Maternal and Child Survival Program (MCSP) Quarterly Report Democratic Republic of Congo (DRC) Year 3, Quarter II January 1 – March 31, 20I8

Submitted to: United States Agency for International Development Under Cooperative Agreement # AID-OAA-A-14-00028

Submitted by: Jhpiego Corporation in cooperation with John Snow, Inc. (JSI) Table of Contents Abbreviations and Acronyms ...... 3 Program Overview ...... 5 Introduction ...... 6 Summary of Activities and Accomplishments ...... 7 Priorities for Next Quarter ...... 24 Annexes ...... 26

Abbreviations and Acronyms ASF Association de Santé Familiale BCZS Bureau Central de la Zone de Santé – District Medical Office CDR Centrale de Distribution Régionale (Regional Distribution Center) CH Centre Hospitalier CMF Centre Modèle de Formation COP Chief of Party CS Centre de Santé CST Country Support Team CTMP Permanent Multisectoral Technical Committee for Family Planning CUSO Canadian University Service Overseas D5 Directorate for Primary Health Care Development D9 National Division of Hygiene and Sanitation D10 Dixième Direction du Ministère de la Santé Publique (Direction de la Santé de la Famille et de Groupes Spécifiques) D11 Onzième Direction du Ministère de la Santé Publique (Direcorate of Continuing Education) DEP Division des Etudes et Planification (Department of Studies and Planning) DHIS-2 District Health Information System 2.0 DPS Division Provinciale de la Santé DRC Democratic Republic of Congo DSNIS Cinquième Direction du Ministère de la Santé Publique (Direction de formation Continue) Directorate of National Health Information Systems ENAP Every New Born Action Plan FP Family Planning HBS Helping Babies Survive HCF Healthcare facility HGR Hôpital Général de Référence iCCM Integrated Community Case Management IHP+ Integrated Health Project IMCI Integrated Management of Childhood Illness IMNCI Integrated Management of Newborn and Childhood Illness IUD Intrauterine Device KSPH Kinshasa School of Public Health LiST Lives Saved Tool MCSP Maternal and Child Survival Program MCZS Médecin chef de Zone de santé – «District Medical Officer » MOH Ministry of Health MSP Ministère de la Santé Publique ONIC Ordre Nationale des Infirmiers de Congo (National College of Congolese Nurses or ONIC) PATH Program for Appropriate Technology for Health PICAL Participatory Institutional Capacity Assessment and Learning Index PMI-EP President’s Malaria Initiative Expansion Project (PMI-EP) PMP Performance Monitoring Plan PNECHOLMD Programme National d’Elimination de Cholera et de lutte contre les autres Maladies Diarrhéiques (National Program for the Elimination of Cholera and other Diarrheal Diseases; formerly the PNLMD) PNLMD National Diarrheal Disease Control Program PNSA Programme National de Santé de l’Adolescent PNSR National Reproductive Health Program PNDS Plan National de Développement Sanitaire PNIRA National Acute Respiratory Program PNLP National Program for the Fight against Malaria PPFP Postpartum Family Planning PRONANUT National Program for Nutrition PROSANI-Plus Projet Santé Intégré PSI Population Services International RECOSITE Relais Communautaire Sites des Soins (CHW responsible for iCCM sites) RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health RMNCH Reproductive, Maternal, Newborn, and Child Health SCOGO Société Congolaise de Gynécologie et d'Obstétrique SNIS Système National d’Information Sanitaire SOPECOD Société de Pédiatrie du Congo Démocratique STTA Short-Term Technical Assistance UNAAC Union Nationale des Accoucheurs et Accoucheuses au Congo USAID U.S. Agency for International Development WASH Water, Sanitation and Hygiene

Program Overview

Program Name: MCSP/Democratic Republic of Congo (DRC)

Reporting Period: Year 3, Quarter 2: January 1, 2018-March 31, 2018 Program Duration: January 1, 2015 – June 30, 2019 (estimated) Program Goal: To support the DRC in institutionalizing effective organizational plans, structures, and processes for the sustainable implementation of evidence-based reproductive, maternal, newborn, and child health (RMNCH) practices, with a focus on care for newborns and sick children. Program Objectives: 1. To accelerate reductions in maternal and child mortality by strengthening national Ministry of Health capacity to strategically scale up cost-effective, evidence-based interventions. 2. To contribute to improved maternal and newborn survival by strengthening the capacity of Congolese health professional organizations at national level to provide quality in-service training and pre-service education on key maternal and newborn health and post-partum family planning interventions. 3. To contribute to improved child survival and uptake of family planning methods in under- served rural communities in Tshopo and Bas-Uélé provinces by providing technical support for integrated community case management (iCCM), integrated management of childhood illness (IMCI), water, sanitation and hygiene (WASH, nutrition, and community- and facility- based family planning interventions.

Introduction

BACKGROUND The Maternal and Child Survival Program (MSCP) is a global U.S. Agency for International Development (USAID) cooperative agreement to introduce and support high-impact health interventions in 25 priority countries, including the DRC, with the ultimate goal of ending preventable maternal and child deaths (EPMCD) within a generation. In the DRC, MCSP works in close partnership with the Ministry of Health (MOH), USAID, and other reproductive, maternal, newborn and child health (RMNCH) stakeholders to support improved planning, coordination, monitoring, evaluation, documentation, and scale-up of RMNCH activities at the national and provincial levels. To the DRC program, MCSP brings its expertise in maternal, newborn, and child health; family planning (FP); nutrition; water, sanitation, and hygiene (WASH); community engagement; health information systems and other aspects of health systems strengthening; and innovation.

At the national level, under Objective 1, MCSP works to strengthen the Ministry of Health Directorate of Family and Specific Groups’ Health, known as the 10th Directorate (D10) to drive policy development and implementation, human resources capacity-building, partner coordination, and financing. MCSP’s efforts are geared towards supporting the D10, through the reproductive, maternal, newborn, child, and adolescent health (RMNCAH) Task Force and associated technical working groups, to increase the coverage and mobilize resources for high-impact interventions and accelerate reductions in maternal, neonatal, and child mortality. Through building MOH technical and organizational capacity to drive the national RMNCAH agenda, MCSP is directly supporting USAID’s DRC Country Development Cooperation Strategy (CDCS) 2014-2019 and its first development objective, that selected national level institutions more effectively implement their mandates.

Under Objective 2, MCSP works with the Congolese professional associations of birth attendants/midwives (UNAAC), pediatricians (Société de Pédiatrie du Congo Démocratique, SOPECOD), nurses (l’Ordre Nationale des Infirmiers du Congo, ONIC), and obstetrician/gynecologists (Société Congolaise de Gynécologie et d'Obstétrique, SCOGO) to improve care for mothers and newborns on the day of birth, and to adapt and introduce the Helping Babies Survive (HBS) curricula into in-service training. MCSP is also providing organizational and institutional capacity strengthening to SOPECOD and the ONIC through a sub-agreement with the Canadian University Services Overseas (Cuso) International.

Under Objective 3, MCSP is working in 8 health zones in the northeastern provinces of Bas-Uélé and Tshopo. MCSP’s provincial-level activities aim to strengthen the Provincial Health Office (Division Provinciale de Santé [(DPS]) and health zone teams, health facilities, and community care sites, to improve and expand access to child health, family planning, nutrition, and WASH services.

This quarterly report covers the period from January 1-March 31, 2018, which corresponds to the second quarter (Q2) of MCSP Program Year 4 (PY4). However, as this is the third year of MCSP implementation in DRC, MCSP has agreed with USAID to refer to this implementation period as Year 3. Quantitative results on selected performance monitoring plan (PMP) indicators are presented in Annex 1.

Summary of Activities and Accomplishments

Objective 1: To accelerate reductions in maternal, newborn and child mortality by strengthening national and provincial MOH capacity to strategically scale up cost-effective, evident-based interventions

In Q2 of Year 3, MCSP’s support at the national level was focused on developing the iCCM database and website; training a pool of national trainers on essential family practices; supporting the development of the integrated contract approach; building the capacity of national trainers on quality of care; and developing national guidelines for WASH in healthcare facilities.

Activity 1.1 – Provide organizational capacity strengthening support to the national RMNCAH Task Force and new RMNCAH TWG, via the MCSP’s Coordination Unit, and with other RMNCAH partners, for improved policymaking, planning, coordination, management, and monitoring and evaluation of RMNCAH activities Child Health Technical Working Group of the RMNCAH Task Force convened MCSP provided technical and financial support to the Child Health TWG to organize a two-day meeting in March to focus on health information systems and mapping for child health, as well as to review sickle cell anemia management updates. The meeting included 60 participants from the MOH, professional health associations, clinicians, and partners. MCSP and their MOH counterparts at the DSNIS updated the group on the progress on the iCCM dashboard, database, and website. The group also discussed continued gaps in mapping out iCCM services, and MCSP’s plans to collect the GPS coordinates of community care sites, health centers, and other landmarks such as schools and water pumps in MCSP-supported health zones. The key recommendations that came out of the meeting were to continue mapping community care sites in DRC; reinforce supportive supervision of these sites by health center nurses; improve M&E at both the intermediary (health zone, province) and operational levels; and to advocate with technical and funding partners for improving the availability of essential medicines at health centers and community care sites. Activity 1.2 – Provide technical capacity strengthening support to the national RMNCAH, via MCSP’s Coordination Unit and other RMNCAH partners, for improved policymaking, planning, coordination, management, and monitoring and evaluation of RMNCAH activities iCCM scale-up resource team develops iCCM website architecture and indicators MCSP, together with the DSNIS, carried out a three-day workshop in February with other MOH experts and WHO to develop the iCCM dashboard and website specifications; identify 61 priority child health indicators; establish a team responsible for continuously monitoring the website’s functionality; and defining roles and responsibilities. The next steps are to develop the dashboard website; program the new DHIS2 module to take into account new child indicators that are not already available; input child health data; and share a prototype with the iCCM scale-up resource team for feedback. The website will go live in Q3. Activity 1.3 – Support the national Ministry of Health and other RMNCAH partners to implement the 2016-2020 PNDS and the 2017-2021 National Child Health Strategic Plan, including strengthening IMNCI and iCCM programming Integrated contract approach developed MCSP technical and financially supported the Commission for Financing and Universal Health Coverage and the MOH inter-donor health group to discuss the integrated contract approach. This approach aims to reduce the fragmentation of financial resources and duplication of efforts due to lack of coordinated approaches among partners and the MOH. During the meeting, an evaluation guide and norms and procedures document were drafted. Each province will develop a single, integrated contract detailing the health interventions and resources of each partner. Capacity-building on family and community health promotion Last quarter, MCSP supported the revision and updating of tools for the promotion of key family practices. In February, MCSP organized a training of 26 MOH staff on the revised tools. The participants were a mix of former trainers who needed to be refreshed on the updated tools, as well as new trainers. These national level trainers will progressively roll out these updated tools to the provincial and operational levels using a cascade training approach in the two MCSP provinces as well as other select provinces. Training and rollout of integrated quality of care approach In 2016-2017, the MOH’s Division of Primary Healthcare (D5) and partners developed an integrated quality of care approach including a strategic document, standards and guidelines, DHIS2 module, evaluation guide, and training materials. However, the rollout and implementation of the approach has lagged due to lack of resources. To address this gap, MCSP supported the first training of 33 trainers at the national level on the integrated quality of care approach. The trainers represented a cross-section of MOH divisions across nutrition, malaria, respiratory infections, diarrheal diseases, etc. The training included didactic, classroom-based sessions followed by hands-on practice in the Kinshasa DPS, specifically in Masina health zone’s general reference hospital and four health centers in Masina. Next quarter, MCSP will pilot the integrated quality of care approach in 10 MCSP- supported health centers in Tshopo. Lives Saved Tool (LiST) technical working group established at MOH Following the LiST training carried out in August 2017 with MCSP support, the MOH committed to establishing a TWG under the Division of Studies and Planning. This quarter, MCSP supported the development of the TWG’s terms of reference, internal rules, and a budgeted workplan outlining how the tool will be used for planning and evaluation at the national and provincial levels. The finalized documents will be signed by the Secretary General early next quarter. Activity 1.4 – Support the MOH to develop and implement Every Newborn Action Plan (ENAP/DRC) for DRC and to use an integrated package for maternal and newborn healthcare that addresses the mother-infant dyad and improves coordination around newborn health

Following the initial drafting and costing of the Every Newborn Action Plan in November 2017, MCSP supported the Division of Family Health (D10) to revise the plan and prepare it for submission to the service delivery commission (commission de prestation) and the technical coordination committee (CCT). MCSP will support the formal CCT review and validation meeting in early Q3. Activity 1.5 – Strengthen national-level technical capacity of RMNCAH program managers for the development, implementation, monitoring, and evaluation of Annual Operational Plans (AOPs) and Strategic Plans National Community Health Strategic Plan 2018-2020 drafted MCSP played a leading role in supporting the D5 (Division for Primary Health Care) to develop the draft National Community Health Strategic plan along with Sanru and other partners. The genesis of this plan was the DRC’s participation in the MCSP Institutionalizing Community Health Conference in South Africa in March 20127. The plan development process included a situational analysis followed by the drafting of a costed plan, which will be finalized in April 2018. The plan’s objectives include strategies for reinforcing community structures such as cellule d’animation communautaire (community-based sensitization units or CAC) and health area development committees (CODESA); increasing service utilization and quality at the community level; improving financing for community health; promoting social mobilization, advocacy, and communication for community health; and improving M&E and operational research for community health. Activity 1.6 – Support the Ministry of Health to evaluate, scale-up, and strengthen coordination of family planning programming strategies and to monitor adherence to USAID compliance requirements National Multisectoral Family Planning Strategic Plan and FP Communication Plan finalized MCSP provided technical support to the PNSR to finalize the national multisectoral family planning strategic plan 2018-2020 and technical and financial support for the FP communication plan and tools. The strategic plan placed special emphasis on the care of women in the postpartum period and promotion of postpartum family planning. During the workshop, several revised tools including the guide to seven key practices in family planning, job aids, and radio spots were pre-tested with 40 providers and 40 clients at four health centers through interviews and focus group discussions. The finalized plan and tools were disseminated with the MOH and implementing partners. Activity 1.7. Strengthen the institutionalization of the Clean Clinic Approach (CCA) at the national level, support implementation in Tshopo and Bas-Uele provinces, and develop pre-service WASH training National guidelines for WASH in healthcare facilities developed MCSP technically and financially supported a workshop with the MOH and other partners to develop national guidelines for WASH in healthcare facilities, which did not exist before. The workshop brought together 24 participants from different MOH and partner organizations who are active in the field of WASH including KSPH, WHO, UNICEF, the National Water and Sanitation Training School, Sanru and other national MOH bodies including the D10, the National Division of Hygiene and Sanitation (D9), and the Division of Healthcare Facilities (D2) (including representatives from the five provinces of Kwilu, Kasai Oriental, Kongo Central, Tshopo and Bas-Uele). The guidelines include standards for water supply in healthcare facilities (HCF); for hygiene in HCF; for environmental sanitation in HCF; and for HCF management. Once this document has been endorsed by the Minister of Public Health, it will be used to guide the integration of WASH standards and interventions in health facilities, as well as to facilitate monitoring of program quality. Activity 1.8 – Support the KSPH to provide scholarships to MPH and PhD students for the 2018 calendar year

In Q2, MCSP continued to support the 30 MPH students and 3 PhD students from the previous academic year, who were preparing to defend their theses. In addition, MCSP and KSPH signed a new sub-agreement for the 2018-2019 academic year, and MCSP disbursed the first tranche of funding to KSPH for the 30 new MPH students and continued support to the 3 PhD students. MCSP continues to review KSPH’s programmatic and financial reports. Activity 1.9 – Provide technical assistance to the provincial EPI to improve immunization outcomes and coverage and close equity gaps

USAID requested MCSP support to strengthen the quality of routine immunization services by placing an immunization technical advisor with the DPS in six provinces (Kasaï Oriental, Kasaï Central, Sankuru, Haut Katanga, Lualaba and Sud-Kivu), to complement 10 provinces supported by Gavi. The six advisors were selected with the participation of USAID, national immunization program, and Gavi, and plans were made to carry out a joint orientation of the advisors in January 2018 before their deployment to the provinces. However, due to arrears that the government of DRC has with Gavi, this initiative has been put on hold. MCSP will await further guidance from the Mission before moving forward with this activity. Objective 2: Improve maternal and neonatal survival by strengthening the capacity of Congolese health professional organizations at the national level to provide quality in-service training and pre-service education on key maternal and newborn health and PPFP interventions.

MCSP’s work with the professional health associations in Q2 focused on initiating organizational- capacity strengthening with ONIC; launching the Kintambo model training center; carrying out a series of continuous onsite trainings at the model training center on the maternal/newborn/PPFP integrated care package; and carrying out post-training follow-up of trained national trainers. Activity 2.1: Strengthen the technical capacity of the PAs (SOPECOD, UNAAC, SCOGO, and OI) and the trainers of the Ministry of Health to provide in-service training and pre- service education on newborn care, delivery care, prevention and management of hemorrhage and postpartum/post-abortion family planning (HBS/DOB/BAB) Onsite trainings of providers at Kintambo model training center carried out

Professional association trainers, national MOH trainers, and MCSP trained providers at the model training center on three out of the five modules from the integrated package of maternal, newborn, and PPFP care that MCSP and the MOH developed in Year 2. These included preparation for delivery and WASH (34 providers trained; see below for more details on WASH training), essential maternal and newborn care (20 providers trained), and management of select obstetric complications (29 providers trained). The week following the training on each module, the newly trained providers organized themselves in teams of 2 providers in each of the 10 service delivery units of the site. Each team worked together to provide peer-to-peer monitoring and support on developing mastery and transfer of their new skills and competencies, as well as to organize skills- building sessions with other providers who did not participate in the training. Respectful maternity care emerged as a priority area for attention and improvement and has been integrated in all aspects of training and follow-up. In between the three training sessions, professional association member trainers and MOH trainers carried out post-training follow up visits in order to observe clinical practice, provide mentorship and support, facilitate development and implementation of action plans, and ensure that providers are organizing and cleaning their work sites.

Training on the final two modules (care of sick newborns and postpartum family planning) will be completed in Q3. Work is ongoing to install the simulation laboratory, work with the coordination committee to assure quality and develop plans for sustainability of the model training site, and ensure that care is being provided to standard. When the model training site is fully functional toward the end of Q3, nursing students and trainees will begin training activities and rotations at the site. Clean Clinic Approach integrated at the model training center

Given that WASH is an essential component of the maternal and newborn health care quality, MCSP, in collaboration with the D9, trained 34 providers on WASH in healthcare facilities the CCA. The training covered the basics of water supply (access, required quantity, and quality) in healthcare facilities; hygiene measures for infection prevention and control, including hand hygiene, cleaning and disinfection of premises and medical equipment; and medical waste management, including segregation, transportation, storage, treatment and safe final disposal. The training also covered management and leadership for WASH, the Demonstration of hand rubbing techniques during WASH importance of routine audits, personnel training management, mechanisms for gathering and incorporating client feedback, and empowering cleaners as key partners in promoting WASH and quality of care at the facility. In Q3, MCSP will support the model training center in developing a WASH action plan and establishing a WASH committee. Activity 2.2: Strengthen organizational capacities of the Ordre des Infirmiers with Cuso International MCSP is collaborating with Cuso International to strengthen the institutional capacity of ONIC, a prolific professional health association with over 100,000 active members across each of DRC’s 26 provinces. This quarter, MCSP and Cuso gathered documentation on ONIC’s governance, membership, geographic distribution, activities, and collaboration with the MOH and other partners. The partnership among MCSP, Cuso, and ONIC was officially launched in March. An introductory workshop one week later covered the history of ONIC and the organizational development and capacity-building approach, and a detailed plan of action was produced. The action plan covers organizational culture, team performance, internal and external relations, institutional management, gender integration, and institutional strengthening. An in-depth evaluation of ONIC will take place in Q3 in Kisangani, in Kinshasa and in Goma in order to assess multiple provincial chapters.1

Activity 2.3: Strengthen the organizational capacities of SOPECOD by implementing their organizational development plan developed with Cuso International In Year 2, MCSP’s support to SOPECOD focused primarily at the national level and developing a strategic plan. This year, MCSP and Cuso are supporting the implementation of the strategic plan. In Q2, MCSP and Cuso organized a series of workshops to develop a continuous training plan, an annual operational plan, and to follow up on the application of resolutions from the 8th Annual SOPECOD Congress held in Q12. Key elements of the AOP include focusing on resource mobilization and diversification, advocacy for improved quality of care guidelines, improving financial and administrative systems and management, and improving SOPECOD’s visibility. MCSP and Cuso also prepared to launch organizational capacity strengthening for SOPECOD provincial-level chapters in Goma, representing North Kivu, South Kivu, and Maniema provinces, at the beginning of Q3. Activity 2.4 – Support the development of the model training center, a training site for students and service providers in different domains of maternal and neonatal health, post-partum/post-abortion FP, and WASH Kintambo hospital refurbished to serve as training site

In Q2, MCSP made notable strides in rehabilitating the Kintambo Maternity, Clinique Libota Lilamu, and Pediatric Unit of the Kintambo General Hospital in order to render the site functional as a model training center. MCSP supported the refurbishment of the simulation laboratory in the maternity and the outpatient clinic used for postpartum family planning services. The rehabilitation included painting, minor repairs, and furnishing needed materials and supplies. Rehabilitation of the training room, located at the Pediatric Unit and the Kangaroo Mother Care unit is ongoing. Objective 3: Contribute to improved child survival and uptake of FP methods in under-served rural communities in Tshopo and Bas-Uélé provinces by providing technical support for iCCM, IMNCI, WASH, nutrition, and community- and facility-based FP interventions.

In Q2 of Year 3, MCSP-supported health centers and community care sites saw 48,005 new cases of sick children under five years old, launched community-based distribution of family planning in Bas- Uélé, and observed an increased proportion of women delivering in facilities accepting PPFP. IYCF counselling cards were revised, and preparation for the nutrition integration pilot at 25 community care site-health center pairs is underway. A total of four facilities achieved Clean Clinic status, and the Clean Clinic Approach is in the process of being scaled up from the ten pilot health centers to an

1 The Tshopo, Ituri, and Bas-Uélé provincial chapters will convene in Kisangani and the Nord Kivu, Sud Kivu, and Maniema chapters will convene in Goma. 2 They seven key resolutions from the 8th SOPECOD Congress include: (1) establishing a training program to build the capacity of doctors and nurses on pediatrics; (2) developing a costed plan for equipping hospitals with neonatal and pediatric services for submission to the MOH and other partners; (3) supporting the MOH to develop a normative document on the rational use of antibiotics in pediatrics and neonatology; (4) strengthening collaboration with other professional health associations; (5) developing an annual operational plan; (6) increasing SOPECOD’s involvement in all child health-related activities (vaccination, breastfeeding campaigns, health policy decisions, etc.); and (7) introducing KMC to all neonatal departments. additional 25 sites. MCSP provided capacity strengthening to the DPS in Tshopo and Bas-Uélé and eight health zones in data quality and review, supply chain management, and annual health review workshops.

MCSP also successfully transitioned Objective 3 management from ASF/PSI to JSI at the end of Q1 and into the beginning of Q2. MCSP set up new offices in Kisangani, Isangi, and Buta and hired or rehired staff as needed without any major disruption to services. Activity 3.1. Strengthen functionality of key planning, management and coordination mechanisms at the provincial and health zone level RMNCAH Task Force in Tshopo revitalized

In Q2, MCSP supported the revitalization and reorganization of the RMNCAH Task Force and thematic sub-groups. This provincial coordination body is supported by the DPS’ Office of Technical Support, WHO, the National Program for the Fight Against HIV, MCSP, and other technical and funding partners. MCSP supported a meeting convening all RMNCAH partners in the province to commit to quarterly meetings and enhanced coordination on RMNCAH activities. Annual provincial health sector reviews conducted in Tshopo and Bas-Uélé

MCSP provided financial support and technical expertise for the 2017 annual health sector review in the two provinces. The purpose of these reviews is to convene all health zones, the DPS, and primary health care and RMNCAH partners to review data and activities, achievements, and challenges from the previous year against the activities and goals of the annual operational plan and the national health development plan.

In Tshopo, the six health zones supported by MCSP saw performance improvements in accomplishing their planned objectives. Overall, the six health zones supported by MCSP saw an average 13% gain in their scores3, in part due to MCSP’s support for carrying out trainings (on IMNCI, iCCM, FP, WASH), post-training follow up, joint supportive supervision, and provision of commodities.

In 2018, MCSP will continue to support the HZ to improve their performance through strengthening CAC, increasing the number of health centers integrating the WASH CCA, and carrying out a rapid data quality assessment to improve data quality.

In Bas-Uélé, there was an average 23.5% increase in performance from 2016-2017 in the two HZ supported by MCSP. Community care sites transportation systems strengthened

MCSP delivered 434 bicycles leftover from the PMI-EP project to six of the eight MCSP-supported health zones. The bicycles are being given to the two recosites at each site, one community-based distributor who is not also serving as a recosite, and the CAC president of each health area. The bicycles will enable more reliable transportation for these providers to go to the health center each month to share data, participate in monthly meetings, and bring back child health and FP commodities needed for the following month. The bicycles also serve to motivate and recognize these unpaid community volunteers. The two remaining health zones (Yahisuli and Yakusu) will receive their bikes at the beginning of Q2.

3 The scores are based off performance on 30 indicators, including vaccine coverage, ANC coverage, access to essential child health commodities, access to contraceptives, and other elements. Activity 3.2 – Support 8 MCSP HZ to improve management of diarrhea, malaria and malnutrition in children younger than 5 in the two DPSs (Tshopo and Bas- Uélé)

In Q2, MCSP-supported community care centers and health centers saw 48,005 new cases of sick children (see figure 1 below). Of these, 11,230 cases, or 23%, were seen in the community.

Figure 1. Number of sick children seen in MCSP-supported health centers and community care sites, January-March, 2018

A total of 7,707 diarrhea cases, 9,200 pneumonia cases, and 18,745 malaria cases were treated this quarter (see figures 2 and 3). In Bas-Uélé, 2,329 diarrhea cases, 2,302 pneumonia cases, and 6,814 malaria cases were treated. In Tshopo, 3,340 diarrhea cases, 4,716 pneumonia cases, and 11,931 malaria cases were treated. The number of malaria cases treated compared to the number of RDT+ cases was lower than in previous quarters due to commodity stockouts. MCSP is working with Sanru and its subrecipients, who provide the ACT, to address these issues. Figure 2. Number of new cases of diarrhea and pneumonia treated in MCSP-supported health centers and community care sites, January-March, 2018

Figure 3. Number of cases of fever seen, tested, and treated in MCSP-supported health centers and community care sites, October-December 2017

Strengthened CACs to play their community health oversight role

Community-based sensitization units (CAC) are elected community members who help oversee health services in their health area. In DRC’s national community health strategic plan (see 1.5 above), the CAC is considered the focal point for all community-based activities and key mechanism for promoting community involvement. In the two MCSP- supported provinces, many of these bodies either became non-functional over time, or, in some areas, they have not been established. MCSP aims to strengthen these CAC election being presided over by the village chief in Makala aire de santé, Buta HZ. important structures, in collaboration with other implementing partners and donors such as the Association for the Protection of Children in Congo (APEC; a Sanru/Global Fund sub-recipient) and UNICEF. In Bas-Uélé, 100% of the health areas have CAC, following support from APEC in 2017 to establish 1,468 CAC. To complement APEC’s efforts, MCSP is providing technical support to strengthen the CAC’s governance and operations. For example, in March 2018, MCSP supported the CAC member elections in the Makala health area. In Tshopo, CAC coverage is only 52%, thus MCSP will support the establishment and or strengthening of CAC and CODEV (development committees) in the health areas it supports. By supporting the establishment of CAC, MCSP supports the effective implementation of the national community health strategic plan.

IMNCI post-training follow-up carried out to maintain and strengthen provider skills

In November 2016, MCSP and PNIRA trained a pool of 31 provincial trainers in Tshopo and Bas-Uélé on IMNCI and on facilitation techniques. In February 2018, a joint MCSP-PNIRA team traveled simultaneously to each province to support the provincial teams in carrying out the third IMNCI post- training follow up of nurses. The teams visited two health centers per province (CS Triangle and Rive Gauche in Bas-Uele and CS Yelenge and Yubo in Tshopo) and also gathered providers from 48 facilities at the health zone level.

The post-training follow up included review of individual case management forms and registers, discussions with the providers, and direct observation of clinical services. Providers were assessed on theoretical knowledge and clinical competencies, and the results were shared and discussed in order to improve care for children under five (see figure 4 below). The national IMNCI guidelines stipulate that providers should achieve 90% across each domain; therefore, there is continued room for improvement. While the providers were knowledgeable and correctly diagnosed and treated children, there were some areas for improvement identified. These include improving documentation, treating children that needed to be referred for higher-level care prior to referral; and systematically evaluating nutritional status and vaccination status. The team provided feedback, and helped the provincial team develop a plan for carrying out post-training follow up in each of the MCSP-supported health zones and health centers. Having MCSP and PNIRA present also strengthened the DPS’ capacity to carry out post-training follow-up. The DPS will continue post training follow up to cover the 58 remaining health centers. Figure 4: IMNCI post-training follow-up results in a sample of health centers in Bas-Uélé and Tshopo

80% 70% 60% 50% 40% 30% 20% 10% 0% Basoko Yakusu Aketi Yahisuli Buta Yaleko Isangi Yabaondo

Quality of care Document review Operational capacity Quarterly BCZ Supervision iCCM/IMNCI supportive supervision carried out

MCSP carried out supportive supervision at six health centers and four community care sites in Bas-Uélé with the DPS and Buta health zone teams. The supervision team noted that child health commodities are available and the trained providers are active in providing services, however, they are not tracking average monthly consumption of commodities, there are data completeness and data quality gaps, and the infirmiers titulaires, health zone teams, and DPS are not routinely carrying out supervision. These findings Supportive supervision visit to Ngbete community care site in were discussed and actions points were developed. Buta HZ in March 2018. The recosite, Maman Louise, is shown at bottom right.

Activity 3.3 – Support implementation of pilot nutrition integrated approach for improving key nutrition practices in selected MCSP facilities and communities iCCM-Nutrition integration study results analyzed

During Q2, MCSP further refined the iCCM-Nutrition integration study findings report based on the study findings. The report will be disseminated widely in early Q3. Nutrition integration intervention approach designed and pilot sites selected Using the results of the qualitative iCCM/nutrition integration study, MCSP worked with the DPS, PRONANUT, and D10 to define the intervention approach, which is focused on strengthening infant and young child feeding counseling and nutrition assessment, counselling, and support, through adaption of existing IYCF counseling materials. Under the leadership of the health zones and DPS, 25 community care site-health center pairs were chosen for the pilot approach based on accessibility, existence of CAC, level of performance by the IT and recosites, and qualification of the nutrition focal point, among other selection criteria. The 25 sites include 8 community care sites - health center pairs in Yakusu, 9 community care site-health center pairs in Yaleko, and 8 community care site- health center pairs in Isangi HZ. IYCF counselling cards revised and adapted to the local context of the pilot sites

MCSP convened PRONANUT, the DPS, and health zone teams in Tshopo to review the existing IYCF counselling cards and adapt the materials based on the findings of the nutrition-iCCM study. A total of 12 existing counselling cards were revised, and one new counselling card was created. A list of images based on the key messages was also developed. A pre-test of the IYCF counselling cards will be conducted in early Q3 in the pilot sites amongst mothers of children 0-59 months, health care workers, and community health volunteers. Activity 3.4– Integrate RH-FP services in 48 healthcare centers and 40 community care sites, and strengthen provider capacity to increase awareness and demand for FP services in the Tshopo and Bas-Uélé provinces

In Q2, a total of 2,150 new users initiated FP at MCSP-supported sites, including 541 (20% of women delivering in facilities) accepting PPFP (see figure 5).

Figure 5. Number of new family planning users over time in MCSP supported facilities

This was the first full quarter that the community-based distributors (CBD) of family planning provided services in Tshopo. Figure 6 shows that the CBD accounted for a significant proportion of new family planning clients in Isangi, Yabaondo and Yaleko health zones. Due to the transition from ASF/PSI, the CBD post-training follow up was delayed and will take place in Q3. This will enable MCSP to assess challenges noted in Basoko and Yahisulu, which may be due to a mix of incomplete data collection, need for additional community sensitization, reinforcement of CBDs’ skills, and other issues.

Figure 6. Number of new family planning users by site of service in Tshopo province, January-March 2018

Permanent multisectoral technical committee (CTMP) meetings held

One CTMP meeting in Tshopo and one in Bas-UéIé in Q2 with MCSP financial and technical support. In Tshopo, the meeting focused on FP coverage and financing and provision of FP commodities by the province. FP coverage in the health areas increased from 51.4% in 2017 to 58.5% (representing 247 health centers in 17 health zones), with the goal of reaching 60% by the end of the 2018 calendar year. Thirty health areas in three health zones were identified for the integration of FP activities before the end of 2018. The CTMP also committed to requesting a 20% contribution of annual contraceptive needs from the provincial government. A committee was set up to support this resource mobilization effort.

Strengthening social and behavior change In Bas-UéIé, the CTMP meeting was used to communication and FP awareness through radio review progress against the three 2017 priority activities including: (1) integrating a budget line MCSP’s Provincial FP Advisor shared information about FP for FP in the provincial budget, (2) disbursing and answered callers’ questions on the Mabele community those funds to purchase contraceptives, and (3) radio station in Yabaoundo health zone in March 2018. mobilize support from partners to increase FP Health-related programs air for free on many community coverage from 18% to 50% of the health areas radio stations, so MCSP plans to continue this approach to in the province. While efforts were made on reach more community members. the first two priority activities, only the coverage goal was reached. A total of 7 out of the province’s 11 HZ (including MCSP’s two supported HZ) now offer FP.

Post-training follow-up carried out

MCSP supported the PNSR and DPS to carry out the third post-training follow up of FP providers at health centers and hospitals. The data show progressive improvements in the quality of FP services across each of the 8 health zones since FP services were launched with MCSP support. Figure 7 below shows the results of the post-training follow up, which is based on performance on competencies on FP counselling, initiating specific FP methods, knowledge, and review of consultation sheets. All 40 health centers and 8 hospitals receiving MCSP support for FP received post-training follow-up visits.

Figure 7. Progressive improvements in post-training follow up scores at FP sites in MCSP-supported HZ

90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Aketi Buta Basoko Isangi Yabaondo Yahisuli Yaleko Yakusu Moyenne 1st follow-up 2nd follow-up 3rd follow-up

Seven out of the eight HZ achieved scores of 80% or more, which is the MOH’s performance standard. The greatest improvements over time are in Aketi HZ, while Yabaondo HZ will receive more targeted support and mentoring to improve the quality of services. Activity 3.5 – Improve WASH services for children under five and mothers in health care facilities Continuous WASH improvements at CCA sites achieved

MCSP continued to support the ten health centers across three health zones (Buta, Isangi, and Yakusu) with supportive supervision and coaching to reinforce healthcare providers and WASH committees on sustainable WASH management. Technical areas covered during these coaching visits included water treatment, treatment of infectious waste, hand hygiene, and other infection prevention and control measures in treatment rooms and delivery rooms. The improvements over time shown in figures 8 and 9 suggest that a culture of hygiene and sustainable WASH services is taking root in the ten pilot facilities, which in turn suggests increasing client satisfaction with services (see, for example, WASH success story in Annex 2). To date, four of the ten clinics have achieved Clean Clinic status and been certified.

Figure 8. Clean clinic scores in Tshopo, August 2017-March 2018

Figure 9. Clean clinic scores in Bas- Uélé, August 2017-March 2018

Expansion of CCA from 10 to 35 sites

In Q2, MCSP’s planned expansion of the CCA to an additional 25 sites was postponed while awaiting full approval and funds from the USAID Mission, which was received at the end of the quarter. During this period, MCSP prepared training terms of reference and prepared purchase orders for WASH starter kits and other materials such as filters, IEC materials, rainwater collection materials, and chlorine powder. In Q3, providers from the 25 new sites will be trained.

Activity 3.6 – Provide access to essential child health, family planning, and WASH commodities and supplies and strengthen the supply chain management system Stock inventory carried out

During routine supervision visits, MCSP noted that several community care sites and health centers had excess stock of zinc and ORS that, based on average monthly consumption, could not be consumed before the product expired (in July 2018 for ORS and October 2018 for zinc). As a result, MCSP carried out physical onsite inventory of commodities at MCSP-supported health centers and community care sites. The findings are currently being analyzed in order to determine if the medications could be exchanged with other partners such as UNICEF and redistributed to other health areas not supported by MCSP, and, to inform future MCSP procurement needs. This process is still underway, and MCSP will keep USAID apprised of our findings. In addition to ORS and zinc, implants will need to be procured soon. All other commodities are in sufficient supply with later expiration dates. Provincial commodities working group supported

MCSP participated in the provincial commodities working group meeting in Tshopo, along with other technical and funding partners. The group addressed an array of supply chain issues, including duplication of supply in some areas, issues in calculating average monthly consumption at the health zone and health center levels, delivery delays, stockouts in some health areas, and excess stock in other health areas. To address these issues, MCSP plans to support the health zones on supply chain management, and to as much as possible transition from a push system to a pull system.

Activity 3.7- Support ongoing monitoring and evaluation of child health, nutrition, FP, and WASH services Community care site and health center GPS coordinates collected

MCSP and the D5 are working together to geolocalize community care sites, health centers, and other landmarks of interest (schools, churches, water points, bridges, hospitals, etc.) in MCSP- supported health zones. MCSP and the D5 trained health zone and provincial MOH staff to collect GPS coordinates and completed geolocation for 53 health centers, 64 community care sites and developed GIS Shape files to integrate into DHIS2 and the iCCM database under development. Geolocation for the other four MCSP-supported health zones will be completed next quarter to reach 100% coverage of MCSP-supported HZ and sites.

Table 1. GPS coordinates collected in four HZ in Tshopo and Bas-Uélé, March 2018

Health zone # Health areas # Community care sites Buta 12 15 Aketi 15 15 Isangi 12 20 Yakusu 14 15 Total Collected/Expected 53/106 64/119 % Coverage 53% 55%

Data analysis and validation meetings supported

MCSP technically and financially supported data analysis meetings of the SNIS and epidemiological surveillance working group at the DPS in Tshopo. During the meetings, data issues were identified and corrected, for example, inconsistencies between the number of number of family planning methods used and the number of new acceptors plus continuing users and other issues of data completeness and validity. The SNIS working group does not yet exist in Bas-Uélé, however MCSP is advocating with the DPS to establish this group with partner involvement and support. During the IMNCI and FP post-training follow up, feedback was provided to the HZ and health centers. In Q3, MCSP will build the capacity of DPS and HZ staff on carrying out data quality audits.

MCSP also supported monthly data monitoring meetings at the health zone level in each of the 8 HZ. These meetings are an opportunity for nurses and HZ teams to validate and analyze their own data, to share best practices and challenges. MCSP also supported data validation meetings at the health area level, during which nurses, recosites, and the CODEV meet to review and validate data before it is transmitted to the health zones. Strengthened the capacity of the DPS, HZ, health centers, and community care sites to collect, transmit, manage and use data

MCSP supported data collection and use across the eight health zones by providing sites with data collection and reporting tools and providing the HZ and DPS with internet credit to input data into DHIS2. Regular internet access also enables the HZ and DPS to carry out more in-depth data analysis for feedback at the facility and community level during routine supportive supervision visits. Data visualization enhanced

MCSP developed data dashboards for child health and FP indicators in collaboration with the DPS, which were distributed during the IMNCI and FP post-training follow-up missions described above. The purpose of the data visualization is to enhance data feedback and data use for decision-making. MCSP plans to support each health zone with the necessary materials and instructions to continue developing and using the data dashboards.

Development of FP data dashboard at Yalemba health center, Basoko HZ

Priorities for Next Quarter

Objective 1 RMNCAH Task Force Coordination  Develop D10 2016-2020 Strategic Plan  Train D10 on results-based management approaches Child Health  Continue development of iCCM database, dashboard, and website  Finalize Community Health Strategic Plan Maternal Health and Family Planning  Submit revised FP communication tools to the technical coordination committee Newborn Health  CCT review and validation of Every Newborn Action Plan

Objective 2 Model training center  Finalize and sign partnership agreement between the Secretary General and MCSP  Finalize, sign, and put into effect model training center standard operating procedures  Carry out training activities on modules 4 (essential management and care of newborn complications) and 5 (PPFP)  Carry out post-training follow up  Carry out initial WASH evaluation at the model training center  Officially launch model training center  Work with the CMF coordination committee to implement quality assurance activities and move activities forward Professional association organizational capacity strengthening  Carry out in-depth evaluation of SOPECOD provincial chapters in Goma, using the revised MACAT-PICAL tool  Carry out in-depth evaluation of ONIC provincial chapters in Goma and Kisangani, using the revised MACAT-PICAL tool ENAP  Develop the ENAP “Feuille de route” (road map)  Organize advocacy meetings for fundraising

Objective 3 Provincial Coordination  Support the revitalization of the RMNCAH Task Force in Tshopo  Disseminate RMNCAH normative documents at the health zone level  Collaborate with the HZ and provincial authorities to improve management of drug stocks and redistribute excess stocks of ORS and zinc  Technically and financially support the annual HZs board meetings in Yakusu and Isangi Health Zones  Distribute bicycles from PMI-EP project to health centers and community care sites of Yahisuli and Yakusu Health Zones.  Participate in monthly meetings of technical and financial partners  Finalize collection of GPS coordinates for community care sites in remaining four MCSP- supported health zones  Carry out joint quarterly supportive supervision iCCM and IMCI 24 | Page USAID/MCSP DRC Quarterly Report: Year 3, Quarter 2 (January 1-March 31, 2018)

 Launch quality of care pilot in Isangi and Buta health zones (10 pilot sites)  Support the revitalization of CAC in the 119 community care sites  Support supply chain distribution and strengthening  Revitalize RMNCAH Task Force in Tshopo Nutrition  Support DPS and BCZ coaches in carrying out a training of trainers and cascade trainings for service providers, community health workers, and traditional healers for the nutrition integration approach  Support mother-to-mother groups to promote IYCF, care seeking behaviors, breastfeeding, and complementary feeding  Support PRONANUT in organizing a workshop on updating/developing a post-training monitoring guide and coaching guide for the integrated nutrition activities in the community care sites and health centers  Document and share experiences with the integrated approach  Support monthly nutrition cluster meetings with Tshopo DPS to discuss and monitor nutrition data/indicators WASH  Procure and distribute materials (WASH kits, chlorine makers, etc.) for 25 new CCA sites  Carry out training of providers and cleaners at 25 new CCA sites  Certify sites that have achieved CCA status  Produce and distribute WASH IEC materials Family Planning  Carry out training of trainers and training of community-based distributors on community- based distribution of FP in Bas-Uélé  Carry out first post-training follow up of community-based distributors in Tshopo and Bas- Uélé  Strengthen the capacity of providers on FP compliance in the 8 HZ  Organize ‘open door’ days at clinics to promote FP uptake  Reproduce and disseminate FP data dashboards at the 40 clinics and 8 hospitals supported by MCSP  Support implementation of communication plan and tools  Reinforce recosites, health care providers, and health zones on SBCC and FP demand generation and sensitization at the community level Monitoring and Evaluation . Carry out training on rapid data quality assessment, data analysis, and data use for health zone and DPS staff . Technically support data analysis meetings at health zones and DPS . Develop and distribute data dashboards Pool Offices . Participate in data validation and analysis meetings at the HZ and provincial levels . Monitor consumption and distribution of commodities for each health zone . Support the timely collection, transmission, and uploading of data into DHIS2  Follow up on implementation of CCA at 25 health centers and nutrition integration approach at 25 community care sites-health center pairs

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Annex 1. PMP Results

ACHIEVEMENT % of

Year 3 BAS-UÉLÉ TSHOPO target

INDICATORS TARGET KINSHAS achieve Notes Communit Health Communit S Health center A d to y care site center y care site TOTAL Q2 TOTAL Q1 date 14 trained on collection of GPS coordinates ; 12 on post- training follow up ; 26 on promotion of key practices ; 33 on integrated quality of Number of people trained 198 (95 men care 2.3 through USG- supported 2,000 10 16 172 and 103 148 17% approach ; programs (for all objectives) women) 30 on maternal care ; 34 on WASH ; 20 on essential maternal and newborn care; and 29 on management of obstetric complication s Number of cases under five 3.1 184,735 with fever, diarrhea &/or

26 | Page USAID/MCSP DRC Quarterly Report: Year 3, Quarter 2 (January 1-March 31, 2018)

ACHIEVEMENT % of

Year 3 BAS-UÉLÉ TSHOPO target

INDICATORS TARGET KINSHAS achieve Notes Communit Health Communit S Health center A d to y care site center y care site TOTAL Q2 TOTAL Q1 date fast/difficult breathing during the reporting period for whom advice or treatmen Diarrhea 2,329 589 3,589 1,426 7,933 t was Pneumonia 2,317 739 4979 1,481 9,516 sought Fever/suspecte 6,591 2,059 17,476 4,936 31,062 37,281 at from a d malaria§ health facility or centers and CCM- 55,111 56% 11,230 trained community CHWs in TOTAL** 11,237 3,387 26,044 7,843 48,511 sites MCSP- supporte d areas 5,719 at health Number of cases of child centers and 3.2. diarrhea treated in USAID- 35,177 2,329 588 3,390 1,397 7,704 7,615 43% 1985 at assisted (MCSP) programs community sites Number of cases of child 7,018 at pneumonia treated with health antibiotics by trained facility centers and 3.3. 36,083 2,302 735 4,716 1,447 9,200 10,052 53% or community health 2,182 at workers in USG (MCSP)- community supported programs sites Number of children under 5 referred to a higher-level 3.4. health facility by CHW for 1,339 196 408 604 89% treatment of severe 596 diarrhea, pneumonia and

§ At the health centers, this is collected at “suspected malaria,” and at the iCCM sites, this is collected as cases of “fever” ** Note – these may be double counted, as one child can have more than one illness. It is not possible to collect the exact number of children presenting with fever, pneumonia and/or diarrhea through routine data sources

27 | Page USAID/MCSP DRC Quarterly Report: Year 3, Quarter 2 (January 1-March 31, 2018)

ACHIEVEMENT % of

Year 3 BAS-UÉLÉ TSHOPO target

INDICATORS TARGET KINSHAS achieve Notes Communit Health Communit S Health center A d to y care site center y care site TOTAL Q2 TOTAL Q1 date malaria or danger signs in USG (MCSP)-supported programs Percentage of MCSP- Amox:9.6% Amox:7.4% Amox:9.6% Amox: 20% supported health facilities Zinc:5.2% Zinc: 0 Zinc:3.8% Zinc:7% 3.14 with a stock out of any key <15% ORS:3.9% ORS:3.7% ORS:3.8% ORS:4% child health tracer drug in MBZ:16.9 MBZ:11.1% MBZ:15.4% MBZ:34% the last 3 months %

Number of visits by 2,150 women of reproductive women age (15-49 years) for FP initiating and 3.15 9,495 719 26 1,092 498 2,335 1,979 45% services at facilities or 185 trained CHWs in MCSP- returning supported areas users Number of women initiating FP services 3.16 (new users) at facilities 8,503 650 26 1,001 473 2,150 1,860 47% or trained CHWs in MCSP-supported areas Percent of women delivering in MCSP- supported health 19,5% 3.17 facilities who accept a 15% 403/864 138/1,907 15% (541/2,771) method of family planning prior to discharge Number of service delivery points that expanded the types of 48 (40 CS, 8 3.19 40 12 36 48 48 100% contraceptive methods HGR) available with MCSP support 3.20 Number of USG-assisted 120 75% Training of

28 | Page USAID/MCSP DRC Quarterly Report: Year 3, Quarter 2 (January 1-March 31, 2018)

ACHIEVEMENT % of

Year 3 BAS-UÉLÉ TSHOPO target

INDICATORS TARGET KINSHAS achieve Notes Communit Health Communit S Health center A d to y care site center y care site TOTAL Q2 TOTAL Q1 date community health community- workers (CHWs) 90 90 based providing family planning distributors (FP) information, in Bas Uélé to take place referrals, and/or services in Q3 during the last quarter Cycle beads:8.3% Cycle Cycle Cycle IUD: 33.3% beads:13.9% Beads:12.5% beads:25% Implant: 8,3% IUD:27% IUD: 19.4% IUD :22.9% Depo:0% Implant: Imlplant:14,6 Imlplant:40 Percentage of MCSP- Jadelle: 16.7% % supported health 16.7% % Pills:25% Depo:13,9% Depo:10.4% Depo:17% facilities with a stock out F condom: 25% Jadelle:46% 3.21 <20% Jadelle:25% Jadelle:22.9% M condom:16.7% Pills:25% of any contraceptive Pills:5.6% Pills:10.4% method in the last 3 F condom: F condom: F condom: 23% months 13.9% 16.7% M M condom: M condom: condom:19 14% 10.4% %

Number of supervision visits to facilities and 3.24 community sites 318 99 169 268 281 undertaken by health zone management teams Number of supervision visits to iCCM sites 3.25 360 374 530 904 922 undertaken by HF providers teams RDT testing rate: % of children in malaria 99.2% 98,8% 79,8% 91% 87% 90.9% Malari endemic areas, aged 0-59 100% (6,540/ (2,036/ (13,960/ (4,522/ (27,058/ (33,536/ a 1 months presenting with 6,591) 2,059) 17,476) 4,936) 31,062) 36,866) fever who were tested with RDT or microscopy

29 | Page USAID/MCSP DRC Quarterly Report: Year 3, Quarter 2 (January 1-March 31, 2018)

ACHIEVEMENT % of

Year 3 BAS-UÉLÉ TSHOPO target

INDICATORS TARGET KINSHAS achieve Notes Communit Health Communit S Health center A d to y care site center y care site TOTAL Q2 TOTAL Q1 date RDT positivity rate: % of children aged 0-59 months with fever 84.4% 81.8% 77% 72.8% 78.5% 79.9% Malari presenting to (facility or N/A (5,521/ (1,666/ (10,762/ (3,296/ (21,245/ (26,814/ a 2 CHW) who were tested with 6,540) 2,036) 13,960) 4,522) 27,058) 33,536) RDT (or microscopy) and received a positive result Treatment of confirmed malaria: % of confirmed malaria 93% 98% 82% 93% 88% 95% Malari cases in children aged 0-59 100% (5,181/ (1,633/ (8,862/ (3,069/ (18,745/ (25,579/ a 3 months that receive first 5,521) 1,666) 10,762) 3,296) 21,245) 26,814) line antimalarial treatment (ACT)

30 | Page USAID/MCSP DRC Quarterly Report: Year 3, Quarter 2 (January 1-March 31, 2018)

Annex II. Success Stories Number of monthly deliveries in Lilanda Health Center surges following introduction of the Clean Clinic Approach In November 2017, nearly five months after the integration of the Clean Clinic Approach at Lilanda Health Center, the number of women giving birth there quadrupled from an average of five births per month to reach 20-25 births per month. One reason behind this significant increase is the improvement in hygiene conditions. As one client explained, “My name is Kaenga Bakoanga, I live in Lilanda and I am a mother of five; two of them are twins. I gave birth to my first three children in Isangi General Reference Hospital on the other side of the river. This Photo credit: Jean Robert Tshimanga/MCSP time, my husband and I decided that I would give birth in Lilanda NAME Health Center because the maternity ward is now very clean and Kaenga Bakoanga there is water available inside the rooms. The environment in the ROLE center is also convenient and safe.” She added, “I and other Mother women from our village have decided not to take the risk of crossing the river to give birth after the conditions here in Lilanda LOCATION Isangi, Tshopo Province have finally improved and for that we thank MCSP”. The services provided by the maternity ward of this health center not only SUMMARY benefit the women living in Lilanda, but also those coming from Previously, women from Lilanda and nearby the surrounding villages; some of them are located as far as ten villages had to cross a river to give birth in the hospital on the other side of the river. After the kilometers from the Lilanda Health Center. integration of Clean Clinic Approach in Lilanda Health Center by MCSP, there have been Another woman from a different village who is a mother of four significant improvements in the hygiene also shared her experience, saying, “My name is Ruth conditions of the health center. Mothers no Otoatilaobe, I live Botshiangulu, a village located 9 km from here. longer need to cross the river to find a hygienic I gave birth to my first son here and it was not a good experience and comfortable health center to deliver in. because of the poor hygiene conditions”. She continues, “I gave birth to my other two children in the General Reference Hospital, on the other side of the river. It was when I came to attend the

Page | 31 USAID MCSP/DRC Quarterly Report: Year 3, Q2 (January 1 – March 31, 2018)

“I and other women from our village have decided prenatal consultation here at the health center during not to take the risk of crossing the river to give birth my pregnancy that I saw how different the conditions after the conditions here in Lilanda have finally are now – a clean facility, water available, clean toilets improved and for that we thank MCSP.” – so I decided to give birth here and I am very comfortable this time. Many of the women who gave - Kaenga Bakoanga, birth here said that these improvements are the mother of twins results of the MCSP project”. Lilanda Health Center is one of the centers of the Isangi Health Zone which has a population of 7,807 inhabitants in nine villages. It is located 13 km from the General Reference Hospital on the opposite bank of the Congo River with a width of 4.5 km. The monthly average number of deliveries in the maternity ward before the integration of MCSP’s WASH approach was 8 to 10 deliveries a month. After the integration of the Clean Clinic Approach in 2017, both the quality of services and number of deliveries have increased dramatically.

Lilanda Health Center clients are so grateful for the support of MCSP and are requesting an expansion for the project to reach other health centers in the health zone.

By: Dr. Jean Robert Tshimanga, Isangi Pool Manager

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Annex III. STTA Table

Travelers Scope of Work Dates Gbaike Ajayi and  Support supervision visits with professional associations February 12 - 23 Susheela members trained on integrated HBS/DOB/BAB package Engelbrecht  Support development of the model training center including:  Recruiting a local consultant to manage the development of the model training center  Assisting with identifying with selecting the trainers for the model training center  Developing a training strategy and a post-training follow-up plan  Supporting development of a quality assurance process for model training center  Provide programmatic and management support to implementation of model training center activities  Provide administrative support to Jhpiego staff Lior Miller  Orient newly-hired senior Objective 3 management and March 18-April 5 financial staff and provide support on F&A systems and processes  Review progress against workplan targets and program spending in preparation for annual country program review Anna Manukyan  Provide support on F&A systems and processes March 18 - 23  Orient new finance and administration staff  Provide financial analysis capacity strengthening support Telesphore  Support preparation of the national validation workshop for March 25 - 30 Kabore the community health strategy, including agenda and facilitation plan development  Co-facilitation of workshop, in collaboration with national consultants  Participation in progress review meeting  Participation in consolidation/write up of the final community health strategy

Page | 33 USAID MCSP/DRC Quarterly Report: Year 3, Q2 (January 1 – March 31, 2018)