Guinea Ebola Response Plan II: End of Project Report June 02, 2015–May 30, 2016

Guinea Ebola Response Plan II: End of Project Report

June 02, 2015–May 30, 2016

Submitted to:

United States Agency for International Development under Cooperative Agreement #AID-OAA-A-14-00028

Submitted by:

Jhpiego Corporation in cooperation with Save the Children

The Maternal and Child Survival Program (MCSP) is a global United States Agency for International Development (USAID) Cooperative Agreement to introduce and support high-impact health interventions with a focus on 24 high-priority countries with the ultimate goal of ending preventable child and maternal deaths within a generation. The Program is focused on ensuring that all women, newborns and children most in need have equitable access to quality health care services to save lives. MCSP supports programming in maternal, newborn and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. Visit www.mcsprogram.org to learn more.

This report is made possible by the generous support of the American people through USAID under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of MCSP and do not necessarily reflect the views of USAID or the United States Government.

Guinea Summary

Strategic Objectives

Support health care workers and facilities to continue to offer high-quality health services in safe environment by strengthening infection prevention and control (IPC) practices through training, supportive supervision, and complementary monitoring and evaluation.

June 02, 2015 to November 15, 2015 (approved July 9, 2015; extension approved through XXX)

Program Dates PY1 Approved

$2,400,000

Budget Geographic Focus Area

5 prefectures of Boke, Dabola, Dinguiraye, Faranah, and Mandiana

No. of facilities and/or
No. of regions (%)

3/8 (38%)

No. of prefectures (%)

5/38 (13%)

Geographic Presence

communities (%)

59/461 (13%)

Technical Interventions

OTHER: Ebola Response—Infection Prevention and Control

Selected Programmatic Data

Number/percentage of staff in health facility who receive IPC training
1345 (99%)
Number/proportion of health facilities that have appropriate (and sufficient quantity of) personal protective equipment (PPE) for at least 1 month
7/8 (78%) health facilities; 9% (1/11 at second assessment); none of the facilities met this indicator at baseline
Percentage of health facilities achieving / compliant

with at least 75% of IPC performance standards

Among services at the regional hospital in Boke, 18%

(2/11 met the indicator at second assessment, and non at baseline)

Percentage of trained staff who receive post-training follow-up supervision
56%

Guinea Ebola Response Plan II: End of Project Report

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Contents

Recommandations :................................................................................................................................................... 18 Annexe......................................................................................................................................................................... 20

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List of Tables and Figures

Fdfdf Ds Dsds

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Abbreviations and Acronyms

AC CMC DCS DPS DRS DSVco EPI EPMCD EVD
Agents communautaire (community health workers) Centres Médical Communal (Communal Medical Center) Direction Communautaire de la Santé (Community Health Directorate) Direction Préfectoral de la Santé (Prefecural Health Directorate) Direction Regionale de la Santé (Regional Health Direcotrate) Direction Sanitaire de la ville de Conakry Expanded Program on Immunization Ending Preventable Maternal and Child Deaths Ebola Viral Disease
IP IPC
Infection Prevention Infection Prevention and Control
MCHIP MCSP MNH MOH MSF-B NGO PPE
Maternal and Child Health Integrated Program Maternal and Child Survival Program Maternal and Newborn Health Ministry of Health Medecins sans Frontiers- Belge Nongovernmental Organization Personal Protective Equipment

Standards-based Management and Recognition

SBM-R

CHW CMC CMS community health worker

centre médical communal (communal medical center) centre médicosocial (sociomedical health center) Coordination Nationale de Lutte contre la Maladie à Virus Ebola (National

Coordination for the Fight against the Ebola Virus)
CNLEB CS

centre de santé (health center)

CSR CSR CVV DART DCS DPS DRS DSC

centre de santé rurale (rural health center) centre de santé urbain (urban health center)

comité de veille villageois (community surveillance committees) Disaster Assistance Response Team

Direction Communautaire de la Santé (Community Health Directorate) Direction Préfectorale de la Santé (Prefectural Health Directorate) Direction Regionale de la Santé (Regional Health Directorate) Direction de la Santé Communautaire (Community Health Directorate) Direction Sanitaire de la ville de Conakry (Health Directorate of the City of

Conakry)
DSVCo EVD HP
Ebola Viral Disease

hôpital préfectorale (prefectural hospital) hôpital regionale (regional hospital)

HR

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IP

Infection Prevention

IPC

infection prevention and control

Maternal and Child Health Integrated Program Maternal and Child Survival Program Ministry of Health
MCHIP MCSP MOH OFDA NGO PPE
Office of U.S. Foreign Disaster Assistance Nongovernmental Organization personal protective equipment Standards-Based Management and Recognition World Health Organization
SBM-R WHO

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Acknowledgments

Key Partners

• Maternal and Child Survival Program (MCSP) partners, Jhpiego, and Save the Children thank our collaborators and partners.
• Ministry of Public Health and specifically, the Secretary General, the Coordination
Nationale de Lutte contre la Maladie à virus Ebola, National Directorate of Family Health and Nutrition, National Directorate of Prevention and Community Health, National Malaria Control Program, and the National Program on Integrated Management of Childhood Illness

• Regional health offices of Conakry, Kankan, Kindia, Faranah, and N’zérékoré, and the prefectural and communal health offices in these regions
• Health care workers in MCSP-supported facilities and community health workers engaged in bringing health information and services to their communities
• World Health Organization, United Nations Fund for Population Activities, and UNICEF

• Implementing partners of United States Agency for International Development, Office of
U.S. Foreign Disaster Assistance, and the Centers for Disease Control and Prevention
• Médecins Sans Frontières—Belgium, Action Contre la Faim, Alliance for International
Medical Action, Women and Health Alliance International, and other nongovernmental organizations (NGOs) engaged in the Ebola response and in particular, infection prevention and control

• Local NGOs and civil society organizations that collaborated with MCSP

The MCSP Team

• In-country technical team: Professor Yolande Hyjazi, Dr. Mamadou Malal Diallo, Dr.
Gassim Cissé, Dr. Bokar Dem, Dr. Havanatou Camara, Dr. Suzanne Austin, Bamba Mamady Camara, Jacqueline Aribot, Dr. Abdoulaye Diallo, Dr. Ibrahim Pita Bah, and Bakary Berete

• In-country Save the Children team: Fatoumata Diakite, Adama Diop, and the many community organizers

• Finance, administration, and operations team: Antoine Lamah, Sougoulé Ténin, Thierno

Saidou Diallo, El Hadj Mamadou Saliou Bah, and Abbas Kourouma
• Headquarters’ technical support team: Dr. Tsigue Pleah, Professor Blami Dao, Ruparelia
Chandrakant, Willy Shasha
• Headquarters’ program team: Rachel Waxman, Lauren Skolnik, Karine Nankam, Caroline
Tran, Joan Peto, and Linda Benamor (for translation support)

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Executive Summary

XXX…

The focus areas for this project are the capital city of Conakry and three prefectures: Beyla, Forécariah, and Kissidougou, which were prioritized by the CNLEB based on the presence of active Ebola viral disease (EVD) cases in these areas. MCSP is supporting 55 targeted facilities in these areas: three national hospitals (Donka, Ignace Deen, and Sino-Guinéen), three prefectural hospitals (Beyla, Forécariah, and Kissidougou), six centres médical communal ([CMCs], communal medical centers—five in Conakry and one in Beyla prefecture), one sociomedical center (Jean Paul II/ Conakry), and 42 health centers in the three prefectures.

The goal of the MCSP Ebola Response Project in Guinea was to scale up efforts to prevent and control the spread of EVD to protect and maintain quality reproductive, maternal, newborn, and child health services.

The key achievements for this nine-month project are presented by the two project objectives: 1) prevention at facilities and 2) prevention within communities.

Objective 1: Prevention at Facilities

Objective 1

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Introduction

The Maternal and Child Survival Program (MCSP) is a global cooperative agreement funded by the United States Agency for International Development (USAID) to introduce and support high-impact health interventions in 24 priority countries, and has the ultimate goal of ending preventable maternal and child deaths within a generation. MCSP carries forward the momentum and lessons learned from the highly successful USAID-funded Maternal and Child Health Integrated Program (MCHIP), which has made significant progress in improving the health of women and children in over 50 developing countries throughout Africa, Asia, Latin America, and the Caribbean. MCSP interventions build on the development of local training capacity among health care providers in Guinea with a focus on competency-based training methods that work to improve both knowledge and skills. These build from previous work, specifically on infection prevention practices in health care facilities, and a commitment to quality improvement and supportive mentoring and supervision to assist health care providers translate new skills into their ongoing practice.

Jhpiego, an affiliate of Johns Hopkins University, is leveraging the achievements of previous and ongoing projects to improve and extend activities strengthening infection prevention and control (IPC) initiatives in prefectures that currently lack donor support. Through funding from OFDA / USAID, this project is building upon MCSP’s comprehensive IPC training and supportive supervision activities in Conakry, Beyla, Kissidougou, and Forécariah prefectures, which trained 2,985 health workers in 55 targeted health structures from December 2014 - August 2015.

The focus areas for this project are the prefectures of Boke, Dabola, Dinguiraye, Faranah, and Mandiana. This final report describes the activities conducted during the contractual period of the project from June 2015 to March 2016.

Goal and Objectives

The goal of the MCSP Ebola Response Project in Guinea is to scale up efforts to prevent and control

the spread of EVD to protect and maintain quality reproductive, maternal, newborn, and child health services.

The key objective of this activity is to work with the MOH and key partners to support healthcare workers and facilities to continue to offer high quality health services in a safe environment by strengthening infection prevention and control (IPC) practices through training, supportive supervision, and complementary monitoring and evaluation.

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Major Accomplishments

XXX.. some kind of intro here

The key achievements for this nine-month project are presented by the two project objectives: 1) prevention at facilities and 2) prevention within communities.

Objective 1: Prevention at Facilities

Objective 1 focused on supporting health care workers and facilities to continue to offer high quality health services in a safe environment by strengthening IPC practices through training, supportive supervision, and complementary monitoring and evaluation.

1.1. Active Participation of MCSP in Coordination Nationale de Lutte contre la Maladie à Virus Ebola

CNLEB was formed to lead the national,

I. IPC skills-based training of health providers and support staff

From June to December 2015, the MCSP project with funding from USAID/OFDA, organized 48 training sessions on IPC for 1,345 health workers in the DPS health facilities of Boké, Faranah, Dabola, Dinguiraye and Mandiana. These training sessions were conducted by trainers developed by MCSP. Each session lasted five days during which the theoretical course was provided long with classroom simulated practice sessions and field visits with real patient interactions in the different departments of the hospitals and the health center where the trainings were conducted.

The training involved 110 health facilities, of which 60 were public health facilities. Additional details can be found in Table 1 for details on training.

Table 1: Distribution of DPS and DRS Training Participants

# of support staff
# Public Health Facilities
# Private Health Facilities
# of providers trained
# of
DPS/DRS staff
# health personnel trained
# of NGO staff trained

Region

DPS

trained

Boké

Faranah
Faranah Dabola
Dinguiraye
15 14
9
27 14
4
476 323
124
45
63
90
491 326

131

38

6

2

139

9

1

179

34

4

1

184

Kankan Mandiana

13

60

4

201

30

4

0

205

Total

50

1310

271

23

12

1345

II. Supportive supervision of IPC-trained health providers

Health staff present higher risks of infection during outbreaks of EVD. In an effort to minimize these risks, MCSP implemented IPC/Ebola trainings, assessments and supportive supervision for all health workers in the health districts of Boké, Faranah, Dabola, Dinguiraye and Mandiana, aimed at improving and strengthening provider skills.

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The supervisory visits had the following objectives:
1) Ensure that the PCI measures taught and learned during the training sessions were applied to the work sites
2) Strengthen the skills of health personnel in order to achieve a positive IPC behavior change 3) Equip managers and supervisors to use of performance standards to ensure internal supervision and strengthen health and safety committees in each recipient health facility.

The supervisory visits covered the following topics:

••

Lessons learned from previous coaching visits Review of the steps of handwashing with soap and friction, as well as with the hydro-alcoholic product

••

Provision of guidance on putting on and removing gloves Provision of guidance on the preparation of chlorine solutions from bleach and sodium hypochlorite powder

••

Provision of guidance on the sorting of trash, waste management and garbage disposal Provision of guidance on the steps for the processing of instruments

The supervisory visits have achieved the following tasks:

-

Prior to the visit

 Gather / organize documents (standards, checklists dilution formulas, handwashing posters, etc.)
 Gather inputs that will be used to give demonstrations with beneficiaries (gloves, bactigel, chlorine, EPI, etc.)
 Prepare and share with partners and providers the calendar with a precise timetable of activities to achieve targets and expected results
 Inform the departments and the targeted staff of the planned supportive supervision visit

--

During the visit

 Strengthen and improve the IPC practice of providers and support staff using the performance standards and working closely with the health and safety committee
 Check availability of IPC inputs, collection tools, and IPC procedure posters  Check the water access points and their functionality  Check the functionality of the screening and triaging unit  Take pictures and videos to illustrate the findings and record evidence or practices.

After the visit

 Provide feedback results from visit to health staff to initiate quality improvement measures of
IPC practices
 Determine the date of the next supportive supervision visit

For the implementation, six supervisors were selected in each targeted health district, based on their performance in assessments and their availability. The organization of the supportive supervision was coordinated in collaboration with focal points, heads of departments and centers, as well as members of the health and safety committee at each health facilitiy. Table 2 shows the distribution of the number of providers supported in the prefectures of Boké, Faranah, Dinguiraye, Dabola and Mandiana.

Table 2: Supportive Supervision of providers trained in IPC

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During the supportive supervision visits, a total of 267 support staff members were coached across 15 sites in Dinguiraye, 44 in Dabola, 81 in Faranah, 45 in Mandiana and 82 in Boké. Through the use of supervisors, 167 new providers and 68 support staff were oriented on IPC at the DPS sites in Boké.

Overall, almost 61% of trained personnel were mentored during the supportive supervision visits conducted. In addition, 67 untrained providers received on-site orientation from supervisors at the DPS sites in Boké.

III. Donation of IPC materials and consumables to health facilities:

The availability and utilization of IPC inputs is one of the key pillars of an effective IPC program. Under the guidance of the DPS health structures of Faranah, Dabola, Dinguiraye and Mandiana, an IPC donation of materials and consumables was made to the sites aforementioned sites by MCSP.

1) Donation of IPC inputs and materials at the health facilities of Boke, Faranah,
Dabola, Dinguiraye and Mandiana