpartum women in Bangladesh.

On 16 March 2016, a circular jointly signed by the DG of DGFP and DG of DGHS regarding the decision of the 65th NTC meeting, that is, providing PPFP information during each ANC, PNC and immunization visits and making short acting FP method services such as pills, condoms and injectable available at the Immunization sites is sent out to all relevant program managers and service providers working with DGFP, DGHS, NGOs and private sectors.

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q3: Task # 3.1.2.c: Against the 66th NTC meeting decision, that is, NTC approved Implant and Progestin-Only-Pills (POP) as immediate PPFP method and as such Implants and POPs can be provided to clients immediately after delivery irrespective of the woman’s parity; a circular on the use of POP is issued by the FPFSD of DGFP and another one regarding the use of Implant by the CCSDP of DGFP on 04 April 2016 and 17 April 2016 respectively. Q4 3.1.2.a: No NTC Meeting held during this quarter Activity # 3.1.3 ADVOCACY FOR LARC/PM SERVICE PROVISION AT URBAN AREAS Partners/Collaboration MOLGRD&C, MAB, Pourashavas, City Corporations, UPHCSDP POC Bikash Barman/Sadikur Rahman 3.1.3.a Continue advocacy at various levels of It is expected that X X X X Key liaison persons urban areas (UPHCSDP, City Corporations both IRs—1 and 2 identified in the and Pourashavas) to create an enabling will let IR-3 know MOLGRDC, City environment for the provision of LARC the specific policy Corporations, Pourashavas,

and PM services issues that need to UPHCSDP and relevant

be addressed for NGOs and service centers

creating enabling responsible for provision of

environment health and FP services X

Postponed Postponed Regular communications Postponed maintained and need based meetings with liaison persons held to ensure uninterrupted LARC and PM services

114

Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

3.1.3.b Conduct advocacy meeting with the Teams-1 and 2 to 1 - - - One advocacy meeting with 0 1

executive committee of Municipal provide key the executive committee of Association of Bangladesh (MAB) for the activities to be Municipality Association of provision of LARC and PM services in undertaken for Bangladesh (MAB) held

selected 4 municipality areas/Pourashavas service delivery with 30 participants Done in Q2 Done of PY3 Districts which are yet to be and training and in Q2 Done finalized in consultation with MAB> also for SBCC

3.1.3.c Develop and sign an MOU with the MAB Teams-1, 2 and - X - - A MOU with MAB

for introducing LARC and PM services in ME&R team will developed and signed

4 Pourashavas review the draft

Done Done Done MOU and provide Done their inputs 3.1.3.d Support DGFP to organize and conduct Teams-1 and 2 to X X X X 4 advocacy meetings held 0 0

local level advocacy meetings with the provide key with 40 selected

Mayors of 4 Pourashavas activities to be participants at district level undertaken for with MOLGRDC (UP service delivery members & Chairman),

and training and DGFP, DGHS, UPHCSDP Postponed also for SBCC & other key stakeholders Postponed for LARC and PM services provision in Urban areas 3.1.3.e Conduct advocacy meetings at 4 Teams-1 and 2 to - 2 2 - 4 advocacy meetings held 0 0

Pourashavas to strengthen the provision of provide key at selected Pourashavas

LARC and PM services activities to be with 40 participants each undertaken for and need based tripartite service delivery meetings of Pouroshava,

and training and local DGFP office and MH- Postponed also for SBCC, II held at district/Upazilla Postponed and MAB level secretariat

115

Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 3.1.3.f Link Pourashavas with the local All teams’ support - X X X TA to selected Pourashavas NA NA NA NA contraceptive planning of DGFP for for follow-up and provided for affiliation with regular supply of logistics, commodities monitoring during the DGFP (if necessary) of and services field trip is service centers, renewal (if essential necessary) of the same and ensure uninterrupted supply of logistics and commodities from DGFP Quarter-wise Narrative Description of Activity Q1: Task # 3.1.3.c: An MOU has been signed between MAB and MH-II/EHB on 26th October 2015. The specific objective of the MoU is to ensure FP service delivery particularly injectable, implant, IUD, and sterilization services in addition to the existing provision of health services in the Pourashava facilities, partner NGOs and City Corporation health centers and create demand for different FP especially LARCs and PM services among urban population. Task # 3.1.3.d: A need and capacity assessment of 5 Pouroshavas namely PabnaSadar, Bera and IswardiUpazila of Pabna district, SingraUpazila of Natore district and KaliakairUpazila of Gazipur district has been done by MH-II staff. A combined report has been prepared with required activities to be undertaken. Task # 3.1.3.e: At this moment the nation-wide election for Pourashavas are going on and therefore, all relevant activities are withheld until the election completes in 30 December 2015. Q2: Task # 3.1.3.b: In this quarter, a meeting with MAB and selected Pourashavas was held on 31 January 2016 at EHB office at Dhaka. The purposes of this meeting was to bring all existing and newly elected Pourashava Mayors from selected 4 Pourashavas together and share the findings of the Need and Capacity Assessment conducted in November 2015, incorporated the ideas of newly elected Mayors and to agree upon activities for the Pourashavas to increase LARC & PM services in the Pourashava area. Task # 3.1.3.e: MH-II will organize Pourashava level advocacy meeting in the next quarter involving Pourashava, DGFP, DGHS, private clinics, NGOs and local community leaders to implement the agreed activities. Q3: Task # 3.1.3.e: In the last Pourashavas election held in December 2015, some of the influential and committed MAB members including the then Secretary General of MAB were defeated which resulted in the changes and restructuring of MAB executive committee. This newly formed committee is yet to take the responsibility

116

Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 of the MOU signed with the past Secretary General of MAB. Ultimately, the issue severely affected the whole planning of MH-II and therefore, no advocacy meeting with the Pourashavas to strengthen the provision of LARC and PM services was conducted in the reporting period. Q4 In this quarter, no advocacy meeting with the Pourashavas to strengthen the provision of LARC and PM services was conducted. Activity # 3.1.4 ADVOCACY FOR LARC/PM SERVICE PROVISION AT PRIVATE SECTOR FACILITIES Partners/Collaboration MOHFW, DGFP, BGMEA, Meridian Group International, Avenir Health POC Bikash Barman/Sadikur Rahman 3.1.4.a Develop and finalize LARC and PM PM of MIH X X - - LARC and PM Private X Private Sector Working Approach of EHB project is leading Sector Working Approach in consultation with MIH, NGOs like this initiative. finalized

NHSDP and other stakeholders. More support

required from Meridian Group,

Avenir Health, Drafted Teams-1, 2 and Finalized ME&R for review and inputs of the strategy reviewed internally Being

3.1.4.b Continue advocacy with DGFP for timely All teams’ support X X X X Supply of FP commodities

and adequate supply of LARC, PM and for follow-up and to 10 DGFP affiliated

Injectable commodities at DGFP affiliated monitoring during private clinics and hospitals

going going going going

- - -

private clinics and hospitals field trip is serving the very poor -

On On On essential population On

Quarter-wise Narrative Description of Activity Q1: Task # 3.1.4.a: The draft LARC and PM Private Sector Working Approach of EHB is now under review. Task # 3.1.4.b: An advocacy meeting was held on 17 September 2015 with private hospitals and NGO clinics, organized by Thana Family Planning Office in Mirpur, Dhaka. Service providers and managers from 19 private hospitals and clinics participated. Most of the private hospitals and clinics agreed to be linked up with DGFP

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 for FP activities particularly for PPFP services. As a continuation of that effort, on 28 November MH-II provided orientation on PPFP to all FPIs and FWVs of Mirpur, Dhaka. The oriented DGFP staff refer clients to the private clinics now. In addition, an advocacy meeting was organized by MH-II with Divisional Director-FP, Dhaka Division and Deputy Director of Dhaka so that PPFP services could be expanded in another Thana, Tejgaon, of Dhaka city while government logistics, commodities and Imprest funds would be made available in those facilities. Q2: Task # 3.1.4.a: The LARC and PM Private Sector Working Approach is being reorganized/rewritten with support from Ms. Cindi Cisek of Meridian Group International and this working approach would only contain the steps/ideas being pursued or to be pursued by MH-II. The working approach is structured following an agreed upon outline and is expected to be finalized in the next quarter.

Task # 3.1.4.b: In collaboration with Thana Family Planning Office, Mirpur, Dhaka, 3 LARC & PM special days were organized in 3 private facilities in Dhaka city where 27 NSVs were performed. The clients were generated using DGFP’s own field staff located in different parts of the city. Alongside, due to our advocacy efforts in the last quarter, Thana Family Planning Office, Mirpur started to provide Imprest fund, logistics and commodities to 6 private hospitals and 24 PPBTL services have been performed in this reporting quarter. Q3: Task # 3.1.4.a: The LARC and PM Private Sector Working Approach is almost through. The final draft is further shared with MH-II senior staff who are doing their final review. It is expected that the Working Approach to be finalized in the first month of the next quarter. Task # 3.1.4.b: An advocacy meeting was held on 25 May 2016 with private hospitals and clinics, organized by Upazilla Family Planning Office in Sadar, Narayanganj. 60 service providers and managers from 32 private hospitals and clinics participated in the advocacy meeting. Most of the private hospitals and clinics agreed to be linked up with DGFP for FP activities particularly for PPFP services. DGFP also agreed to provide them with required logistics and Imprest fund in connection with the PPFP services from those hospitals and clinics. As a result of this advocacy meeting, 45 PPBTL has been performed in those hospitals and clinics in only 1 month (June 2016). Q4 Task # 3.1.4.a: This quarter the LARC and PM Private Sector Working Approach has been finalized and put on operation. The main objective of this working approach is to address barriers to nonuse of long acting reversible contraceptives (LARCs) and permanent family planning methods (PMs) and accelerate the uptake of LARCs and PMs in Bangladesh through all available private service outlets. Activity # 3.1.5 BUILDING PARTNERSHIP WITH NGOS TO PROVIDE LARC/PM AT WORKPLACES Partners/Collaboration MOHFW, DGFP, BSR, YPSA, BGMEA, Meridian Group International POC Bikash Barman/Sadikur Rahman

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

3.1.5.a Continue advocacy with the DGFP for All teams’ support X X X X Supply of FP commodities

timely and adequate supply of LARC and for follow-up and to BGMEA health centers

injectable commodities at DGFP affiliated monitoring during systems developed and

going going going going

- - -

clinics of BGMEA field trip is made functional -

On On On essential On

3.1.5.b Advocacy with DGFP to permit supply of All teams’ support X X X X FP commodities available

FP commodities from BGMEA affiliated for follow-up and at garment factories from

clinics to garment factories, in order to monitoring during BGMEA affiliated clinics

going going going going

- - -

increase uptake of LARC and injectable by field trip is and health centers with -

On On On garment factory workers essential systems established and On

made functional

3.1.5.c Environmental scanning for inclusion of Support from X X X A report containing the SRHR/FP as one of Health Compliance Meridian Group recommended actions steps point for Garment Factories International developed and

disseminated including

inclusion of the availability Done

of SRHR/FP information report isavailable report

and services as a isavailable report A A compliance point A

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 3.1.5.d Build partnership with BSR working at the Meridian will X X X X FP, particularly LARC/PM garment factories (where YPSA is not support information and referral working) to introduce/incorporate LARC development of services incorporated in the and PM referral and services this partnership BSR supported factories based on their following development and existing 5-year signing of an MOU with global relationship BSR Through this initiative

with BSR. we will reach out to at least

Teams- 1 and 2 25 new garment factories

would provide

Done Done Done Training and Done SBCC related supports to BSR once the MOU is signed. A separate M&E plan to be developed by ME&R team. Quarter-wise Narrative Description of Activity Q1: Task # 3.1.5.a: MH-II provided technical support to BGMEA to apply for affiliation of BGMEA clinics with DGFP to get commodities and impress fund support. During this quarter BGMEA submitted 4 applications to DGFP to obtain affiliation for 4 BGMEA clinics located in Narayanganj, Gazipur and Dhaka districts. Task # 3.1.5.d: MH-II has signed an MOU with Business for Social Responsibilities on 27 October 2015. Under this MOU, MH-II developed an Action Plan through a workshop with the participation of MH-II staff and representatives of BSR HERhealth project partners—Change Associates, Awaj Foundation and Momota held on 8 December 2015. The action plan covers issues and activities associated with service delivery and training, demand generation, monitoring, follow-up and documentation of impact and sustainability plan. MH-II is now revising FP training module of BSR’s HERhealth project. MH-II would provide TOT to BSR’s master trainers once the module is revised and endorsed by both MH-II and BSR. Task # 3.1.5.b: To ensure supply of DGFP commodities in all mini clinics of the garment factories, MH-II has also started advocacy for signing a tripartite MoU among DGFP, BGMEA and EHB. A draft MoU has also been developed and shared with DGFP and BGMEA for their review and input.

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q2: Task # 3.1.5.a: MH-II continues providing technical support to BGMEA in getting affiliation of BGMEA clinics from DGFP so that they obtain family planning commodities and impress fund support from DGFP. BGMEA has total 10 clinics in Dhaka. Of those 7 are already affiliated and are receiving DGFP commodities and imprest fund for providing both short acting and LARC&PM services. During this quarter 1 BGMEA clinic located at Narayanganj city obtained affiliation and started receiving FP commodities from DGFP. 2 others got clearance from Upazila and District FP offices and were forwarded to DGFP HQ. MH-II also continues advocacy with the DGFP to supply DGFP family planning commodities and other applicable support directly to the readymade garment factories. A tripartite MOU was signed by the Directorate General of Family Planning (DGFP), Bangladesh Garment Manufacturers and Exporters Association (BGMEA) and EngenderHealth Bangladesh. Under this tripartite MOU, only the short acting methods (oral pills, condom and injectable) to be made available in the mini clinics within the RMG factories, not to the BGMEA clinics. This menas that for clinical services to be provided by the BGMEA clinics DGFP affiliation is still a prerequisite, as for clinical services there are certain infrastructural and medical preconditions/indicators those must be met by the individual clinic. The specific objective of this collaboration is to make family planning services available within the garment factories. BGMEA is a platform for 4,200 garment factories where 5.2 million people work, 80% of their workers are women and most of them are young. Because of this MOU, all BGMEA garment factories are now allowed to receive DGFP family planning commodiites without affiliation which has resulted in easy access to family planning services in the garment factories. Task # 3.1.5.c: David Wooford, Vice President (Public Private Partnership), Meridian Group Internatinal, Inc. visited Bangladesh on 22-30 January 2016 for the purpose of environmental scanning for inclusion of SRHR/FP as one of Health Compliance point for Garment Factories. During this visit, he visited ready made garment factories, corporate brand offices, and also met with ILO Better Work, UNFPA, UN Global Compact, BSR, Solidarity Center/Bangladesh and USAID. Mr. David will prepare the policy environment and strategy report and share it with Engenderhealth Bangladesh in early February 2016. Task # 3.1.5.d: Following the signing of an MoU with BSR in the last quarter, an action plan was developed in this reporting quarter involving BSR’s 3 partner organizations namely Change Associates, Mamata, and Awaj Foundation. MH-II has reviewed BSR’s Family Planning and MCH Training Modules based on that a TOT for BSR trainers is scheduled to be held on April 6-7, 2016. Q3: Task # 3.1.5.a: MH-II continues providing technical support to BGMEA in getting affiliation of BGMEA clinics from DGFP so that they obtain family planning commodities and impress fund support from DGFP. BGMEA has total 10 clinics in Dhaka. Of those 8 are already affiliated and are receiving DGFP commodities and imprest fund for providing both short acting and LARC&PM services. During this quarter 2 BGMEA clinics located at Savar/Dhaka and Gazipur city obtained clearance from Upazila and District FP offices and were forwarded to DGFP HQ. It is expected that the affiliation process of these 2 clinics would be completed in the first month of the next quarter and then would start DGFP logistics, commodities and imprest fund to provide both short acting and long acting FP services to the cleints, especially to the RMG workers. As reported in the last quarter that because of a tripartite MOU between BGMEA, DGFP and MH-II, all BGMEA garment factories are now allowed to receive DGFP family planning commodiites without affiliation which has resulted in easy access to family planning services in the garment factories. As a continuation of this effort, 65 clinical service providers (nurse, paramedics and medical assistants) working in 44 RMG mini clinics were trained on FP focusing on Oral Pill, Condom and

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Injectable in 4 batches. The 2-day batch trainings were held during 23-24 April, 25-26 April, 27-28 April and 24-25 May 2016 at MFSTC so that trainees get adequate number of clients for practice of Injectable services. After completion of the trainings, DGFP has issued a circular in favor of all those RMG factories so that they receive contraceptives (Oral Pill, Condom and Injectable) from local Upazilla FP offices located in Dhaka, Narayanganj, Gazipur and Mymensingh districts. Task # 3.1.5.c: David Wooford, Vice President (Public Private Partnership), Meridian Group International, Inc. visited Bangladesh on 22-30 January 2016 for the purpose of environmental scanning for inclusion of SRHR/FP as one of Health Compliance point for Garment Factories. During this visit, he visited readymade garment factories, corporate brand offices, and also met with ILO Better Work, UNFPA, UN Global Compact, BSR, Solidarity Center/Bangladesh and USAID. During this quarter Mr. David has prepared the policy environment and strategy report and shared that with EngenderHealth Bangladesh. The strategy has outlined some immediate action steps for MH-II: 1. BGMEA policy activities and brand convening. The BGMEA Basic Requirements need to be updated and improved. This work is a logical outgrowth of the MOU, and MH-II is well positioned to lead this activity. MH-II should also propose to develop a guidance document for factory leadership and senior managers building on its current experience in factories and that of its partners. Both documents would be important contribution to the field and would lay the foundation for longer-term policy advocacy with government agencies on worker access to family planning. One outcome of one or both of these products would be a brand and industry convening where the new guidelines and guidance is shared with these key stakeholders. MH-II can also build on the MOU to work with BGMEA to engage the Ministry of Labor to develop a related program to ensure large workplaces are meeting their new requirements on reproductive health. 2. A stakeholder convening with UNFPA. A full process of stakeholder engagement requires time and staff resources. But an initial stakeholder convening is feasible – and can serve several purposes, from sharing information on the MOU and other workplace programs to gaining input BGMEA guidelines to building support for an ongoing stakeholder process to advocate for workplace reproductive health policies. 3. Engage with Better Work on workplace activities. As the Alliance and Accord wind down, Better Work will be expanding and playing a major role in oversight and capacity building of factories. MH-II should collaborate with Better Work as a means of institutionalizing the family planning program in major factories. Furthermore, Better Work has a research program that could contribute to a broader research agenda for reproductive health in factories. 4. Design, if not implement, a sustainable training program for factory nurses and health practitioners. The skills and knowledge in general of workplace nurses, but particularly relating to counseling and provision of family planning, are central factors for improving workplace health practices. Yet capacity building for nurses needs to be institutionalizing, possibly through a public-private partnership between industry, educational institutions, NGOs and brands. 5. Develop with USAID and USAID options for a more robust research component for the MOU. A first step would be a gap analysis of the research that has already been done in the RGM on worker and workplace health issues. This would be followed by the design of a research program, depending on interest and funding by USAID.

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 3.1.5.d: Last quarter MH-II has reviewed BSR’s Family Planning and MCH Training Modules. Based on that a TOT for BSR trainers was held on April 6-7, 2016. 13 trainers from BSR’s partner organizations (Change Associates, Awaj Foundation and Momota) attended the 2-day training course which was held at the MFSTC. Q4 Task # 3.1.5.a: During this quarter 2 BGMEA clinics located in Savar/Dhaka and Gazipur city obtained DGFP affiliation. Now, they have started to receive DGFP logistics, commodities and the Imprest fund to provide both short acting and long acting FP services. Task # 3.1.5.c: A report containing the recommended actions steps (for detail, please see Q3 progress report) developed and disseminated including inclusion of the availability of SRHR/FP information and services as a compliance point. A detailed discussion was made with David Wooford, Vice President (Public Private Partnership) and Ms. Cindy of Meridian Group International, Inc. Some of the recommendations were incorporated in the Workplan of PY4. Activity # 3.1.6 ADVOCACY WITH THE DGFP TO STRENGTHEN COMPLIANCE CULTURE IN MONITORING OF PERFORMANCE OF FIELD WORKERS Partners/Collaboration DGFP POC Sadikur Rahman/Azmal Hossain/Ninad Afrin Zohora

3.1.6.a Organize meeting and brainstorming Require 2 - - - 2 brainstorming sessions 0 4

sessions with the DGFP to discuss substantial held at the DGFP with 30 alternative ways of supervising and involvement of participants and a report monitoring field workers’ performance. ME&R team, and generated

MH-II senior Done in Q2 Done staffs in Q2 Done

3.1.6.b Organize a brainstorming session with Require - 3 - - 3 brainstorming sessions NA 1 1 Upazilla level managers to discuss substantial held at the divisional level alternative methods DGFP supervisors involvement of with 40 district and could monitor field workers’ performance. ME&R team, and Upazilla level participants MH-II senior selected randomly from staffs PY1, PY2 and PY3 Districts and a report

generated Q3 on done be To

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 3.1.6.c Collaborate with the MH-II ME & R team Require - X X X An innovative program NA NA to initiate and pilot the recommended substantial approach is designed and alternative scheme in 1 district of PY3 for involvement of implemented in 1 district of six months and recommend for possible ME&R team PY3; quick assessment of scale-up the intervention is conducted and a report

containing next steps for Pilotstarted advocacy and scale-up is generated PilotQ3 in started 3.1.6.d Organize national level meetings with the Require - - - 1 1 meeting held at the DGFP NA NA NA NA DGFP to discuss the results of the pilot and substantial with 40 participants discuss about the possible nation-wide involvement of scale-up ME&R team, and MH-II senior

staffs Quarter-wise Narrative Description of Activity Q1: Task # 3.1.6.a: In order to design the compliance culture to capture the performance of the DGFP field workers in one of the MH-II PY3 districts, a letter has been sent to LD, CCSDP/DGFP requesting him to issue a call-up letter for holding a barnstorming session with the Deputy Program Managers, Program Managers and the Directors and Line Directors of all units of the DGFP. A concept note covering the rationale for introducing a compliance culture, the intervention modalities, monitoring and assessment of the pilot intervention and potential scale-up was also developed and sent to the LD, CCSDP with the request letter. Q2: Task # 3.1.6.a: During the reporting quarter MH-II in collaboration with the CCSDPof DGFP organized and conducted 4 regional level workshops in Dhaka, Rangamati, Chittagong and Comilla with the participation of all district and upazila level program managers and service providers. A detailed report on the workshop has been developed and shared with the DG of DGFP. The mentioned initiative that is introducing non-performance based monitoring (compliance culture) got laudable attention of the participants of the brainstorming sessions. The recommendations of the sessions for the next steps are: (1) For introducing non-performance based monitoring of the DGFP field workers, a pilot will take place in one district covering all of the Upazilas of that District. The district would preferably be from Chittagong division; (2) The step-wise pilot will include: (a) sharing of the findings of the national and regional level brainstorming sessions with the upazila level managers through a workshop at the district level. The participants are Deputy Director, Assistant Director (FP/CC), Upazila Family Planning Officers, Medical Officers (MCH-FP), Medical Officer (Clinic), Assistant Family Planning Officers, Assistant Family Welfare Officers, selected 5 Family Planning Inspectors, selected 5 Family Welfare Visitors, selected 5 Sub-Assistant Community Medical Officers and selected 5 Family Welfare Assistants; (b) redefining the roles and

124

Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 responsibilities of the staff: (all staffs shall have to be made understand that contraceptive performance is a composite outcome of all of the activities carried out by FWAs, FPIs, FWVs, SACMOs, UFPOs, MOs (MCH-FP) and others; FWAs: FWA’s home visitation would be based on client segmentation; not all of the registered couples be visited; mobile follow-up of clients and a provision of transfer of FWAs from one unit to another; FPIs: assigning client referral and specific contraceptives projection to be given; make them responsible for health education activities particularly for the male; transfer of FPI from one union to another; peer reviewed system to be introduced, i.e., an FPI would be assigned to review the performance of another FPI and report accordingly; FWVs: more community level BCC work during the satellite clinic days; SACMOs: assigning for client counseling, client referral and giving responsibility of contacting males; (3) in the monthly meeting reporting should include number of home visits, number of court yard meetings, number of client referrals, number of interpersonal communications, number of couple counselling, number of client follow-ups, number of monthly meetings along with the achievements of the contraceptive projections and (4) Meeting minutes of all of the monthly meetings be written, documented and reviewed in the next monthly meeting. Q3: Task # 3.1.6.b: Following an approval letter dated 27 April 2016 from the DG of DGFP indicating Feni as the piloting district for introducing non-performance based monitoring (compliance culture), a two-day workshop on piloting the ‘non-performance based monitoring (Compliance Culture)’ at Feni district was held on 29-30 May 2016 with the participation of Deputy Director (FP), Assistant Director (FP/CC), Upazila Family Planning Officers, Medical Officers (MCH-FP), Medical Officer (Clinic), Assistant Family Planning Officers, Assistant Family Welfare Officers, selected 12 Family Planning Inspectors (2 from each Upazila), selected 12 Family Welfare Visitors (2 from each Upazila), selected 12 Sub-Assistant Community Medical Officers (2 from each Upazila) and selected 12 Family Welfare Assistants (2 from each Upazila). The workshop identified the package of interventions to be undertaken in the district for the next 1 year. The package of interventions are: (1) targeted visit to nulliparous, high parity couples and pregnant women by FWAs; (2) FP/Health education session at satellite clinics by FWAs (3) Mobile follow-up by the FWAs; (4) Mobile follow-up by the FPIs; (5) Health education session and counseling by the FWVs during satellite sessions; (6) A package of job-aid and counseling materials to be made available to all satellite sites including CCs; (7) FP assignment for the SACMO, particularly SACMOs to be given monthly projection and would provide FP services in the days when FWVs have satellite clinics; (8) Ensuring MO (MCH-FP)’s visit to FWC level at least once in a month. In case of non-availability of MO (MCH-FP), a private doctor to be hired. MH-II would provide remuneration to this private doctor (9) Ensuring UFPO’s visit to FWC level at least once in a month; (10) Infrastructure/facility readiness; (11) Organizing special FP service delivery days at least once in a month in each FWCs; (12) Calendar of events for satellite clinic, school health education session, EPI session, ANC, PNC and Injectable due dose can be developed; (13) Ensuring discussion on and writing of meeting minutes of each of the Upazila level meeting (Issues to be discussed in the monthly staff meeting at Upazila level and district levels are number of client segmented home visits, number of court yard meetings, number of client referrals, number of interpersonal communications, number of couple counselling, number of client follow-ups, number of monthly meetings at FWCs, number of satellite clinics, number of school health education sessions, number of special service days, number of FWC visits by the MO (MCH-FP)/private doctors and UFPOs and the achievements of the contraceptive projections by FWAs, FWVs, SACMOs and FPIs); (14) Training/upazila wise orientation for FWA, FPI, FWV and SACMO; (15) Need based BCC materials (e.g., LARC/PM leaflet and PPFP leaflet) to be made available in all CCs, FWCs and UHCs; (16) Writing and documentation of monthly staff meeting minutes; (17) Follow-up and monitoring.

Task # 3.1.6.c: Based on the agreed package of intervention, 10 bacthes of 1-day training on non-performance based monitoring (Compliance Culture) and role of he specific staff on this piloting were held at 6 Upazilas in Feni. 35-40 particiapnts including Assistant Upazila Family Planning Officers, Assistant Upazila Family Welfare Officer (MCH-FP), Upazila Family Planning Assistant, Family Planning Inspector, Sub-assistant Community Medical Officer, Family Welfare Visitor, Family

125

Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Welfare Assistant attened in each of the trainings held on 19-21 June at Sadar, 22-23 June at Sonagazi, 25 June at Porshuram, 26-27 June at Dagonbhuiya, 28 June at Chhagalnaiya and 29 June at Fulgazi in Feni district. It is expected that after the one-year piloting of this intervention, a culture of comprehensive group accountability for contraceptive performance would be developed among all cadres of FP staff who work at the field up to the upazila level. Thus, the topics those are discussed in the monthly staff meeting at the office of the Upazila Family Planning Office would cover issues/activities other than the contraceptive performance by the Family Welfare Assistants only. The discussion would extend to the accomplishments of the tasks those are supposed to be carried out by all other staff. Q4 Task # 3.1.6. b: Based on intervention modalities of compliance culture, a 6 days training on IUD was held at Feni district from July 17 to 22, 2016. Total 9 female SACMOs from 5 Upazilas (Sadar 2, Dgaanbhuiya 4, Sonagazi 1, Fulgazi 1 and Chagalnaiya 1) participated in that training. The objective of the training was to enhance the skill of the female SACMOs providing IUD services and to improve their knowledge on IUD (advantage, disadvantage, side effect management)

Task# 3.1.6. c: After successful completion of the training and orientation sessions on compliance culture for all the field level DGFP staff of Feni district, one assigned staff from Mayer Hashi-II visited and attended regularly at the monthly meetings at the Upazila Family Planning Offices to follow up the intervention of compliance culture. The intervention modalities of compliance culture focuses on delivering family planning services based on client segmentation, strengthening services (e.g. satellite clinic, court yard meeting, school health session, counseling) besides traditional projection system for field staff, follow up through mobile phones and effective documentation and monitoring of all accomplished services.

The purposes of those follow up visits were to monitor the agreed and implemented accomplishments under compliance culture by the field staff, support Upazila FP Offices in documenting the performances of staff and provide necessary assistance for further strengthening FP service delivery.

The monthly meeting of district/upazila offices were held on July 12, August 6-11 and September 4-9, 2016 consecutively where MH-II staff attended those meetings.

Besides, for ensuring that interpersonal communication and counseling is done properly during satellite clinics, court yard meetings, total 2280 number of flip charts, PPFP job aids, Counseling Job aids, PPFP Roman banners, LARC/PM Roman Banners and 651 number of Court Yard roman banners were distributed at Feni district. Mostly Family Welfare Visitors (FWV) and Family Welfare Assistant (FWA) would use those materials. The 6 Upazila offices decorated their all satellite clinics by the distributed IEC/BCC materials.

So far, the following positive changes happened due to the intervention of compliance culture: 1. DDFP attends all meetings at the Upazilla offices and supervises all staff working the district 2. Upazilla Family Planning Officers are doing surprise visits and doing mobile phone follow up of their filed staff 3. The frequency of holding satellite clinics and court yard meetings increases as the issues are being discussed in the monthly meetings 4. Upazilla Family Planning Office (Parshuram) initiated special initiatives for FP services (e.g. Special PPFP information campaign for only pregnant mothers) 5. To motivate the staff to provide FP services, DDFP initiated ‘Staff of the Month’ certificate award for the field staff

126

Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 6. The reporting system of monthly meeting has updated and discussed on other issues rather than only monthly projection by the staff Activity # 3.1.7 SUPPORT DGFP TO USE THE ICV ENTRENCHED BOTTOM-UP CONTRACEPTIVE PLANNING APPROACH Partners/Collaboration MOHFW, DGFP, DGHS, UPHCSDP, City Corporations, Pourashavas, NGOs POC Farhana Yeasmin/Nusrat Zaman Sohani 3.1.7.a Continue support to DGFP to train/orient 15 25 30 30 TA provided to CCSDP to 33 18 0 0 field workers to do contraceptive planning organize 100 Upazilla exercise through client segmentation mostly from PY3 Districts process considering ICV norms level orientations for 6500 field workers

3.1.7.b Advocacy to strengthen/revise client Support from X X X X The existing Software

segmentation and bottom-up contraceptive ME&R team become more user friendly

planning software developed by required for DGFP users

going going going going

- - -

MIS/DGFP for CCSDP/DGFP so that it -

On On On reflects the local needs with possible use of On EH Reality Check tool. Quarter-wise Narrative Description of Activity Q1: Task # 3.1.7.a: During 1st quarter, MH-II supported DGFP to organize and conduct 33 bottom-up contraception planning workshops in 33 Upazilas of 8 districts namely Chittagong, Pabna, Satkhira, Panchgar, Bogra, Jessore and Bramhanbaria. A total of 4,012 field workers of DGFP have been oriented on bottom-up contraceptive projection and planning. Additionally, to see the efficacy of the bottom-up contraceptive projection and planning, 2 iDQAs have been conducted in Laxmipur and Rangpur districts during this quarter. The finding of iDQAhaveyet to be analyzed. However, primary data shows that in the last FY bottom-up projection and planning exercises were done in each and every level—from the field workers to the district FP offices although they were unsure of the kind of qualitative contributions are being made by these exercises in terms of improved uptake of FP methods and LARC and PM in particular. Q2: Task # 3.1.7.a: During 2nd quarter MH-II supported DGFP to organize and conduct 18 bottom-up contraception planning workshops in 18 Upazillas in 5 districts, Joypurhat, Munshiganj, NarayanganjNaogaonand Sylhet. A total of 1007 field workers from the DGFP have been oriented on bottom-up contraceptive projection and planning. Q3:

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 3.1.7.b: To identify the need for strengthening and/or revising of client segmentation and bottom-up contraceptive planning software developed by MIS/DGFP for CCSDP/DGFP so that it reflects the local needs with possible use of EH Reality Check tool, a tripartite meeting was held on 10 May 2016 at CCSDP Conference Room with the presence of representatives from CCSDP/DGFP, MIS/DGFP and MH-II/EHB. In that meeting CCSDP took the responsibility of identifying their needs while running the software in presence of the MIS folks. On 29 May 2016, a follow-on meeting was held between MH-II/EHB and CCSDP/DGFP at the office of the LD, CCSDP. The meeting ended with no substantial decision as CCSDP couldn’t identify any specific needs in connection with the strengthening of client segmentation and bottom-up contraceptive planning software. Q4: During the reporting quarter no bottom-up contraceptive planning workshop held. Sub-IR3.2 National standards, guideline, curricula and policies are implemented by personnel at teaching institutions and service delivery points. Activity # 3.2.1 SUPPORT THE DGFP/MOHFW TO REVISE THE RELEVANT SECTION OF THE NATIONAL FAMILY PLANNING MANUAL PRINTED IN 2010 Partners/Collaboration MOHFW, DGFP, DGHS, NTC POC Nahid Anjum Siddiqui/Md. Abul Quiyume/Azmal Hossain

3.2.1.a Review the Medical Eligibility Criteria All IR teams, X - - - Changes in the 5th edition

(MEC) of WHO (5th edition), CDC/US and especially support of WHO MEC identified

Neighboring Countries and adapt from Capacity and to be used to revise the

going going going

- -

necessary changes according to Building Advisor relevant sections of the -

Done

On On Bangladesh needs is considerably National FP Manual On important

3.2.1.b Review recent policy changes not reflected The list to be X X - - A list of changes are

in the National FP Manual 2010 and reviewed by MH- developed and incorporated going

develop a list of changes to be incorporated II senior staffs in the FP Manual -

Done Done Done

in the revised FP Manual On

3.2.1.c Disseminate the list of needed changes in All staff X 1 dissemination meeting

the FP Manual with 20 participants from going

CCSDP, FSDP and MCH -

Done Done Done

of DGFP On

128

Review Committee and to include DGHS and PM of MIH review committee formed

representative to revise FP Manual project to be inclusive of DGHS

included in the membership and supported

going going -

review committee to organize need based -

formed

On On

Review Committee committee 1 meeting held meeting

meetings is committee A

3.2.1.e Support revision of the draft manual and MH-II senior staff - - X X The revised

finalization of the FP Manual and obtain and PM of MIH sections/portions of the FP

going going going going

- - -

approval from the review committee would review the Manual finalized and ready -

On On On draft at hand for printing On 3.2.1.f Print the revised portion of the FP Manual - - - X 5000 copies of the revised NA NA NA NA portion of the FP manual printed and attached as an addendum/ inserter of the existing manual The National FP Manual is available in DGFP and other relevant websites

3.2.1.g Revise and print the PPFP Handbook IR-1 team will X - - - PPFP handbook is revised

provide technical upon the approval of

support for the Implant as the immediate

revision of the PPFP method and 2000 handbook copies of the same is

printed

sections

Progress only the changed changed the only

PPFP handbook is available

Further review in in review Further Review inProgress Review in DGFP and other relevant inProgress Review

websites Printed

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

3.2.1.h Print the Laminated Job-aid for PPFP IR-1 team will X - - - Laminated Job-aid for NA NA

provide technical PPFP is revised upon the support for the approval of Implant as the revision of the immediate PPFP method

job-aid and 5000 copies of the Printed Printed inQ3 Printed same is printed copies 5,000 Quarter-wise Narrative Description of Activity Q1: Task # 3.2.1.a: During the reporting period, IR3 team has reviewed WHO MEC and the recent policy changes those are not reflected in the National FP Manual 2010 and developed a matrix of suggested changes needed to be incorporated in the revised FP Manual. The matrix has also been shared with the senior technical persons of MH-II for their review and input. Q2: Task # 3.2.1.d: As mentioned in the previous quarter, MH-II has sent out a letter to the DG of DGFP requesting him to form a ‘FP Manual Review Committee’. CCSDP has proposed names of the experts from different units of the DGFP HQ, training centers, field level program managers and service providers, NGOs (EHB, MSCS) and development partners (WHO, UNFPA, etc.) who could be included as the members of the committee. It is expected that after DG of DGFP’s approval in early April 2016, the committee would formally start reviewing the EHB developed matrix of suggested changes and do the revision of the manual accordingly. Q3: 3.2.1.b: MH-II reviewed recent (2013-2016) policy changes not reflected in the National FP Manual 2010 and developed a list of suggested changes to be incorporated in the revised FP Manual. 3.2.1.d: DGFP formed a ‘FP Manual Review Committee’ consisting 36 members from different units of the DGFP HQ, training centers, field level program managers and service providers, NGOs (EHB, MSCS) and development partners (WHO, UNFPA, etc.). This committee met on 26 April 2016 at CCSDP/DGFP Conference Room where MH-II identified changes those need to be incorporated in the revised FP Manual were presented. The committee agreed to revise 12 chapters of the Manual and has given responsibility to different members to rewrite and/or edit the text of those chapers aligned with the recent policy changes. It is expected that in the next quarter the revision of the FP Manual would get completed. 3.2.1.g: As Implant got NTC approval as the immediate PPFP method, PPFP handbook has been revised and only relevant section of the handbook is printed (2,000 copies) and attached with the PPFP handbook as errata. 3.2.1.h: Following the NTC approval of Implant as the immediate PPFP method, MH-II has revised and printed 5,000 copies of the Laminated Job-aid for PPFP. This job-aid is used by the service providers as a counseling tool.

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q4: 3.2.1.d: In the meeting of 26th April 2016, a decision was made to revise 12 chapters of the FP manua. The changes were shared on 22nd September 2016 with the FP manual review committee. It was decided that a further technical revision is needed on the Manual. It is expected that the revision would be completed in the 1st quarter of 4th year of the project. Activity # 3.2.2 MONITORING AND FOLLOW-UP OF THE IMPLEMENTATION OF CHANGED POLICIES IN COLLABORATION WITH DIFFERENT IR TEAMS OF MH-II AND USE OF ICT Partners/Collaboration MOHFW, DGFP, DGHS, MOLGRD&C, UPHCSDP, Private Sector, NGOs, City Corporations, Pourashavas, BGMEA, BSR, BERDO POC Nusrat Zaman Sohani/Md. Abul Quiyume/Ninad Afrin Zohora

3.2.2.a Include monitoring and follow-up of All teams X X X X ME&R Team of MH-II

implementation of changed policies in the involvement included a section in the

regular program/activity/trip report particularly of regular trip report on ME&R team is monitoring and follow-up

considerably of implementation of Done

Done in Q1 Done in Q1 Done important changed policies in the PY1 in Q1 Done and PY2 Districts

3.2.2.b Review trip reports and share with the Support from X X X X An analytical report NA

local managers to ensure implementation ME&R team is indicating the places where g

of changed policies required the changed policies have

going goin going

- -

been implemented and the -

On On places where problems On were faced 3.2.2.c Share the policy changes through social Team-2’s X X X X Changed policy NA

media, quick updates and other ICT based involvement is information disseminated

efforts of MH-II substantially through MH-II Facebook

required page, MH-II quick updates,

going going going

- -

DGFP and DGHS Website -

On On and BHE and IEM On newsletters

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circulars periodically from different units are required and circular from different

of DGFP and share those with MH-II staff units of DGFP are collected

and relevant stakeholders including DGHS, and shared with MH-II staff

going going going going

- - -

NGOs like NHSDP and private sector and relevant stakeholders -

On On On facilities including DGHS, NGOs On like NHSDP and private sector facilities Quarter-wise Narrative Description of Activity Q1: Task # 3.2.2.a: In the first quarter of PY3, IR3 team has developed a checklist which has been introduced to monitor and follow-up the implementation of changed policies. The follow-up is inbuilt with regular field trips of MH-II team members. During this quarter, a total of 145 DGFP service providers and program managers at district and Upazila levels have been followed-up with by MH-II team members. The filled-in checklists have yet to be analyzed. However, primary findings reveal that all of the program managers and services providers are aware of the recent policy changes and that they disseminated changes with their colleagues during the monthly meetings. The district and upazila level program managersare very poor in documenting the relevant circular and many of them are not convinced to allow nulliparous women to accept implants. Q2: Task # 3.2.2.a: During the reporting quarter a total of 79 DGFP service providers and program managers at district and Upazila level have been followed-up by MH- II and MIH team members (20 by IR1, 5 by IR2, 39 by IR3, 12 by ME&R and 3 by MIH). Monitoring findings reveal that knowledge about all the 12 modified/new policies are not universal—highest (95%) know that Implant can be provided to nulliparous while only 42% know that for the management of excessive bleeding following implant use, two tablets of low dose oral contraceptive pills (Shukhi) can be used for 21 days; if bleeding does not improve within 1 cycle, then 2 cycles can be given, keeping a 7-day interval between cycles. Many of the program managers are not getting circulars and/or notifications from the DGFP HQ whereas the documentation of the circulars by them is also very poor. The policy change issues are shared with the field staff (91% regarding Tubectomy during C-section), still some of those are not disclosed among the staff (62% regarding Injectable by CHCPs). Many of those changed policies are not being implemented by them due to various reasons. For example, CHCPs are allowed to provide Injectable but being non-DGFP providers, they are not getting Injectable supply directly from DGFP.

For implementation of changed policies, MH-II has already taken several steps. The key steps are: - Resending of DGFP and DGHS issued circulars to over 4,200 program managers and service providers of DGFP, DGHS, NGOs and private sectors across the country via regular surface mail - Sending to over 700 program managers and service providers of DGFP, DGHS via email

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 - In the district advocacy meetings and any other field level events of MH-II, staff are disseminating the information and discussing the issue so that the changed policies are implemented - The Sr. QA&FP compliance officers are discussing the issue in the districts and upazila level monthly meetings of the DGFP - To double the effect, the district immunization medical officers (DIMOs), the WHO supported local level staff of DGHS, are also being oriented so that they disseminate the information and ensure that in each ANC, PNC and immunization services, PPFP counseling is done - A free of cost android based application is also under development to monitor the implementation of changed policies. - To institutionalize the changed policies, MH-II reviwed the recent policy changes those are not reflected in the National FP Manual 2010 and developed a matrix of suggested changes needed to be incorporated in the revised FP Manual. As Implant got NTC approval as the immediate PPFP method, PPFP handbook has been revised and the Laminated Job-aid for PPFP has been revised, printed and being distributed to the service providers. Q3: Task # 3.2.2.a: During the reporting quarter a total of 41 DGFP and DGHS service providers and program managers at district and Upazilla level have been followed- up by MH-II team members. For DGFP, the findings are quite similar to the last quarter. DGHS providers (N=13) was not found aware of the policy changes except Obs/Gyn. consultants (N=2) who know about the changes in the policies of Implant use and PPFP services in the DGHS facilities. To ensure the implementation of changed policies, several steps were taken in the last quarter: - The circulars in connection with the decision of the 65th and 66th NTC meetings (PPFP counseling can be done during each and every ANC, PNC and Immunization visits; FP services for short acting methods such as pills, condoms and injectable are now available at the immunization sites; and Implants and Progestin-only-Pills (POP) can be provided to clients immediately after delivery of a baby irrespective of parity of that particular woman) were sent via regular surface mail to 4,508 Program Managers and Services Providers of DGFP (1,716), DGHS (1,642), and NGOs/Private Sectors (1,150). - In the district advocacy meetings and all other field level events like training and orientation meetings, MH-II staff are disseminating the information and discussing the issue so that the changed policies are implemented - The Sr. QA&FP compliance officers are discussing the issue in the districts and Upazilla level monthly meetings of the DGFP - On 14th June 2016 at EPI Conference Room of DGHS, all 32 district immunization medical officers (DIMOs), the WHO supported local level staff of DGHS, along with the EPI Program Manager and Deputy Program Managers of DGHS were oriented on the recent policy changes, particularly on the issue of PPFP counseling during ANC, PNC and Immunization services and making short-acting methods available in the Immunization sites. As committed by the DIMOs, it is expected that they would discuss the issue with the respective Civil Surgeons, Upazilla Health & Family Planning Officers and other concerned to ensure that in each ANC, PNC and immunization services, PPFP counseling is done and short acting methods are provided in the immunization sites. - A free of cost android based application is also under development to monitor the implementation of changed policies. The development of this application would be completed in July 2016. - To institutionalize the changed policies, MH-II reviewed the recent policy changes those are not reflected in the National FP Manual 2010 and developed a matrix of suggested changes needed to be incorporated in the revised FP Manual. As Implant got NTC approval as the immediate PPFP method, PPFP handbook has been revised and the Laminated Job-aid for PPFP has been revised, printed and being distributed to the service providers.

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Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q4: During the reporting quarter, 23 DGFP and DGHS service providers and program managers at the district and Upazila level were followed-up with by MH-II team members. Finding for the DGFP were similar to last quarter: DGHS providers (N=9) were found not to be aware of the policy changes except Ob/Gyn. Consultants (N=2) who knew about the policy changes related to implant use and PPFP services in DGHS facilities. Activity # 3.2.3 SUPPORT CCSDP OF DGFP FOR THE SCALE-UP OF YMC INTERVENTION AT SELECTED DISTRICTS Partners/Collaboration DGFP, UNFPA POC Nahid Anjum Siddiqui/Azmal Hossain 3.2.3.a Provide TA (on a needs basis) to CCSDP IRs 1 & 2 would X X - - Need based TA provided to

of DGFP for the revision of the training review the CCSDP for revising and

curriculum for training of the peers who curriculum and finalization of training will be recruited by CCSDP under the ME&R team will curriculum for training of YMC scale-up program develop a M&E the peers and as such

plan training curriculum is ready Done

Done in Q1 Done in Q1 Done at hand for training of the in Q1 Done

peers

3.2.3.b Provide TA to CCSDP for the recruitment IRs 1 & 2 would X X - - A selection and recruitment Q1 of peers for the YMC scale-up program. review the criteria is developed in recruitment consultation with FSDP and

criteria and CCSDP Done

Done in Done in Q1 Done provide inputs in Q1 Done

3.2.3.c Provide need based TA to CCSDP for the Team 2’s - 2 - - 2 TOT sessions organized NA

TOT for DGFP trainers (who will train involvement is and conducted at regional YMC peers). substantial and level near the Upazillas need to lead this where YMC would be

training as BCC is scaled up with the

Postponed Postponed the main participation of 20 trainers Postponed component in each session 3.2.3.d Provide need based TA to CCSDP for the Team 2’s X X X X Need based TA to CCSDP NA NA NA NA conduction of training of the peers involvement is for the conduction of substantial and training for the peers (25

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component At least 75,000 YMCs are reached by the peers

3.2.3.e Provide need based IEC/BCC materials All the required - X X X Required IEC/BCC NA

and demand generation support to CCSDP materials to be materials are distributed to Q2

for the promotion of LARC and PM in the provided by CCSDP and a monitoring Q2

Done Done in Done PY3 Districts including a monitoring plan Team-2 plan developed in Done Quarter-wise Narrative Description of Activity Q1: Task # 3.2.3.a/b: Although YMC scale-up intervention has been incorporated in the Operational Plan of the CCSDP, the implementation of this program has not yet started because of the long bureaucratic approval procedure for the recruitment of YMC peers from the Ministry of Health and Family Welfare and the Ministry of Finance. The Ministry of Health and Family Welfare approved the recruitment issue which was then sent to the Ministry of Finance. This second approval is expected to be obtained by the early next quarter. Notably, MH-II has provided technical support to CCSDP for the development of the selection and recruitment criteria of the YMC peers. In the meantime, IR3 team in consultation with the CCSDP has developed a training curriculum for training of the peers which is also ready at hand for training of the peers. Q2: Task # 3.2.3.a/b: The Ministry of Finance has approved the recruitment of 1195 volunteers in 14 hard-to-reach Upazilas in 7 low-performing districts. CCSDP/DGFP has sent out a circular to these districts to complete the recruitment of the volunteers by the end of March. The circular contains the selection and recruitment criteria for the YMC peers. The implementation of the intervention is expected to start in the next quarter with a 2-day TOT for all Program Managers and Service Providers of the districts. Then cascaded training would be started for the YMC peers. For this, MH-II has sent different kinds of IEC/BCC materials and job aids (1195 copies each of LARC/PM Flipchart, Volunteer Guidebook, Court Yard Meeting Roman Banner, Bag, Umbrella, Diary and 239000 LARC/PM leaflets) to CCSDP. Q3: Task # 3.2.3.d: MH-II provided technical support to CCSDP/DGFP in organizing and conducting 2-day training to all DGFP recruited YMC volunteers in 14 hard-to- reach Upazilas in 7 low-performing districts. The events took place in Noakhali during 23-26 April (4 batches in 2 Upazilas); in Cox’s Bazar during 02-05 May (4 batches in 2 Upazilas); in Barugna during 07-10 May (2 batches in 2 Upazilas); in Rangamati during 07-10 May (2 batches in 2 Upazilas); in Jamalpur during 24-25 May (2 bactehs in 2 Upazilas); in Sunamganj during 24-27 May (2 bactehs in in 2 Upazilas) and in Sirajganj during 24-27 May (2 bactehs in in 2 Upazilas). Notably,

135

Tasks Inter-Team Implementation Time Benchmark/Deliverables Quarterly Achievement of Collaboration Frame Benchmark/Deliverables Task # Task Description Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 report from 7 out of 14 Upazilas shows that by this time the volunteer referred 1,259 clients have accepted different types of LARCs (IUD-64, Implant-1153) and PMs (NSV-10, Tubectomy-32). Task # 3.2.3.e: MH-II has provided different kinds of IEC/BCC materials and job aids (1195 copies each of LARC/PM Flipchart, Volunteer Guidebook, Court Yard Meeting Roman Banner, Bag, Umbrella, Diary and 239000 LARC/PM leaflets) to CCSDP. The materials were distributed to the volunteers who were trained on how to use each of the materials during the above mentioned trained programs. Q4 Task # 3.2.3.d: After receiving training in last quarter, YMC volunteers started to refer client at the service centers. Up to Septembers 2016 YMC volunteer referred 4628 clients have accepted different types of LARCs (IUD 277, Implant 4101) and PMs (NSV 98, Tubectomy 152). Activity # 3.2.4 DEVELOPMENT AND DISSEMINATION OF AN ADVOCACY BOOKLET ON ‘WHY LARC AND PM’ Partners/Collaboration MOHFW, DGFP, DGHS, NIPORT, UNFPA POC Azmal Hossain/Farhana Yeasmin 3.2.4.a Desk review of the available literature on Avenir Health’s X X - - Available literature

the LARC and PM involvement is including Costed

substantial; ME& Implementation Plan of inQ3

R team would also UNFPA and those of

going going

- -

support during NIPORT are reviewed, Done

On On

review process summarized and used in the Done booklet

3.2.4.b Case studies and relevant points collected Avenir Health and X X - - A booklet developed

from MH-II experience and other sources ME&R team containing the 5 collected

such as NHSDP that supports the would provide case studies and other going

importance of LARC and PM guidance on case points - Done

study On Done in Q2 Done methodology in Q2 Done

136

staffs review and and finalized

input is required 5000 copies of the

for the finalization

- going

advocacy booklet printed going - of the booklet -

and shared with the DGFP,

Finalized On DGHS, NGOs and Private On sector stakeholders Quarter-wise Narrative Description of Activity Q1: Task # 3.2.4.a/b: As a part of the development of this booklet called ‘Why LARC and PM’, a guide for case study collection was developed by Avenir Health. To the extent possible, the case studies will point to some results arising from innovative, successful and/or promising interventions undertaken or supported by MH- II. Broadly speaking, there will be 2 types of case studies—the case studies (2-3) that illustrate the health, economic, and social-psychological rationale for improving access to LARC/PM and case studies (2-3) on potential or recent LARC/PM acceptors who were counseled and/or were provided with LARC/PM services by the clinicor community workers trained by MH II or other USG projects. The first draft of the booklet is expected to be shared in mid-February 2016 as the draft is linked with the publication of the final report of the Bangladesh Demographic and Health Survey 2014 which will be published in early January 2016. Q2: Task # 3.2.4.a/b: Following the case study collection guide developed by Avenir Health in the last quarter, MH-II had recruited a consultant who collected 17 cases from Cox’s Bazar, Sylhet, Khulna, Mymensingh and Gazipur. The cases were shared with MH-II senior staff as well as with Avenir Health. They later then 3 case studies in the draft version of the booklet ‘Why LARC and PM in Bangladesh’ which is targeted only for the Policy Makers. A complied feedback from MH-II has been sent to Avenir Health for further revision of the booklet. Another version of the booklet targeting the field workers and service providers is being drafted by Avenir Health and will be shared with MH-II soon. Now, it is forseen that in the next months both the booklets would be ready to share with EH, HQ and USAID Bangladesh for comments and feedback for finalization. Q3: Task # 3.2.4.c: Avenir Health, with inputs of and support from MH-II staff, have finalized the zero draft of the booklet called ‘Why LARC and PM’. This booklet has been shared with EH, NY. After getting EH, NY feedbacks and incorporation of those (if any), this booklet is expected to be finalized and printed in next quarter. Q4 Task # 3.2.4.c: Avenir Health, with inputs of and support from MH-II staff, have finalized the booklet called ‘Why LARC and PM’ and the PDF version of the booklet is ready to shared with the stakeholders.

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PY3/ME&R Workplan (October 1, 2015 –September 30, 2016) Activity Gantt Chart Achievements through Quarter 3

Monitoring Evaluation and Research (ME&R) Activity # 1 Program Progress Monitoring Activity 1.1 REVIEW AND UPDATE THE ME&R PLAN ME&R team review and updates the annual ME & R plan based on annual Workplan. Partners/Collaboration Population Council POC Shahana Rahman

Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.1 a Review and update the ME&R plan based All team X

on annual Workplan of IR teams

Done Done

1.1b Share draft plan and seek approval of AOR X Updated ME&R Plan 2 d d

USAID shared and approved

in Q

receive

updated Send to USAID Send to USAID Commends not Quarter-wise Narrative Description of Activity Q1. Task # 1.1a & 1.1b: Reviewed and updated ME&R plan based on PY3 Workplan and will be sent to HQ NY for their review. Q2. Task # 1.1a & 1.1b: Reviewed and revised ME&R plan based on PY3 Workplan and have sent to HQ NY on 22nd February 2016 for their review; as well as shared with USAID for review. After receiving the comments from HQ and USAID we will finalize the ME&R plan and will be submitted to USAID. Q3 Achievement: Task # 1.1b: The revised ME&R plan was submitted to USAID for review and comments during Q3. However, since then no feedback has been received by the mission. Q4 Achievement:

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Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 1.1b: The revised ME&R plan was submitted to USAID for review and comments in Q2. The plan will be finalized upon receiving inputs form the Mission. Activity 1.2 ESTIMATE PROJECTION FOR USAID STANDARD AND CUSTOM INDICATORS

This is a yearly based USAID requirement, where the benchmarks for standard and custom indicators of MH-II project will be establish. Partners/Collaboration NA POC Liaquat Ali 1.2a Conduct benchmark estimation exercise X Performance data table

with program staff based on baseline and

yearly target and achievements

Done in Done Q1 in Done Q1 1.2b Estimate benchmarks for standard and X Estimated benchmark table

custom indicators and send to IR teams for shared with AOR

review and revise

Done in Done Q1 in Done Q1 1.2c Finalize benchmarks for standard and X Finalized benchmark available

custom indicators and submit to USAID/D

Done in Done Q1 in Done Q1 Quarter-wise Narrative Description of Activity Q1. Task # 1.2b & 1.2c: Estimate benchmarks for standard and custom indicators finalized and submitted to USAID/Dhaka. Q2. Not applicable for this quarter. Q3 Achievement:Not applicable for this quarter. Q4 Achievement: Not applicable for this quarter.

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Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Activity 1.3 CONDUCT INTERNAL DATA QUALITY ASSESSMENT (iDQA) Internal Data Quality Assessment is a process to assess and monitor the implementation of selected planned activities, quality, and timeliness of MH-II activities to provide feedback to the IR teams about their work and decision making. Partners/Collaboration N/A

POC Shahana Rahman

1.3a Identify at least one activity from each IR IR team 1,2, and 3 X X X X iDQA tools adapted

team and adapt tools for conducting iDQA

DQA DQA

Done 2 tools done Not done Not 1.3a-i Conduct iDQA and debrief facility X X X X iDQA reports generated

and used by the respective

managers and concerned IR teams about up

the visit; and provide guide to data use for persons DQA

decision making. i

2 2 bottom

Preparing report Preparing report Done

1.3a-ii Prepare report and share with IR teams X X X X Reports shared with IR

Teams

with with staff

Shared Shared

Not yet yet Not yet Not 1.3a-iii Review of previous iDQA findings and X X Review the implemented N/A N/A N/A follow-up whether recommendation has recommendations been implemented

140

Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.3b Conduct iDQA of sub-awarded projects: IR Team 1 and 2 X X X X iDQA tools adapted identify at least onesub-warded projects for iDQA visit in consultation with IR teams and develop tools for iDQA.

(Linked with IR team 1 activity# #1.1.4a,

and IR team 2 activity IEC/BCC # 2.1.1e,

Workplace # 2.1.3a, Shushilan # 2.3.1.a,

BRAC # 2.3.2.a, YPSA (BGMEA, RTMI

Community) # 2.3.3.a, Mukti # 2.3.4.b,

District based NGOs# 2.3.4.c and ICT # DQA

2.3.4e) i

4 iDQA in BRAC, YPSA, Eastwest Medical collage and Ali Monsur medical collage

2 conducted iDQA 7 conducted iDQA 3 1.3bi Conduct iDQA and debrief facility X X X X iDQA conduction schedule 4 7 3 managers about iDQA visit developed

1.3. bii Prepare iDQA report and share with X X X X iDQA reports 2

concerned authority of sub-awardee and IR

teams to make informed decisions

3 reports reports 3 shared 7 report 7 shared 4 reports shared Quarter-wise Narrative Description of Activity Q1. Task # 1.3a: iDQA of IR team activity: bottom-up contraception: To assess and monitor the implementation of client segmentation and bottom-up contraception projection activity, the ME&R team has conducted two internal data quality assessment (iDQA) in Rangpur and Luxmipur districts. In the Luxmipur district, the iDQA team comprises the Program officer ME&R, Program Manager and Program officer from IR team 3, and the ADP of CCSDP, DGFP. In the Rangpur district, the team comprises DD and PM (QA) CCSDP, DGFP and Program Manager, ME&R, EHB. The data collected through interview with DDFPs, UFPOs, MOs (MCH-FP), FPIs and FWAs. The team also verified the contraception projection number by examining different level of forms prepared by the UFPOs, MOs(MCH-FP), FPIs and FWAs. Task # 1.3b: Two iDQA were also conducted to assess the data quality of RTMI mobile service delivery team. One iDQA was conducted at Hakimpur UHC, Dinajpur on 16-19 November, 2015. ME&R team conducted another iDQA in Rupganj & Sonargaon upazilas of Narayanganj District on 18 November 2015. The overall finding revealed that there are some data inconsistencies between field level data and their reports submitted to EHB. To improve the data quality and receiving correct data a meeting was held with the senior management of RTMI at EHB. Afterwards, RTMI has taken some measurement to improve the data quality.

141

Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q2. Task # 1.3a: Prepared iDQA report of Q1 iDQA Task # 1.3b: Four iDQA were conducted in this quarter. ME&R team has conducted internal DQA (iDQA) at BRAC in Chittagong on 27-28 January 2016. The ME&R team of EHB Program Manager and Program Officer along with BRAC representatives, Dhaka Divisional Manager & District Coordinator, visited BRAC Rangunia and Patiya office and their catchment areas. The team verified the data of training, referral and referral clients who received services. There was some data inconsistency identified and the ME&R team suggested to revised their complied reporting form. BRAC revised their form and shared with the ME&R team. One i-DQA was conducted in YPSA in Chittagong District on 19 January, 2016. The team comprising Ms. Caitlin Shannon, Director, KM, ME&R, EngenderHealth NY; Program Manager E&R and Program Officer, IR team2, EngenderHealth Bangladesh. The team verified the client referral data and did not identify any inconsistency. An iDQA was conducted at East West Medical College & Hospital on16 March, 2016 to review the reporting system on LARC&PM services data by the RHSPO. During this visit no data inconsistency was identified with the reports submitted to EHB in last 5 months, October 2015 to February 2016. Similarly, another iDQA was conducted at Mansur Ali Medical college and did not identify any data inconsistency with the data submitted to EHB.

Q3 Achievement: Task # 1.3b: During this reporting period, the ME&R team conducted seven iDQA visits to different sub-awardees, including MUKTI office in Kushtia district from April 23-26, 2016 and another at the VPKA offices in Rajbari and Faridpur districts from April 27-28, 2016. For both of these sub-awardees, some calculation errors were identified during the data compilation. The MH-IIM&E team prepared an Excel file sheet for data compilation for MUKTI, which they will use in the future. An iDQA visit was conducted at YPSA in Chittagong on June 8, 2016, where the team found that YPSA’s reporting system was well organized. No major data inconsistencies were identified. Another iDQA in Chittagong at BRAC was conducted on June 6,7, and 9 where the team verified data from the training, referred clients, and referral clients who received services. There were a few data inconsistencies identified in the referral and the referred clients received services. The team shared the finding during the monthly meeting with BRAC where all Program Coordinators were present. The ME&R team conducted an iDQA at PSTC in Dhaka from April 24-25, 2016. The team identified some transcription errors. It was noted that the referrals slips are properly kept and in the client consent forms had the volunteer’ name recorded correctly as referrers. However, there were few reporting errors identified. Similarly, an iDQA visit was conducted at YPSA micro credit program in Comilla and Feni where some reporting errors were identified. The ME&R team suggested to conduct another follow up visit soon. One iDQA visit was conducted at one of the Dhaka based BGMEA clinics on May 25, 2016, where very few data errors were identified. In all of the iDQA visits towards the end of the visit, a hands on session is conducted on data collection, recording, and reporting.

Q4 Achievement:

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Task# 3.1b: During this quarter ME&R team conducted three internal DQA (iDQA) visits including PSTC office at Sadar Upazilla of Barisal district on July 19 to 20, 2016. There was no major inconsistence identified however a few transcription errors were identified. Another iDQA was conducted at MUKTI office in Kustia district on August 29, 2016. During our last iDQA visit to MUKTI some calculation errors were identified in their report therefore to minimize the error we have prepared an Excel data base program for compiling their quarterly data. During this visit the team introduced and trained the staff of MUKTI on this Excel file and they found it was very useful. The team also conducted an iDQA visit at VPKA office in Rajbari & Faridpur districts and identified some data inconsistence and reporting errors. The ME&R team also introduced an Excel data base program for compiling their quarterly data with less effort. Activity 1.4 CONDUCT DATA QUALITY ASSESSMENT (DQA)

This activity will assess the data quality of the public MIS reported from the field. Partners/Collaboration N/A POC Shahana Rahman Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.4a In consultation with USAID and X X X X DQA visit schedule

DGFP/DGHS identify districts to conduct developed

joint 2 new DQA and 2 follow-up DQA

visits. The districts will be selected from

1 follow up up follow 1 visit DQA Done Done

PY1 and PY2 districts. done Not

Done Done

1.4b Conduct DQA and debrief facility X X X X 4 Debriefing session held managers and concerned IR teams about after the DQA visit

the visit. completed

1 1 debriefin g 1 Debrief Debrief 1

1 Debrief Debrief 1

1.4c Prepare DQA reports and share with MIS X X X X 4 DQA report generated unit to make informed decision; and and letters written to

strengthen the capacity of DGFP. concerned staffs of DGFP

1 report report 1 generate d 1 report 1 generated

1 report 1 generated Quarter-wise Narrative Description of Activity Q1. In this quarter joint DQA has not been conducted because the staffs of the DGFP were involved in trainings in ICV and FWA register. EHB ME&R team also provided support for these training and was present.

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Q2. Task # 1.4b: A DQA was conducted to review the quality of data (validity and reliability) of the permanent and long acting and injectable family planning service delivery system at district, Upazilla and union levels of the government and non-government organizations. A team consisting of Director (MIS), and DPM MIS Unit of DGFP and program officer ME&R of EHB visited in different locations of Kushtia Sadar Upazilla of Kushtia district and Chuadanga Sadar & Alamdanga Upazilla of Chuadanga district from 14-15 February 2016. During the debriefing with the staff of all Upazillas of Kushtia and Chuadanga districts the Director (MIS) requested all officers to file-up the consent form properly. Currently all consent forms are available but they have been kept in different places with different service providers. He also emphasized that postpartum bilateral tubal ligation (PPBTL) should be properly reported on a monthly basis particularly in Chuadanga district the service providers reported all tubectomies as interval BTL including the PPBTL ones. He also requested the service providers to record the name of the referee of the clients of MUKTI (a MOU partner of MH-II). Q3 Achievement: Task 1.4 a & 1.4b: A DQA visit was conducted to review the quality of data (validity and reliability) of the permanent, long acting and injectable FP service delivery systems at district, Upazillas and union levels of the government and NGOs. A team consisting of the Director of the MIS DPM MIS Unit of the DGFP and Program Officer ME&R of EngenderHealth Bangladesh visited Avaynagar Upazilla UFPO, Chougachha Upazilla FP office, Jessore Sadar Upazilla FP office, Jessore MCWC, and two NGOs (FPAB and BAVS) in Jessore district from June 26-28, 2016. The team identified some data transcription errors and consent forms were not organized properly at DGFP facilities. During the debriefing, the DQA team requested the DGFP staffs of Jessore Sadar to pay more attention towards data collection, recording and reporting. Q4 Achievement: Task#1.4 a & 1.4b: During the last DQA visit in Q3 Director MIS, and DPM MIS Unit of DGFP was accompanied by MH-II ME&R staff. The team visited Chougachha Upazilla in Jessore district and identified some data transcription error and some consent forms were not in the appropriate place. The team advised the UFPO to report correctly and all consent should be kept in the correct place. MH-II team made a follow-up DQA visit in this quarter Chougachha Upazilla on 1st September, 2016, During this follow-up visit the team did not find any data inconsistency and all the consent forms were file-up properly and organized in a systematic manner.

Activity 1.5 ORGANIZE QUARTERLY PROGRESS REVIEW MEETINGS, PREPARE& SUBMIT QUARTERLY AND ANNUAL PROGRAM PERFORMANCE REPORTS TO USAID/DHAKA Progress review meetings are a quarterly activity intended to review and discuss the achievements of the previous quarter and plan for the following quarter. After the meeting, the quarterly program performance report is finalized. The project’s achievements are submitted to the AOR within 30 days of end of each quarter. Similarly, an annual activity based on each year achievements (cumulative data of all four quarters) is submitted to the AOR within 30 days at end of each year. Both the quarterly and annual reports will contain the description of mutually agreed contents with AOR. Partners/Collaboration EngenderHealth HQ

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POC Shahana Rahman Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.5a Circulate updated activity Gantt Chart All teams X X X X

matrix to all IR teams for quarterly activity

information

Done Done Done

done Done Done

1.5b Collect the Gantt Chart matrix and compile X X X X

the report and update the indicator tracking

table

Done Done Done Done Done Done

1.5c Review draft report, share with IR teams X X X X

for clarification and revise the draft report

Done Done Done Done

Done Done

1.5d Share updated indicator tracking table with X X X X Updated indicator tracking

d ed IR teams inviting comments and table

suggestions

Updated Updated &Shared Updated &Shared dat Up share an

Updated & Updated Shared

1.5e Incorporate suggestions and share the draft All teams X X X X

report with EH/HQ for feedback

Done Done Done Done 1.5f Conduct quarterly review meetings and All teams X X X X

meeting with the AOR

No yet No Done On 1 2016June

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1.5g Finalize the report and submit to USAID X X X X Four Quarterly Reports for their review and approval (two sets of hard copies along with soft copy to

AOR)

Q3 Q3 Submitted Q1 report Q1 submitted report Q2 submitted 1.5h Compile four quarters data and update X Updated annual N/A N/A Don annual performance indicators tracking performance indicator e table and analyze annual performance data tracking table

based on the indicators Done

1.5i Compile and prepare draft annual progress X N/A N/A

report based on IR Teams’ four quarterly

activity matrix

Done Annual report started 1.5j Share draft annual program performance X N/A N/A report with EH/ HQ for feedback

Done

1.5k Finalize the annual program performance X A annual report, two sets of N/A N/A report and submit it to USAID for review hard copies along with soft

and approval copy to AOR Submitted Submitted Quarter-wise Narrative Description of Activity

Q1. Task# 1.5d to 1.5g: Developed indicators progress tracking table for Q4 and annual progress tracking table for PY2. Prepared Q4 report and annual report of PY2.Shared draft Q4 performance reports with EH/ HQ for their feedback. Finalized the Q4 report and annual program performance report and submitted it to USAID/D for review and approval. Also developed the quarterly report for Q1 of PY3 will be sent to EH HQ for feedback and the final report will be submitted to USAID by 31 January, 2016.

Q2. Task# 1.5d to 1.5g: Developed indicators progress tracking table for Q1of PY3. Prepared Q1 report of PY3 and shared draft Q1progress reports with EH/ HQ for their feedback. Finalized the Q1 report and submitted it to USAID/D for review and approval. Also developed the quarterly report for Q2 of PY3 and shared draft Q2 progress reports with EH/ HQ and incorporated their feedback. The final report submitted to USAID. Q3 Achievement:

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Task# 1.5d to 1.5g: During this quarter MH-II prepared the Q2 report for PY3 and shared the draft Q2 progress report with EngenderHealth HQ for their feedback. After incorporating the feedback from HQ the final Q2 report was submitted to USAID/Dhaka for their review and approval. A quarterly review meeting on Q2 report was conducted with the AOR on 1 June, 2016. During the reporting period the ME&R team developed the draft quarterly report for Q3 for PY3 which will be sent to EngenderHealth HQ for feedback and the final report will be submitted to USAID. Q4 Achievement: Task# 1.5d to 1.5g: During this quarter MH-II shared the Q3 report with EngenderHealth HQ. The Q3 report will be finalized and submitted to USAID. The quarterly report for Q4 of PY3 will be sent to EngenderHealth HQ for feedback and the final report will be submitted to USAID by 31 October, 2016. Activity 1.6 REGULAR PROGRESS MONITORING OF MOU PARTNERS, SUB-AWARDED PROJECTS AND SOME SPECIFIC ACTIVITIES To monitor progress, assess performance and track against deliverables of the sub-awarded NGOs; and provide evidences for strategic changes, and actions accordingly. In PY3 several sub-awardees and partners NGOs and few specific activities such as BRAC, YPSA, RHSPO, Shushilan, RTM international OGSB, IEC/IPC Material Distribution, MUKTI, MAB, Client segmentation activities, Satisfied NSV and IUD client, Religious leaders training and collaboration with MSD. Partners/Collaboration Population Council

BRAC, YPSA, RHSPO, Shushilan, RTM international, OGSB, IEC/IPC Material Distribution, MUKTI and UPHSDP POC Liaquat Ali Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.6a Collaborative monitoring activities with IR All IR team X X Reports generated after

teams (e.g. OGSB, use of Android, scale each monitoring visits

up IUD and injectable program, BCC

material distribution.)

In In Progress Data collection going Data collection on going Data collection on going 1.6b Provide support for monitoring (e.g. IR Team-1 X X X X Orientation sessions 1

conducted on monitoring up up

Linked with IR Team1 activities up

- -

Strengthening Injectable services #1.1.7d tools and methodology

and ICT #1.2.3d)

Draft Draft report prepared follow visits follow visits Quarter-wise Narrative Description of Activity

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Q1. ME&R team has conducted several collaborative monitoring activities with IR teams: Task # 1.6a: • In PY2 MH-II conducted training to the service providers on use of Android for 78 facilities. To assess the use of Android ME&R team has developed a brief checklist and oriented the QA and Compliance officers for collecting data from 47 facilities. Data collecting on use of Android assessment is underway. • The data collecting on scale up IUD and injectable program is on-going. The data collection on IUD service delivery of FWV’s and female SACMO is underway in Chittagong and Bogra. Monitoring the service provision of female physician and female SACMO for IUD service delivery and CHCP for injectables second and subsequent doses (linked to IR 1.1.6 g & h in PY2). Task # 1.6b: As a part of implementation of ‘1st dose injectable performed by CSBA/FWA and 2nd and subsequent dose performed by CHCP’ policy. MH-II engaged training teams in Brahmanbaria district to cover training requirement of CSBA, CHCP, FWA and FWV. The ME&R team also conducted visits to observe and review and streamline the collection process of first dose injectable performed by CSBA/FWA and second and subsequent doses injectable performed by CHCP (who received training on 23rd November 2015). Another orientation session was held in Chittagong from 19th December to 21 December 2015. Q2. Task # 1.6a: To monitor progress and assess performance of some of the activities ME&R team has arranged monitoring visits in 69 upazillas. For this monitoring the staff from all IR teams visited different upazillas and collected information by using structured checklists. The monitoring visit includes: • Follow-up for LARC and PM special day • Monitoring of changed/modified polices during 2009 to 2015 • Monitoring distribution and use of BCC materials The findings revealed that among these 69 upazillas in 62 facilities have fixed day for LARC/PM special session. More than half (36) of the facilities conducted 6 to 10 LARC/PM sessions in a month. Average client flow in each session is 12. UFPO of 26 facilities mentioned that other organizations such as Marie Stopes, Family Planning Association of Bangladesh and other local NGOs provided support to conduct session for LARC/PM. For example, these NGOs hired surgeon of DGFP and referred clients to the government facilities. In all these facilities UFPO & MO (MCH-FP) mentioned that they know most of the changed/modified policy. From this monitoring visit findings IR teams will take measurement accordingly. In addition to that ME&R team has conducted several collaborative monitoring activities with IR teams: • Data collecting on use of Android assessment is underway. QA and Compliance officers are collecting data from 47 facilities while conducting their regular scheduled work till date data has been collected from 35 upazillas. • The data collecting on the scale up IUD and injectable program is on-going. The data collection on IUD service delivery by FWV’s and female SACMO is underway in Chittagong and Bogra. Task # 1.6b: MH-II project in collaboration with the Field Service Delivery Program of DGFP started piloting in three districts Dhaka, Brahmanbaria and Cox’s Bazar after approval of the policy which has been that ‘1st dose of injectable to be provided by CSBA trained FWAs and 2nd and subsequent dose can be given by

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CHCP of the CCs’. During the pilot period in collaboration of DDFP office the project has developed a reporting system in alignment with the regular DGFP MIS injectable report for capturing of 1st dose injectable performance of CSBA trained FWA and 2nd and subsequent doses of injectable performance of CHCP. In this quarter the DGFP and EHB staff also conducted follow-up visits in Brahmanbaria and Cox’s Bazar to monitor the data collection and streamline the process. Q3 Achievement: Task# 1.6a: Data collection in relation to assessing the use of Androids for counseling was completed. Data analysis and report writing was done for internal use. Findings revealed that all FWVs (36) are using the Android tablet for FP counseling in their respective facilities. The FWVs reported that (76%) of clients showed an interest in receiving information on advantage and disadvantages of the FP methods followed by how to use the methods (68%) and side-effects (62%) of the methods. More than half of the FWVs reported that it is easy to counsel the clients using the tab (54%). Task# 1.6b: During this quarter, reports from the pilot districts (Brahmanbaria and Cox’s Bazar) on the policy of “1st dose of injectable to be provided by CSBA trained FWAs and second and subsequent doses can be given by CHCP of the community clinics (CCs) have been submitted to MH-II. In five Upazilas in Cox’s Bazar have not yet started on recording data for injectable contraceptive at the local level and therefore are not submitting the required reports. A follow-up visit was done by MH-II staff, on-site-training was given on record keeping and reporting. In Dhaka, most of the CSBA-trained FWAs and CHCPs have started providing services after receiving training. Q4 Achievement:

Task# 1.6a ME&R team has developed a software to record the event data (some basic information of an event) through mobile by using android application platform. Nineteen relevant staff received training on data recording for event report through mobile and send the data from field. From PY4 the use of mobile apps will be started in full-swing.

Task# 1.6b During this quarter, among the pilot districts on the policy ‘1st dose of injectable to be provided by CSBA trained FWAs and 2nd and subsequent dose can be given by CHCP of the CCs’ from Brahmanbaria district all Upazillas are providing performance reports regularly to MH-II. Trainee follow-up activities is going on in Brahmanbaria, Cox’s Bazar, and Dhaka. In addition to that telephonic follow-up with trained providers is conducted. Due to the continuous follow-up of DMPA vial supply related problem to CHCP of Community Clinic has been resolved. Meanwhile, ME&R team of MH-II started the documentation for NTC meeting presentation and reporting. Which will be held on October 9, 2016.

Activity 1.7 QA AND FP COMPLIANCE DATA ANALYSIS

Partners/Collaboration Population Council POC Liaquat Ali Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

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1.7a Quarterly QA and FP compliance data X X X X Four QA and compliance

storing, processing, analyzing, and summary finding reports

preparing summary findings.

On going On 1 report 1 report 1 on Going 1.7b Share findings of QA and FP compliance X X X X 4 finding sharing meetings

with IR teams, donors and partners held

particularly with DGFP.

sharing sharing

Not yet Not Data in shared quarterly report 1 meeting

Quarter-wise Narrative Description of Activity Q1. Task # 1.7a: QA and FP compliance data storing processing is on-going. Task # 1.7b: A comparative analysis between the first visit and follow-up visit of QA and compliance has been conducted. The findings suggested that the quality of the facilities has improved after the recommendations of first QA and compliance visits. ME&R team has shared findings with the IR teams. Q2. Task # 1.7a: QA and FP compliance data storing processing is on-going. Task # 1.7b: Findings of comparative analysis between the first visit and follow-up the visit of QA and compliance shared with USAID during the quarterly review meeting of Q1 of PY3 on 24th February, 2016. Q3 Achievement: Task # 1.7a: QA and FP compliance data storing, processing, and documentation is an ongoing activity. Task # 1.7b: Data processing and analysis of QA and compliance visits of Q3 was completed. (Appendix 2). Q4 Achievement: Task # 1.7a: QA and FP compliance data storing, processing, and documentation is an ongoing activity during this quarter ME&R team has accomplished this tasks. Task # 1.7b: Data processing and analysis of QA and compliance visits of Q4 was completed (Appendix 2). Activity 1.8 DATA USE FOR INTERNAL DECISION MAKING

Partners/Collaboration Population Council POC Liaquat Ali Inter-Team Implementation Time Quarterly Achievement of Task Description Benchmark/Deliverables Collaboration Frame Benchmark/Deliverables

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Task # Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.8a Analyze data of those Upazillas where X X An analysis report available

Bottom-up contraceptive projection have

been held

Done Done Done Done

1.8a-i Analyze Upazilla level MIS data on CAR X An analysis report available

and method mix and compare that with the

BDHS relevant data.

N/A yet Not done Draft report going

1.8a-ii Share finding with IR teams, ME&R/ HQ X A report

and donors and DGFP

Shared Shared findings Shared gindings the at DGFP N/A IR Shared teams

1.8b MIS data analysis, comparing pre and post X X

“satisfied NSV acceptors’ workshop”

findings and performance

Done Done shared the with teams Done Done Done Done

1.8b-i Share finding with IR teams, ME&R/ HQ X A report

and donors and DGFP

Shared IR IR Shared teams IR Shared teams

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1.8c MIS/MH-II data analysis share with IR IR Team 1 and 2 X X X X Finding tables based on teams for decision making different IR teams request (Linked with IR Team1 activities RTM #1.1.b, 1.1.d; PPFP #1.1.2a, 1.1.2i, PAC#1.1.3d, performances of urban facilities #1.1.4e, BGMEA#1.1.5c, IUD service of SACMO and FWV# 1.1.6d, NGO #1.1.8c, OGSB # 1.2.1d, QA and FP compliance#1.2.2f and #1.2.2o Linked with IR Team2 Shushilan #2.3.1.a,

IEC/BCC materials # 2.1.1.e, RHSPO

#2.1.2.b, Workplace #2.1.3a, BGMEA #

2.1.3.h, BRAC # 2.3.2.a, YPSA# 2.3.3.a

Done Done Done Done Done Done

1.8c-i Share findings with IR teams. X X X X

one one

Done D D Quarter-wise Narrative Description of Activity Q1. Task # 1.8a: Analyzed Upazila level MIS data of those Upazilas where bottom-up contraceptive projection orientations had been held. The findings revealed that the bottom up contraception projection orientation have positive impact on increasing the uptake of LARC/PM. Task # 1.8b: MIS data analysis is going on to compare pre and post “satisfied NSV acceptors’ workshop” findings and performance. Findings will be shared soon. Task # 1.8c: Periodically data of sub-awardees shared with relevant teams for decision making.

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Q2. Task # 1.8c: • MIS data was analyzed for different types of internal decision making at the request of IR Team 1, 2, and 3 such as IR Team 1 used the data of performance trend of different activities, performance PPFP, performance of RTMI, IUD performance by SACMO, injectable performance of BRAC, training and event information of MFSTC, IR Team 3 used the data of LARC and PM performance of DGFP, CAR data of 17 districts, number of community clinics by upazilas, number of delivery disaggregated by NVD, C-section types. • Periodically data and some analysis of sub-awardees and partner NGOs shared with relevant teams for decision making. • Analyzed PPFF data and shared with IR team1, based on the findings the team has planned to provide training at all Sadar Upazilas and data will be collected from those upazilas form MIS data of DGFP. • Specific activity wise progress analysis done and shared with IR teams. Q3 Achievement: Task # 1.8c: Periodically, data from the sub-awardees and partner NGOs are analyzed by MH-II ME&R staff and shared with relevant teams for decision making. Task 1.8a-i: During this quarter the Line Director, Clinical Contraception Services Delivery Program (CCSDP) of DGFP requested EngenderHealth Bangladesh to conduct a third party study to understand the difference between contraception acceptance rate (CAR) compared to contraceptive prevalence rate(CPR). The analysis has been drafted and once complete will be shared with CCSDP. Q4 Achievement: Task # 1.8c: MIS data was analyzed for different types of internal decision making at the request of IR Teams 1, 2, and 3, IR Team 1 used the data of performance trend PPFP, f RTMI, IUD performance and injectable performance of pilot districts namely Brahmanbaria, Cox’s Bazar, and Dhaka. Similarly, periodically data and some analysis of sub-awardees and partner NGOs shared with relevant teams for decision making. Task 1.8a-i: The Line Director, Clinical Contraception Services Delivery Program (CCSDP) of DGFP requested o EngenderHealth Bangladesh to conduct a third party study to understand the Contraceptive acceptance rate (CAR)- Contraceptive prevalence rate (CPR) difference. EngenderHealth Bangladesh analyzed the CAR-CPR difference by using secondary data. DGFP MIS data was used to assess the situation and dynamics of CAR; and reviewed Bangladesh Demographic Health Survey (BDHS) reports to understand dynamics of modern CPR. On September 26, 2016 in the Conference Room of CCSDP a very lively meeting was held where EngenderHealth Bangladesh shared the analysis explaining the difference between CAR vs. CPR DG of Family Planning and Directors from different units of DGFP were present. Other stakeholders were also present in the meeting such as NIPORT and UNFPA. Activity 1.9 ACTIVITIES FULFILLING ENGENDERHEALTH HQ REQUIREMENTS According to EH HQ requirements ME&R team prepare EngenderHealth Global organizational indicators update which they do annually. Prepare the semi- annual portfolio review report and quarterly Country projects updates Partners/Collaboration NA

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POC Shahana Rahman/ Liaquat Ali Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.9a Compile, analyze and submit MH-II X Updated annual N/A N/A Don project annual data on selected indictors of standardized organizational e annual standardized organizational indictors project data indictors Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.9b Compile information for Semi-annual X X Two Semi-annual portfolio N/A portfolio review report and submit to EH reports

report report

1 submitted N/A 1 submitted

1.9c Country projects updates (quarterly) X X X X Four Country projects -

updates reports

report report

1 report report 1 submitte d 1 submitted 1 submitted Quarter-wise Narrative Description of Activity Q1. Task # 1.9b The semi-annual portfolio review report and the PowerPoint presentation for the time period of April to September, 2015 prepared and submit to EH HQ. Task # 1.9c: In addition to that quarterly country projects’ updates for the months of April to June submitted to EH HQ. Q2. Task # 1.9c: Prepared quarterly country projects’ updates for the months of July to December, 2016 and submitted to EH HQ. Q3 Achievement: Task# 1.9c: The semi-annual portfolio review was conducted with EngenderHealth HQ on June 22, 2016, for which a report and PowerPoint presentation for the period of October 2015 to March 2016 was developed. Q4 Achievement: Task# 1.9a: During this quarter ME&R team submitted data on selected indictors in monthly FP report to HQ. ME&R team compile, analyze and submit MH-II project annual data on selected indictors of annual standardized organizational indictors.

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Task# 1.9c: As required quarterly country projects’ updates for the months of January to June, 2016 prepared and submitted to EH HQ. Activity Data Management

Activity 2.1 UPDATE MH-II MIS DATABASE

This is a regular monthly activity to incorporate the MH-II accomplishments reported from program staff, partners, NGOs and private sectors through an efficient web-based data input and output system. For sub-awarded projects data collect in the standard format prepared by ME&R team.

Partners/Collaboration NA POC Saiful Hasan 2.1a Collect data from/ data entry by program X X X X Updated MH-II database

staff, partners, NGOs and staff of private

sectors through web-based input output

system

Done Done Done

Done Done

2.1a-i Data cleaning, error checking X X X X

Done Done Done

Done Done

2.1a-ii Update database routinely X X X X

Done Done Done Done Done

2.1a-iii Trouble shooting of new database X X X X

N/A N/A N/A

2.1a-iv Refresher training on new web-based X

system

For IR 1 ForIR in Done Q1 N/A

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2.1a-v Update and maintenance of web-based data

system (i.e software update, equipment) as

and required

N/A N/A 2.1b Data Management of sub-awarded X X X X

projects: Collect sub-awarded projects data

in the standard format prepared by ME&R

team and analyze these

Done Done Done done

2.1b-i Update data base regularly X X X X Updated database

Done Done Done Done

2.1b-ii Update Performance data tracking table X X X X Updated tracking table

quarterly for internal monitoring

Updated Updated Updated Updated updated Up datedQuarter-wise Narrative Description of Activity Q1. Task # 2.1a: Routinely data collected from program staff, partners, NGOs and staff of private sectors. Task # 2.1a-v: Pilot basis data entry in web-based data system has been started. Task # 2.1a-iv: Refresher training on new web-based system was conducted for IR team 1 Task # 2.1b-i: Collected quarterly data of sub-awarded projects in the standard format prepared by ME&R team, checked the data and recommended for corrections where necessary; and analyzed those data for decision making. Task # 2.1b-ii: Updated program performance data tracking table for Q4 and annual performance data tracking table for PY2. Program performance data tracking table for Q1 of PY2 is underway. Q2. Task # 2.1a: Routinely data collected from program staff, partners, NGOs and staff of private sectors. Task # 2.1a-v: Pilot basis data entry in web-based data system is continuing. Previous years back lock data will be uploaded in the web-system soon. Task # 2.1b-i: Collected quarterly data of sub-awarded projects in the standard format prepared by ME&R team, checked the data and recommended for corrections where necessary; and analyzed those data for decision making.

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Task # 2.1b-ii: Updated program performance data tracking table for Q1 performance data tracking table for PY3 and Program performance data tracking table for Q2 of PY3 is underway. Q3 Achievement: Task # 2.1a: For routinely reporting and monitoring ME&R team collected data from program staff, partners, NGOs and staff of private sectors. Task # 2.1b-i: Quarterly data of sub-awarded projects also collected in the standard format prepared by ME&R team, checked the data and recommended for corrections where necessary. The team also analyzed those data for decision making. Task # 2.1b-ii: During this quarter ME&R team updated program performance data tracking table for Q3 of PY3 and for Q4 of PY3 program performance data tracking table is underway. Q4 Achievement: Task # 2.1a: For routinely reporting and monitoring the data collected from program staff, partners, NGOs and staff of private sectors. Task # 2.1b-i: Quarterly data of sub-awarded projects collected in the standard format prepared by ME&R team, checked the data and recommended for corrections where necessary; and analyzed those data for decision making. Task # 2.1b-ii: Updated program performance data tracking table for Q3 of PY3 and Program performance data tracking table for Q4 of PY3 has been completed.

Activity # 2.2 UPDATE USAID TRAINET ONLINE DATABASE ON TRAINING INFORMATION

This is a regular monthly activity intended to update MH-II training information every month to the USAID TraiNet. Partners/Collaboration NA POC Rajatangshu Saha Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2.2a Identify training events and relevant X X X X

information from MH-II database

Done Done Done

Done

2.2b Compile training information according to X X X X

TraiNet need

Done Done Done Done Done

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2.3c Upload training information on the TraiNet X X X X

online input system

Done Done Done

Done Done

2.2d Prepare summary training report from the X X X X Four summary reports

TraiNet database and submit to USAID/D

report report report report

submitted submitted submitted 1 1 1 1 Quarter-wise Narrative Description of Activity Q1. Task # 2.2a: Identified training events of IR teams 1, 2 & 3. Task # 2.2c: Uploaded Q4 of PY2 training information on the TraiNet online input system and Q1 of PY3 training information uploading is in process. Task # 2.2d: Prepared Q4 of PY2 summary training report from the TraiNet database and submitted to USAID/Dhaka. Q2. Task # 2.2a: Identified training events of IR teams 1, 2 & 3. Task # 2.2c: Uploaded Q1 of PY3 training information on the TraiNet online input system and Q2 of PY3 training information uploading is in process. Task # 2.2d: Prepared Q1 of PY3 summary training report from the TraiNet database and submitted to USAID/Dhaka. Q3 Achievement: Task # 2.2a: Identified training events of IR teams 1, 2 & 3. Task # 2.2c: As a regular monthly activity during this quarter also ME&R team uploaded training events information of IR teams 1 and 2 for Q2 of PY3 on the USAID TraiNet online input system and for Q3 of PY3 training information uploading is in process. Task # 2.2d: The summary training report of Q2 was submitted to USAID/Dhaka. Q4 Achievement: Task # 2.2a: Identified training events of IR teams 1, 2 & 3 Task # 2.2c: As a regular monthly activity during this quarter ME&R team uploaded training events information from IR teams 1 and 2 were uploaded Task # 2.2d: for Q2 of PY3 on the USAID TraiNet online input system and Q3 of PY3 training information uploading is in process.

Activity TA/Collaborative activities

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Activity 3.1 MAINTAIN LIAISON WITH DGFP FOR GATHERING NATIONAL MIS SERVICE STATISTICS AND PROVIDING FEEDBACKS This activity describes the liaison with DGFP to through providing TA in checking the online MIS data and provides feedbacks to the DGFP. Partners/Collaboration NA POC Saiful Hasan Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

3.1a Check DGFP online MIS data consistency X X X X

and provide feedback to DGFP

Done Done Done

Done Done Done 3.1b Gather FP service statistics from the online X X X X FP service statistics

available

database of DGFP

Done Done

Done Done Done

3.1c Store gathered FP service data in the MH- X X X X

II data input system

Done Done Done

Done Done Done Quarter-wise Narrative Description of Activity Q1. Task # 3.1a-3.1c: ME&R team checked and verified MIS data of DGFP for the months of August to October 2015 including calculation of service data and data consistency. The ME&R team stored/ gathered FP service data in the MH-II data input system for the month of August to October, 2015. Service statistics data of LARC, PM and injectable analyzed for various purposes, such as CYP calculation as well as to observe LARC and PM trends, and shared these with IR teams. Q2. Task # 3.1a-3.1c: ME&R team checked and verified MIS data from the DGFP for the months of November to December 2015 including calculation of service data and data consistency. The ME&R team stored/ gathered FP service data in the MH-II data input system for the months of November to December, 2015. Service statistics data of LARC, PM and injectable analyzed for various purposes, such as CYP calculation as well as to observe LARC and PM trends, and shared these with IR teams. Q3 Achievement:

159

Task # 3.1a-3.1c: In Q3 of PY3, the ME&R team verified MIS data from the DGFP for January-March 2016, including assessing service data consistency. The ME&R team stored/gathered FP service data in the MH-II data input system for the months of January-March 2016. Service statistics of LARC, PM, and injectables were analyzed for various purposes, such as CYP calculation, as well as to identify LARC and PM trends, and shared those with IR teams. Q4 Achievement: Task # 3.1a-3.1c: ME&R team checked and verified MIS data from the DGFP for the months of April to May 2016 including calculation of the service data and data consistency. The ME&R team stored/ gathered FP service data in the MH-II data input system for the months of April to May, 2016. Service statistics data for LARC, PM and injectable was analyzed for CYP calculation as well as to observe the LARC and PM trends, and shared these with the IR teams.

Activity 3.2 TA/COLLABORATIVE SUPPORT TO IR TEAMS Partners/Collaboration NA POC Shahana Rahman / Liaquat Ali Implementation Time Quarterly Achievement of Inter-Team Task # Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 3.2a Provide support to develop M&E plan IR Team 1, 2 and X X X X 10 M&E plans developed 1 1 3 3 for different important Muk VPK (Linked with IR Team 2 activities: activities of the Workplan ti A, RHSOP # 2.1.2.b, lessons learned from PST RHSOP # 2.1.2d, YPSA #2.3.4a, Mukti C, #2.3.4b, District based NGOs#2.3.4c, ICT and NGOs#2.3.4e YPS A Linked with IR Team 3: MAB #3.1.3.c, micr BSR # 3.1.5d, BERDO# 3.1.5.e, NGOs o

working at workplaces #3.1.5.f, YMC credit

scale up 3.2.3a) done

160

3.2b Provide support to develop tools for IR Team 1, 2 and X X X X 10 monitoring tools 3 1 3 monitoring and other TA 3 developed/adapted Muk ti (Linked with IR Team1 activity #PPFP #1.1.2a, IR Team 2 IEC/BCC# 2.1.1.f, Workplace, BGEAM #2.1.3h, IR Team 3 mapping # 3.1.1c, data analysis for advocacy # 3.1.1.e, Advocacy on LARC/PM monitoring --- pilot#3.1.4.a, Reality check # 3.1.7.b, changed policy # 3.2.2.a and 3.2.2b (include a session in trip

report), case studies # 3.2.4.b and best

practices # 3.2.5.a) done Quarter-wise Narrative Description of Activity Q1. Task # 3.2a: M&E plan developed: • In Q1 of PY3ME&R team prepared the M&E plan for BSR. Task # 3.2b: Developed monitoring tools and TA to IR teams: • ME&R team has also conducted training on data recording and reporting system of the participants from the partner NGOs of BSR. • Prepared standard formats for community level data collection tools for PSTC and provided training on data recording and reporting. • Developed checklists for interview the Managers, FPI and FWA to assess the implementation of client segmentation and bottom-up contraception projection activities. • Visited Bogra districts to train and assist two QA and Compliance officers on data recording system of QA and Compliance visit checklist. • A comprehensive follow-up check list has been developed which includes all IR teams relevant follow-up check lists. • A tool has developed to assess the proper use of BCC materials which are distributed in GOB facilities. Provided technical assistance to IR team 3 to develop check list for changed/ modified policies. To monitor the implementation of changed/ modified policies approved through the initiative of EHB. These two tools have been attached as a part of comprehensive monitoring for any staff who will conduct field visit for any activities/purpose.

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• Three monitoring visit has been conducted by ME&R team on material distribution and implementation of changed/modified policies at Family Planning Office of Shibganj upazila of Bogra district, Mithapukur upazila, Pirganj upazila of Rangpur district on 29 to 30 December, 2015. Q2. Task #3.2a: M&E plan developed: • In Q1 of PY3 ME&R team prepared the M&E plan for Mukti. Task # 3.2b: Developed monitoring tools and TA to IR teams: • A tool has been developed to assess the proper use of BCC materials which are distributed in GOB facilities for data collection. • Reviewed the reporting tools of BRAC, and suggested to revise the format of monthly compiled report of Shatho Kormi (field level worker) as the reporting format is very complicated. BRAC has revised this and send to us for review. • Visited Shushilan a sub-awadee to observe the activities of ‘Pot song’ for preparing an assessment plan, the ME&R team will develop this soon. • Two monitoring visits have conducted by ME&R team on material distribution and use in Rangunia upazila FP office and Kachui FWC of Patiya upazila. In total with other activities ME&R team conducted materials distribution monitoring by using a checklist developed by MH-II in 12 facilities. • Compiled the data of materials distribution follow-up through phone call. • Complied and analysis the data of materials distribution and use. Q3 Achievement: Task #3.2a: Prepared M&E plan for sub-awardees namely VPKA, PSTC, and YPSA micro credit volunteer program at Comilla and Feni. Task # 3.2b: The ME&R team also conducted training on data recording and reporting system of the participants from the partner NGOs of BSR on April 7, 2016.

Q4 Achievement: Task #3.2a: ME&R team prepared an excel database program for quarterly data reporting for two MOU partners MUKTI and VPKA to minimized the errors due to manual calculation. Task # 3.2b: The team trained the relevant staff of MUKTI and VPKA on this program. Activity 3.3 KNOWLEDGE MANAGEMENT (KM)

The purpose of creating KM to leverage knowledge, evidence, and experience to improve performance and program results and better fulfill our goal.

Partners/Collaboration EngenderHealth HQ POC Shahana Rahman

162

Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

3.3a Develop and finalize Knowledge X A KM plan developed which would be utilized

Management (KM) plan way Draft

internally and externally

under DraftKM plan developed Final KM plan developed

3.3b Share with EH HQ X

Not yet Not to Send HQ to Send HQ

3.3c Assist IR teams in documentation and use X X X A KM system

of KM documents.

Shared Shared plan KM IR with teams Not yet Not yet Not Quarter-wise Narrative Description of Activity Q1. Task # 3.3.a: A meeting of KM team was held on the 15th November 2015 regarding the outline of EHB KM plan. The KM team discussed the internet and external KM plan with Program Associate, Knowledge Management of EH HQ in a skype meeting. The draft out line of KM with EH HQ. In consultation with HQ it was decided that a consultant will be involved for developing plan and implementing the Knowledge Management. The recruitment process is underway. Q2. Task # 3.3.a: KM consultant was recruited in mid-January 2016. A Skype meeting was conducted on 21 January with Christopher Lindahl, Senior Program Associate, Knowledge Management and Caitlin Shannon, Director, Knowledge Management, Monitoring, Evaluation and Research from HQ, KM team from EHB and KM consultant. The consultant shared a draft outline of the Knowledge Management plan and KM framework on pipeline products with the KM team in the meeting. The KM members have provided their comments. The KM plan is now being finalized. Q3 Achievement: A draft EngenderHealth Bangladesh KM plan was developed by a local consultant circulated among KM team members for review. After incorporating the comments and feedback the draft ‘Country Knowledge Management Plan’ and ‘Implementation & Performance Measuring Framework’ has been shared with EngenderHealth HQ for their review. EngenderHealth HQ has sent their feedback, the consultant and KM team is now working on it. Q4 Achievement: During this quarter on the basis of HQ comments the KM plan has been revised and send the KM plan to EngenderHealth HQ. A skype meeting was held on August 18, 2016 with Christopher Lindahl, Senior Program Associate, Knowledge Management, from HQ on KM plan, KM pipeline product

163 and KM standards and practices. A meeting was held on September 29, 2016 on sharing KM plan developed by EngenderHealth Bangladesh and KM standards and practices prepared by EH HQ. Sixteen participants were present in this meeting. The meeting minutes will be shared with EH HQ.

Activity 3.4 PROVIDE TECHNICAL ASSISTANCE FOR GENDER SENSITIVE APPROACHES IN MH-II PROGRAM

This activity is to strengthen the integration of gender in EHB programs and for promoting gender equitable staff dynamics and attitudes. A Gender Focal Team (GFT) has been formed to look after the gender issues in EHB. A session on gender will be included in all trainings or orientations of service providers, if the duration of the training more than two days.

Partners/Collaboration EngenderHealth Global Technical Support Team POC Shahana Rahman Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 3.4a Organize quarterly Gender Focal Team GFT X X X X Meeting minutes 1

(GFT) meeting

1 meeting meeting 1 held meeting 1 held 3.4b Monitor whether gender issues are X X X X included in all trainings /orientations (if the duration of the training more than two

days)

and Monitor gender indicator regularly and

feedback to IR teams.

Done Done Done Done

3.4c Gender training for the relevant staff of all IR Team 1, 2 and X Training report 19

- new

sub awardee projects and other gender 3 s issues related activities staff of

EHB

Done Done from sub awardee 19 staff Quarter-wise Narrative Description of Activity

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Q1. Task # 3.4a: Gender orientation training integrated into technical providers’ trainings, in all trainings if the duration of the training more than two days. Collecting pre-post test result of the participants of gender training for monitoring the gender indicator. Task # 3.4c: Gender training for sub awardees will be held soon. Q2. Task # 3.4a: A gender focal team members meeting has been conducted. It was decided that the gender training module developed by the Senior Program Associate Gender/Men As Partners, EH NY will be translated in Bangla as per the training module which was translated in Bangla. Task # 3.4c: According to the plan a gender orientation was held on 4th February, 2016 for the IR1 team members who are conducting training for service providers. After this orientation in all service providers’ trainings ‘Orientation on basic gender issues’ started by the IR1 (training) team members. In this quarter total 78 participants have received the training. In this orientation we have used the gender training module developed by Senior Program Associate Gender/Men As Partners, EH NY. The purpose of this orientation is to increase the awareness of the service providers to provide gender sensitive services. Pre and post test have administrated during the training and the result shows that 93% participants achieved more than 80% number in the post test. Q3 Achievement: Task # 3.4a: A Gender Focal Team (GFT) members’ meeting was conducted on May 22, 2016 at which the development of EngenderHealth Bangladesh’s gender policy (and expanded version of the Gender section of the EngenderHealth Bangladesh Human Resource Manual) was discussed. Task # 3.4c: In accordance with the project Workplan, an orientation to gender was conducted for 19 staff from seven sub awardees and partner NGOs (BRAC, YPSA, VPKA, PSTC, Shushilan, Mukti, RTMI, and OGSB). At the end of the training, a tentative action plan was developed by all the sub-awardees for orienting their respective staff on gender. Q4 Achievement: An orientation on basic gender issues for the new staff was held on August 4, 2016. Nineteen participants were participated in the orientation. Mr. Fabio Verani, Senior Technical Advisor, Gender/Men As Partners, EH HQ and gender focal point EngenderHealth Bangladesh facilitated the orientation. A draft gender policy was developed and shared among Gender focal team (GFT) members for their comment. After incorporating those comments, the policy has been shared with Mr. Fabio for his feedback and comments. Activity Research and Evaluation

Activity 4.1 EXPLORING MENSTRUAL BLEEDING AMONG INJECTABLE CONTRACEPTIVE USERS, AND DISCONTINUERS: AN ONGOING EXPLORATORY STUDY

Partners/Collaboration Population Council and EngenderHealth Global ME&R Team POC Shahana Rahman/ Mahabub Anwar Inter-Team Implementation Time Quarterly Achievement of Task Description Benchmark/Deliverables Collaboration Frame Benchmark/Deliverables

165

Task # Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

4.1a X

Data collection

Completed Completed

4.1b X

Data review, transcription, & translation

Done Done

4.1c X X Qualitative data available

Data analysis

Analysis Analysis ongoing 12 FGD

4.1d Report writing X A study report

send report HQ to Underway Underway report Draft completed

4.1e X PowerPoint presentation

Dissemination of findings with key

stakeholders

Not yet yet Not yet Not yet Not 4.1f Incorporate counseling messages for IR team 1 training sessions and training materials for service providers

4.1g An updated counseling information guide IR team 1 and 3 circulated to all providers through DGFP Quarter-wise Narrative Description of Activity Q1. Task # 4.1a: 12 FGDs have been conducted; from two districts Lalmonirhat and Netrokona. In each district two FGDs with injectable users, two FGDs with discontinuers and two FGDs with service providers. Task # 4.1b, 4.1c and 4.1d: Transcription and translation in English of these FGDs have been completed. Report writing is underway.

166

Q2. Task # 4.1d: The report writing is underway. The report will be completed in next quarter. Q3 Achievement: Task # 4.1d: A draft report on the study “Exploring menstrual bleeding among injectable contraceptive users and discontinuers” was developed and circulated among senior MH-II staff for review. This is set to be finalized by next quarter. Q4 Achievement: Task # 4.1d: A draft report on the study “Exploring menstrual bleeding among injectable contraceptive users and discontinuers” was developed and was send to EngenderHealth HQ for feedback. After receiving comments from EngenderHealth HQ we will incorporated those and will finalize the report.

Activity 4.2 EXAMINING THE UNMET NEED BY AGE, PARITY AND DIVISION TO IDENTIFY LARC AND PM PROGRAMMING GAPS

Secondary data of BDHS 2014 will be used for this purpose. Partners/Collaboration Population Council and EH Global ME&R Team POC Shahana Rahman/ Mahabub Anwar Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

4.2a X Concept note developed N/A

Prepare concept note

Not Not started Not started 4.2b X Secondary data available N/A Collect secondary data from NIPORT,

MEASURE DHS and BDHS etc.

4.2c Data analysis and Report writing X A study report N/A 4.2d Develop intervention based on the X Intervention developed N/A secondary analysis findings 4.2e Coordinate with other IR teams to X N/A implement the intervention

167

4.2f Share findings with relevant stakeholders X Policy brief N/A Quarter-wise Narrative Description of Activity Q1. Not applicable for this quarter. Q2. Not applicable for this quarter. Q3 Achievement: Not started. Q4 Achievement: USAID did not approve therefore; this study has been dropped.

Activity 4.3: EXPLORING PROVIDERS’ PERCEPTIONS ON DISCONTINUATION OF LARC TO IDENTIFY PROGRAMMING GAPS Secondary data will be used; and FGD and in-depth interview with service providers will be conducted for this study. Another organization is conducting a study on exploring the clients perception

Partners/Collaboration Population Council and EH Global ME&R Team POC Shahana Rahman/ Mahabub Anwar

Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

4.3a X X

Prepare concept note

Draft Draft concept note

not not by approve USAID

4.3b X Collect secondary data from NIPORT,

MEASURE DHS and BDHS etc.

On On going

4.3c X X

Literature review and data analysis Not yet yet Not

168

Implementation Time Quarterly Achievement of Inter-Team Task Description Frame Benchmark/Deliverables Benchmark/Deliverables Task # Collaboration Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 4.3d Develop proposal following E&R SOP of

EH Not yet yet Not 4.3e Get EH HQ, USAID and Ethical approval N/A 4.3f Conduct FGD/in-depth interview with X N/A service providers. 4.3g Data analysis and report writing X A study report N/A 4.3h Develop intervention/s based on secondary X Intervention/s developed N/A analysis findings 4.3i Coordinate with other IR teams to X N/A implement intervention/s 4.3j Share findings with relevant stakeholders X Policy brief N/A Quarter-wise Narrative Description of Activity Q1. Task # 4.3a: A concept note developed. Q2. Task # 4.3a: The concept note will be reviewed internally and send HQ for their review. Q3 Achievement: Task # 4.3a: A draft proposal on “Exploring providers’ perceptions on discontinuation of LARC to identify programming gaps” was developed and circulated among senior MH-II staff for review. Their inputs have been incorporated and the proposal will be sent to EngenderHealth HQ soon for their review and feedback. Q4 Achievement: Task # 4.3a: A draft concept note on “Exploring providers’ perceptions on discontinuation of LARC to identify programming gaps” was developed and circulated among senior MH-II staff for review in Q2. However, USAID did not approve it because BDHS 2014 data is not sufficient for this analysis. Therefore, this study has been dropped.

169

Appendix 1: Indicator Tracking Table

MH-II Indicator Tracking Table USAID Standard Indicators and Project Required Indicator Mayer Hashi–II Indicator Tracking table (PY1-PY3) Target VS Achievement

PY1 (FY 2014) PY2 (FY 2015) PY3 (FY 2016) PY1 - PY3 PY1 PY1 PY2 PY2 PY2 PY3 Achieve Achievem Achievem Quarter 4, Achiev PY3 PY3 Achievemen Achievem Annual Achievem Achievem Annual ment ent ent Jul 1 - ement Achievem Achievem PY1 - PY1 t (Oct13- ent Target ent ent Target Quarter Quarter 2, Quarter 3, Sep 30, of Q4 ent ent PY1-PY3 PY3 SL # Program Elements/ Indicator Target Annual Sep14) (Oct13- (Oct14 - (Oct14 - 1, Oct Jan 1 - Apr 1-Jun 2016 in % (Oct15- (Oct15- Achieveme Achiev (PY1-PY3 Target Sep14) Sep15) Sep15) in 01- Mar 31, 30, 2016 Sep16) Sep16) in nt ement in % % Dec31, 2016 % in % 2015 Project Objective: Increased use of effective family planning (FP) and reproductive health (RH) services F:3.1.7.1 Couple years protection (CYP) in sites 3,676,131 2,350,857 64% 3,734,491 3,560,984 95% 5,271,489 969,303 1057253 1,063,389 1,118,681 85% 80% 12,682,111 10,120,467 80% supported by MH-II project 4,208,626 Implant Method CYP 460,775 240,294 52% 516,490 620,663 120% 1,029,080 203,760 207335 183,295 207,745 86% 802,135 82% 2,006,345 1,663,091 85% (Implanon) Implant - 15637 11,605 13,327 40,569 - 40,569 (Jadel) IUD 529,526 340,911 64% 427,776 825,751 193% 1,167,764 219,926 246146 281,437 244,669 84% 992,179 85% 2,125,066 2,158,840 102% Female 1,091,569 451,012 41% 1,174,642 1,023,945 87% 1,643,700 266,019 260936 247,247 303,290 74% 1,077,492 66% 3,909,911 2,552,449 65% Sterization NSV ,321,220 502,462 38% 1,389,679 850,447 61% 1,128,513 203,970 196040 186,225 208,104 74% 794,339 70% 3,839,412 2,147,248 56% Injectable 273,040 816,178 299% 225,904 240,179 106% 302,432 75,628 131159 153,580 141,546 187% 501,912 166% 801,376 1,558,270 194% IR1: Effective and high quality FP services delivered nationwide F:3.1.7.1- % of USG-assisted service delivery sites 3 providing family planning (FP) counseling 1273 1777 140% 2473 3314 134% 3642 2,534 1,012 113 91 10% 3,750 103% 7,388 8841 120% and services Type of DGFP 1114 1680 2252 2961 131% 3228 2,352 903 56 91 11% 3,402 105% 6,594 8,043 122% sites Public Sector sites DGHS 31 33 56 78 139% 81 29 3 6 0% 38 47% 168 149 89% NGO 110 43 130 213 164% 242 131 95 1 0% 227 94% 482 483 100% NGO/Private Private Sector sites 18 21 35 62 177% 91 22 11 50 0% 83 91% 144 166 115% Sector Custom # of injectable, LARC and PMs provided by # 2 mobile team/TA in public, NGO and 29250 18247 62% 122746 111885 91% 127977 31303 25588 25,393 42,427 133% 124711 97% 279,973 254,843 91% private sectors sites supported by USG fund Method Implant 7000 8103 116% 15900 59,343 373% 73953 16418 13349 13,345 27,023 146% 70,135 126% 96,853 137,581 142% IUD 2650 1207 46% 3854 9759 253% 8646 3015 2433 1,763 2,027 94% 9,238 142% 15,150 20,204 133% female Sterization 7100 1394 20% 9432 15988 170% 12954 3747 1827 1,733 3,686 114% 10,993 113% 29,486 28,375 96% NSV 4000 2797 70% 15000 15884 106% 20025 3011 2258 2,754 5,147 103% 13,170 88% 39,025 31,851 82% Injectable 8500 4746 56% 78560 10911 14% 12399 5112 5721 5,798 4,544 147% 21,175 228% 99,459 36,832 37%

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Method Female Sterization 1991 300 15% 5306 7207 136% 8814 1804 941 1208 2,446 111% 6,399 97% 16,111 13,906 86% NSV 1989 394 20% 10281 9482 92% 11031 2494 1751 2015 2,982 108% 9,242 112% 23,301 19,118 82%

Injectable 1000 122 12% 1860 1388 75% 2060 765 1034 890 448 87% 3,137 203% 4,920 4,647 94%

MH-II Implant 5819 5886 101% 9801 19487 199% 25890 4541 4935 4534 10,163 157% 24,173 124% 41,510 49,546 119% facilitate IUD 2050 1160 57% 754 6894 914% 4870 2089 1215 480 442 36% 4,226 116% 7,674 12,280 160% d service

by Female Sterization 5109 1094 21% 4126 8781 213% 4140 1943 886 525 1,240 120% 4,594 148% 13,375 14,469 108% Method NSV 2011 2403 119% 4720 6402 136% 8994 517 507 739 2,165 96% 3,928 58% 15,725 12,733 81%

Injectable 7500 4624 62% 76700 9523 12% 10339 4347 4687 4908 4,096 158% 18,038 233% 94,539 32,185 34%

Custom # of clients who adopted postpartum # 3 family planning (PPFP) methods (within 48 6465 3208 50% 8810 6976 79% 15010 2772 3625 5,479 6,253 167% 18,129 121% 30,285 28,313 93% hours) PPFP-Tubecomy 5726 2076 6510 4370 11844 2310 2968 4,008 4,726 14,012 24,080 20,458 85% PPFP-IUD 739 1132 2300 2606 3166 462 657 1,471 1,527 4,117 6,205 7,855 127% Sub-IR 1.1: Capacity of public and private sector service providers to provide LARCs and PMs increased Custom # of providers receive training/or on-the- # 5 job training, orientation or mentoring 7784 9039 116% 13484 19206 142% 15009 5843 8068 6,895 1,477 39% 22283 148% 36,277 50,528 139% with USG fund Sex Number of Women 6148 6820 10518 13859 10656 4171 5813 4,817 990 15791 27,322 36470 Number of Men 1636 2219 2966 5347 4353 1672 2255 2,078 487 6492 8,955 14058 Cadre of Medical & Para-Medical 536 807 692 975 736 25 2428 - 3771 trainees Total Sex Number of Women 493 731 583 875 635 22 2115 - 3339 Number of Men 43 76 109 100 101 3 313 - 432 Others Total 8503 18399 5,151 7,093 6,159 1,452 19,855 - 46757 Number of Women 6,327 13,128 3,588 4,938 4,182 968 13,676 - 33131 Number of Men 2,176 5,271 1,563 2,155 1,977 484 6,179 - 13626 Custom % of MH-II trained service providers who # 6 performed at the national standard in the 85% 85 99.52 85% 91.5 91.5 85% 73.0 73.3 79.3 84.9 99.91 103.48 0.85 93.2 110% past year Custom # of service providers trained at regional 200 0% 180 88 49% 192 58 104 24 0 0% 186 97% 572 274 48% # 7 training center established by SUG fund

Sub-IR 1.2: Training, support, and performance improvement mechanisms institutionalized Custom # of supported sites that received at least # 8 226 199 88% 300 210 70% 210 89 67 71 66 126% 293 140% 736 702 95% one supervisory visit within the past year

Public DGFP 158 188 87 64 65 59 275 621 DGHS 20 7 1 - 1 28 NGO 14 13 2 3 3 8 35

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IR2: Demand for FP services, especially LARCs and PMs increased

Sub-IR 2.1: Communication strategies promoting social norms for delaying, spacing, and limiting implemented

Custom # of communication materials 10 13 130% 7 9 129% 15 8 3 23 22 587% 56 373% 32 78 244% # 11a developed/updated by MH-II project

Custom # of communication materials distributed 1,895,450 1,919,569 101% 3,454,281 5,048,328 146% 11,314,604 527,786 1,785,082 3,187,443 3,020,364 107% 8,520,675 75% 16,664,335 15,488,572 93% # 11b by MH-II project Sub-IR 2.2: Accurate knowledge of FP, especially LARCs and PMs, increased among community leaders, families, and clients

Sub-IR 2.3: Client identification and referrals increased through community-facility links

IR3: Supportive enabling environment advances access to LARCs, PMs and other FP/RH services Custom # of organizations/agencies including # 15 other ministries that incorporate FP 5 7 140% 1 - 0% 2 - 2 - - 0% 2 100% 8 9 113% messages and activities into their training programs, and the nature of the work NILG of MOLGRDC incorporated FP

messages and activities into their trainings 1 - - 1 programs FP action plan of different ministries in line

with Population Policy is under process of 1 - - 1 development All MH-II partner organizations such as NHSDP, BRAC, MSI, SDLG, UNFPA, SMC and

so on use MH-II FP training materials and 5 - - 5 other BCC materials in their works Based on MoU with BSR involving its 3 partner organizations namely Change Associates, Mamata, and Awaj Foundation. MH-II has reviewed BSR’s FP and MCH

Training Modules and has provided TA - - 1 1 1 incorporating FP component in their Training Manual. Based on that a TOT for BSR trainers has been organized. Based on tripartite MoU among BGMEA, DGFP and EHB, DGFP will provide free contraceptives and commodities to BGMEA

workers through their clinics. This initiative - - 1 1 1 has been materialized with the TA by MH-II of EHB.

Sub-IR 3.1: Key policy barriers to LARCs and PM removed

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Calcium 500 mg fortified with Vit.-D 1 - - 1 during every three months interval. Enhancing provision of 2nd and subsequent dose of injectales

contraceptives by CHCP of the 1 - - 1 community clinic after they are being trained Provision of IUD services by Female

SACMOs after they are being trained 1 - - 1 For the management of excessive bleeding following Implant use, client can use two Tab. Shukhi daily for 21 days. If this regimen does not control

the excessive bleeding then two such 1 - - 1 cycle of Tab. Shukhi can be used keeping 7 days interval between the cycles. Provision of first and subsequest doses of Injectable contraceptive by the

Family Welfare Assistants (FWAs) after - 1 - 1 they being trained - A circular will be issued to provide postpartum family planning information during each ANC, PNC and Immunization visits jointly signed by Director General of DGFP and Director

General of DGH. - - 1 1 1 - family planning Services of short acting methods such as pills, condom and injectable should be available at the Immunization sites. Provision of Implant right after

delivery as an immediate postpartum - 1 1 1 2 Family Planning method Sub-IR 3.2: National standards, guidelines, curricula, and policies and implemented by personnel at teaching institutions and service delivery points Custom # of training regulatory bodies/training # 17 institutions that introduce or update pre- service and continiting medical education 100% 100% 0% 0% 0% 0% 3 2 67% curriculum to include training on 1 1 1 1 1 - injectable, LARC & PMs, and the nature of the changes

Private Institutions (Northern Medical

College, Rangpur; Kasiuddin Medical 1 1 - College, Rangpur; Ad-din Akiz Medical

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OGSB RH & FP Training Center, 1 Mirpur, Dhaka 1 Custom Proportion of service providers who # 18 report increased clear understanding on 6148 0% 10518 - 0% 432 9 88 20 9 8% 126 29% 432 126 29% gender after the USG supported training Sex Number of Women 699 1196 307 9 79 12 9 109 109 Number of Men 5449 9322 125 0 9 8 - 17 17 Clear understanding on gender after the 90 98.1 92.7 90.0 96.3 107% 94 105% USG supported training

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Appendix 2: Findings from QA and FP Compliance Monitoring Visit

PY3-Q4 (July-September 2016) • A total of 69 facilities were visited during Q4 of PY3 (9 Maternity and Child Welfare Centers [MCWCs], 52 Upazila Health Complexes [UHCs], one Health & Family Welfare Centre [H&FWC], and seven nongovernmental organizations [NGO] clinics) in 32 Districts. Among these, 42 were first time visits (6 MCWCs, 28 UHCs, one H&FWC, and 7 NGO clinics) and 27 were follow-up visits (3 MCWCs and 24 UHCs). Among first time visits and follow-up visits, 23 were joint visits with the Regional Supervisor of the FP Clinical Supervision Team/Quality Assurance Team (FPCST/QAT) QAT of the DGFP of different regions and the Directorate General of Family Planning [DDFP] of different Districts. • During follow-up visits conducted in the 27 facilities, some changes or improvements were observed according to the recommendations and suggestions provided by Senior Quality Assurance (Sr. QA) and FP Compliance Officers during their first visit. These included a) the Tiahrt chart being hung in the proper place and used during counseling, b) the counseling of clients individually rather than in a group to maintain auditory privacy and confidentiality, c) counseling job-aids now being used during counseling, d) all sections of consent forms for voluntary surgical contraception (VSC), implant, and IUD services now being properly completed, e) IUD insertions being undertaken following standard technique in accordance with the flow-chart supplied by MH-II (and in most facilities, IUD services being provided in the Operation Theatre (OT) instead of a space behind the Almirah/big size cupboard in the Family Welfare Visitor’s [FWV’s] room), f) IP materials are procured and available in facilities, and g) emergency drugs have been procured and kept in the emergency tray. Some of the identified gaps could not resolved due to the inability of the local Upazilla FP Officer (UHFPO), such as a) the inability to provide extra room for counseling due to room shortage, b) the vacancy of Medical Officers (MOs) for maternal and child health (MCH) and FP in some UHCs, and c) the lack of supervision and monitoring being done in some facilities. • No evidence was found regarding method specific numbers or targets imposed on individual providers or referral agents in any of the 69 facilities visited. This was ascertained by observing the presence of the Tiahrt wall chart and through interviews with FP Managers.

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• No incentives were found to be provided to clients or providers at any of the visited health facilities. Standard Government of Bangladesh (GOB)-approved reimbursements for clients choosing long-acting and reversible contraception (LARC) and permanent methods (PMs) (which include travel costs, food, and wage loss) were provided according to national rules and regulations. This information was obtained through discussions with FP Managers and a number of interviews with clients the day of their visit. • Comprehensive FP wall charts (Tiahrt charts) were displayed and visible to FWVs and clients in either the waiting area or counseling room at 51 of the 69 facilities visited. In the remaining 18 facilities, the Tiahrt chart was hung on a distant wall and was not easily visible by FWVs or clients. To resolve this issue, MH-II Sr. QA and FP Compliance Officers conducting the visit moved the Tiahrt chart to a more visible wall location. • FP information, education, and communication (IEC) materials for clients and counseling job aids for providers were available in all 69 facilities visited. • All FP methods were available in 61 of the facilities visited. VSC, implants, and IUD services were not being provided in eight facilities (one H&FWC and 7 NGO clinics where only short- acting FP methods were available). However, from these eight centers, referrals are made to UHCs for the FP services they do not provide. • Consent forms for VSC, IUD, and implant services were found to be filled in properly. Client’s signature/thumb impression and the surgeon’s/provider’s signature were found in their proper place on the form in 61 facilities visited that provide these services. In all of these facilities, pre- procedure vital signs, procedure notes, and post-procedure vital sign records were not completed. When sharing findings from compliance visits with FWVs and FP Managers, MH-II staff addressed this issue and FWVs agreed to fill-in consent forms properly in the future. Compliance with this agreement will be assessed during the next site visit. • A separate space for FP counseling and screening to maintain client privacy and confidentiality was not available in 52 of the facilities visited. MH-II Sr. QA and FP Compliance Officers discussed this issue with the UFPO and MO (MCH-FP) and it was agreed that these facilities would install a curtain around the FWVs siting area to ensure that at least visual privacy is maintained. • A separate space/room for IUD insertion was not available in 31 of the facilities visited. MH-II Sr. QA and FP Compliance Officers discussed with the UFPO and MO (MCH-FP) the importance of establishing a separate space/room for IUD insertion to ensure client privacy and confidentiality and requested that they use the existing OT for this service in the future. After successful advocacy by the Sr. QA and FP Compliance Officers, the respective DDFP in three Districts (Joypurhat, Gaibandha and Nilphamari) issued a circular to Upazilla FP Managers under their jurisdiction regarding the utilization of the OT for IUD insertion. Now, 18 UHCs in these three districts are utilizing the OT for IUD insertion. • Approximately 85% of the facilities visited had a functional spotlight for use during IUD insertion, a functional OT light, a functional sucker machine, and infection prevention (IP) materials. In the remaining 15% of the facilities, the above mentioned equipment is not functioning. This issue was also discussed with the UFPO and MO (MCH-FP) to ensure the availability of this required equipment and supplies were subsequently requested from the Supply Officer from the Regional Ware House (RWH). • In approximately one-seventh of the facilities visited, drugs for managing emergencies were not available. Again, this issue was discussed with the UFPO and MO (MCH-FP) to ensure that required emergency medicine is procured locally according to the circular issued by the Clinical Contraceptive Services Delivery Program (CCSDP) Unit of the DGFP. • Steps for IUD insertion and removal were not followed in 11 facilities visited. Sr. QA and FP Compliance Officers demonstrated the proper steps for IUD insertion using a pelvic model and requested that the MO (MCH-FP) monitor the steps of IUD insertion going forward.

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