PROJECT TITLE: PROVISION OF HEALTH, NUTRITION, AND PROTECTION LIFE-SAVING SERVICES FOR VULNERABLE POPULATIONS IN THE NORTHERN (TIMBUKTU AND TAOUDÉNIT) AND CENTRAL (SÉGOU) MALI Country: Mali Donor: USAID/Office of U.S. Foreign Disaster Assistance (OFDA) Award Number: 72OFDA19GR00053 Reporting Period: October 1, 2019 to March 31, 2020 Submitted By: International Medical Corps SEMI-ANNUAL REPORT 1 Program Goal: Total Number of People Affected in the Target Area: 525,746 Total Number of People Targeted (Individuals): 367,010 Total Number of Internally-Displaced Persons (IDP) Targeted (Individuals) as subset of above: 16,263 Program Objectives: Health: To improve access to free, quality, lifesaving health services and ensure the sustainability of the health services for targeted conflict-affected populations Nutrition: To contribute to mitigating excess mortality and morbidity due to malnutrition among children under five and pregnant and lactating women by providing preventive and curative nutrition services Protection: To improve access to services and support for survivors of gender-based violence (GBV) and strengthen communities’ capacity to mitigate GBV in the Northern region (Timbuktu), Mali WASH: To contribute to improved drinking water quality, hygiene practices, and sanitary environment in supported health facilities and households 1. PROGRAM SUMMARY Since May 2019, International Medical Corps (IMC) has been implementing a health, nutrition (with WASH), and protection project through OFDA funding to save the lives of vulnerable people in Timbuktu, Taoudénit and San. Many activities have been completed in all targeted sectors during the reporting period of this second semi-annual report. In the Health sector, IMC continued to maintain 12 health facilities in providing free and quality primary and secondary health care. This was done through capacity building of the centers, based on the six World Health Organization (WHO) pillars. This project aimed to initiate cost recovery in Timbuktu and Taoudénit. Different discussions were carried out with OFDA during the reporting period, which resulted in a transition back in favor of cost-free care for all persons, continuing until the end of this project in 2021. During the reporting period, 18,426 people, including 4,934 men; 5,657 women; 4,099 girls; and 3,736 boys directly benefited from health services supported by IMC in the Timbuktu and Taoudénit Regions. International Medical Corps also contributed to the management of Severe Acute Malnutrition (SAM) with and without medical complications in 24 outpatient therapeutic programs (OTP) and 2 stabilization centers (SC) in the Timbuktu, Taoudénit and Ségou regions. International Medical Corps carried out activities with community-based organizations to educate the population on good infant, young and child feeding (IYCF) practices. In total, 23,319 people, including 3,027 men; 18,791 women; 652 girls; and 849 boys directly benefited from nutrition services. 2 International Medical Corps has been working with Community Health Workers (CHWs), Community Health Volunteers (CHVs) and ASACOs (Associations de santé Communautaire – French acronym for community health associations) to promote hygiene, ensure nutrition community based activities and behavioral changes within households and communities. Key activities included training committees on Infection Prevention and Control (IPC); awareness campaigns; individual awareness; and household and community discussions on specific hygiene and sanitation behaviors. These activities reached 24,899 people, including 8,002 men; 9,427 women; 4,040 girls; and 3,430 boys who directly benefited from WASH services. International Medical Corps reinforced the prevention of gender-based violence (GBV) and GBV survivors’ case management in close collaboration with community-based organizations, including three women and girls' safe spaces (WGFSs) in two districts. International Medical Corps also supported two international campaigns (i.e. “16 Days of Activism” and “International Women’s Day” on March 8, 2020). General GBV prevention community awareness-raising activities were also conducted. A total of 35,359 people, including 21,132 women; 9,415 men; 1,867 girls; and 975 boys were reached with GBV messaging. International Medical Corps participated in several field coordination meetings with relevant stakeholders, such as with health authorities, other NGOs, ASACOs, the Regional Directorate of Women, Children and Family Promotion and traditional leaders in all targeted sites. At the national level, IMC attended Cluster meetings (i.e. Health, Nutrition and Protection) as well as meetings with OFDA. In March 2020 COVID-19 pandemic cases were officially reported in Mali. This situation became a critical health priority for the Government of Mali, humanitarian actors, donors and the Malian population. The regions of Timbuktu and Ségou, which had initially remained on the fringes of the epidemic, recorded three and one cases respectively. The pandemic will raise new constraints concerning project implementation as all activities with a gathering of individuals, such as meetings, workshops, and awareness-raising sessions will need to be adapted or cancelled. Local authorities may also not be as available with some activities therefore needing to be rescheduled. The availability of partners may also be impacted due to shifting priorities. Most importantly, the pandemic may change priorites for some time, thus impacting household circumstances (e.g. agriculture, access to income, malnutrition) and impacting their health. 1.1 AWARD LEVEL BENEFICIARIES Cumulative Targeted Total 367,010 IDP 16,263 (from Baseline) Reporting Period Total 77,389 IDP 11,608 Reached (SAR 1: May 7 to September 30, 2019) Reporting Period Total 101,459 IDP 15,219 Reached (SAR 2: October 1, 2019 to March 31, 2020) Cumulative Reached Total 178,848 IDP 17,564 (May 7,2019 to March 31,2020) 3 1.2 SECTOR LEVEL BENEFICIARIES Cumulative SAR 1 Reporting SAR 2 Reporting Cumulative Targeted Period Reached Period Reached Reached in the (May 7 to (October 1, 2019 to Project (May 7, September 30, March 31, 2020) 2019 to March 31, 2019) 2020) Sector Total IDP Total IDP Total IDP Total IDP Health 105,448 9,380 20,070 3,011 18,426 2,764 38,496 5,775 Nutrition 201,183 5,079 21,134 3,170 23,319 3,498 44,453 6,668 Protection 59,784 8,968 26,943 4,041 34,815 5,222 61,758 9,263 WASH 248,010 8,105 9,242 1,386 24,899 3,735 34,141 5,121 2. EXECUTIVE SUMMARY – PROGRESS TO DATE HEALTH Health Systems and Clinical Support i. Mobile Medical Unit (MMU) Intervention From October 2019 to March 2020, the Mobile Medical Unit (MMU) deployed by IMC in the Taoudénit Region conducted eight visits in each of the three targeted health districts (Araouane, Al-Ourche and Boujbeha). Through the MMU interventions beneficiaries received curative, preventive and promotional activities. There were 4,814 curative consultations, of which 2,671 were women and 2,143 men. Children under 5 years represented 22% of total consultations (1,083/4,814). The predominant diseases were: acute respiratory infection (ARI – 28%); malaria (15%); diarrhea (14%); high blood pressure (12%); trauma (14%); sexually transmitted infection (STI – 12%) and mental health conditions (0.5%). The Mobile Clinic's maternal health service reached 92 women and included: 55 women for the first antenatal care visit; 18 women for the second antenatal care visit; one for assisted delivery and 23 women for post-natal care. Among these women, 31 received the first dose of anti-tetanus vaccine (ATV1) and 13 received the second dose (ATV2). The Mobile Clinic also registered 18 new users of family planning services and 492 mothers received nutritional advice for themselves and their children. As part of an expanded program on immunization and vaccinations for children, 139 children were vaccinated with tuberculosis vaccine (Bilié de Calmette et Guérin - BCG); 131 children with Penta3; 27 children against measles; and 57 children against yellow fever. In March 2020, the MMU was deployed to investigate suspected measles cases in the Al Ourche area, conducted in collaboration with the Taoudénit Regional Directorate of Health. Five cases were confirmed in this measles outbreak. International Medical Corps will support the immunization response campaign currently being planned to reduce the spread of the outbreak. During curative activities, 879 children aged 6-59 months were screened; among these, 32 were identified with moderate acute malnutrition (MAM) and 19 others with SAM. These cases were referred to the nearest nutrition centers for treatment while their mothers also received nutritional education. ii. Strengthening Health Information Systems 4 A shortcoming noted during the first semester of the project related to delays in uploading health data on to the District Health Information System 2 (DHIS2) online platform. To improve this, IMC supported the Timbuktu Health District in organizing a three-day data validation workshop (from October 14 to 16, 2019) covering 2019 third quarter data. A total of 23 participants (5 women and 18 men), including health workers (8 doctors, 5 nurses, 10 technicians) from all health facilities in Timbuktu district attended the workshop. At the workshop data was analyzed, indicators improved and recommendations made by health authorities, the World Food Program (WFP), and IMC, including: - Providing all URENAMs with MAM inputs to reduce dropouts - Strengthening Family Planning activities